Cholinesterase-inhibiting drugs : benefit <50% of patients
Tacrine (Cognex): can be hepatotoxic; must be given QID
Donepezil (Aricept): given once daily; fewer side effects
Antipsychotics, antidepressants, and anxiolytics
Useful for behavioral disturbances: most common cause of nursing home placement
CT scan in Alzheimer’s disease . Note the marked dilatation of the sulci and fissures, especially frontally, the poor visual distinction between grey matter and white matter, the ventricular enlargement – greater on the patient’s left (right of picture) and the general reduction in brain size. The picture is not diagnostic of Alzheimer’s disease: similar abnormalities occur in Huntington’s disease and Niemann-Pick’s disease.
10% to 20% of elderly patients with dementia have MRI or CT evidence of focal stroke with focal signs on neuro exam
Dementia begins with stroke and progression step-wise , suggesting recurrent vascular events
Develop : early incontinence, gait disturbance, and flattening of affect
Treat risk factors for vascular disease : BP control, smoking cessation, diet modification, and anticoagulation (if needed)
CT scan in multi-infarct dementia . The ventricles are normal in size, but there are patchy radiolucencies throughout the white matter. These indicate the presence of demyelinated patches, which result from multiple small infarcts in the brain.
Patients improve within minutes to hours of removal of 30 to 40 mL of spinal fluid
Trauma or subarachnoid hemorrhage
Cause is derangement of CSF hydrodynamics
Hydrocephalus in an active 69-year-old man . This axial MRI at the level of the ventricular bodies shows severe ventricular enlargement, but the sulci of the brain are normal. The patient had communicating (normal pressure) hydrocephalus, associated with minimal memory impairment but no other significant abnormality. Many patients develop the clinical triad of dementia, ataxia, and incontinence.
Slow Virus Infection / Chronic Meningitis / Dementia Related to AIDS
Human Immunodeficiency Virus
Enters CNS through monocytes and microglial system
Causes neuronal cell loss, vacuolization, and lymphocytic infiltration
Dementia : bradyphrenia and bradykinesia
Executive dysfunction, impaired memory, poor concentration, and apathy