Sunday, October 6, 2024
Dr. David Vossler will complete his two-part series about Dementia this Sunday, October 6, at 9 AM. If you missed last week’s Forum, you can watch it on our YouTube page here.
Diagnosis and treatment of the dementias
Many families are touched by a loved one with dementia. Although primary care providers and general neurologists do treat people with dementia, there is a sub-specialty called behavioral neurology that specializes in advanced diagnosis, treatment, education and research of this complex area. There are, in fact, many different causes of dementia, but we will discuss only the main 4 causes: Alzheimer disease, vascular dementia, and frontotemporal dementia, Lewy body dementia.
Alzheimer disease (AD) is the most common, affecting 3% of people aged 65 – 74 years and 47% of people aged 85 years and older. Risk factors are high blood pressure, high cholesterol, heart attack, stroke, insomnia, obstructive sleep apnea, moderate – severe alcohol use, traumatic brain injury, and genetics. Episodic memory problems are the first sign. Deficits in attention, visuospatial processing, naming/language, and executive functions may later occur, followed by problems with executive function. Under a microscope, senile plaques made of amyloid-beta and neurofibrillary tangles made of phosphorous-tau are visible. These are the causes of AD. Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), and cerebrospinal fluid tests are often used to diagnose AD and the other 3 major dementia types. As of July 2023, 2 specific treatments that slow the progression of AD exist: Leqembi and Kisunla given once a month by intravenous infusion.
Vascular dementia is a disorder in which repeated ischemic strokes or hemorrhages cause cognitive decline. It is the 2nd most common cause of dementia. Treatment is the prevention of future strokes: antiplatelet or anticoagulant medications, aerobic exercise, Mediterranean diet, stopping smoking. Also, reducing high blood pressure, sugar, and cholesterol through diet, exercise, medication.
Frontotemporal dementia (FTD) accounts for about 2% – 10% of all dementia cases. Lewy body dementia is an umbrella term that includes dementia occurring in people with existing Parkinson disease, and Dementia with Lewy bodies (DLB). DLB is about 4% – 7% of all cases of dementia. No specific treatments exist yet for FTD or DLB.
David G. Vossler, MD. Clinical Professor of Neurology, University of Washington
