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Alzheimer's Disease  

Dementia is an acquired syndrome in which intellectual ability decreases to the point that it interferes with daily function. There are two major causes of dementia in older persons: Alzheimer's disease and vascular dementia. Approximately 60 percent of dementing illnesses are caused by Alzheimer's disease, 15 percent are caused by vascular dementia and many of the remainder involve concurrent Alzheimer's disease and


Alzheimer's disease is associated with diffuse neuron injury and death, with senile plaques and neurofibrillary tangles. The average duration of the disease is 10 years, during which afflicted persons progress from mild memory loss to the need for 24-hour supervision to total dependency and death. Risk factors for Alzheimer's disease are age, a family history of the disease, and Down syndrome Alzheimer's Disease, Alzhimers, Alzheimers, Alzheimer, Alzimer, Alsheimer, Alzeimer, Ginkgo biloba, ginko

Vascular dementia is generally one of two types: multi-infarct dementia or subcortical vascular dementia. In multi-infarct dementia, the neurologic examination reveals focal, asymmetric abnormalities, and multiple strokes are evident on computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Subcortical vascular dementia ( Binswanger's disease) is characterized by vascular disease that

Diagnostic evaluation

Dementia should be suspected whenever an older person is reported to have gradually increasing difficulty in the ability to learn and retain new information, handle complex tasks, or reason. Difficulties with spatial ability and orientation, language and behavior are common. The degree of

Diagnostic Criteria for Delirium, Dementia, Alzheimer's Disease and Vascular Dementia

Diagnostic criteria for delirium

A change in cognition or development of a perceptual disturbance is present and not explained by a preexisting, established or evolving dementia.

The disturbance developed over a short period of time (usually hours to days) and tends to fluctuate.

The level of consciousness (awareness of the environment) is disturbed or fluctuates.

There is evidence that a drug, acute illness or metabolic disturbance is present that could explain the change in cognition.

Diagnostic criteria for dementia

Cognitive impairment is present, as demonstrated by: (1) memory loss and (2) impairment of language, praxis, recognition or abstract thinking.

The cognitive impairment is chronic and progressive and has resulted in functional decline.

Delirium has been ruled out.

Diagnostic criteria for Alzheimer's disease

Dementia is present.

History, physical and mental status examinations are consistent with Alzheimer's disease.

Screening blood tests (CBC, BUN, calcium, liver function, thyroid function, vitamin B12) and review of medications do not reveal any cause of cognitive impairment.

Brain imaging study (CT or MRI) is normal or shows atrophy.

Diagnostic criteria for vascular dementia

Dementia is present.

Two or more of the following are present: (1) focal neurologic signs on physical examination; (2) an onset that was abrupt, stepwise or stroke-related; (3) brain imaging study (CT or MRI) shows multiple strokes.

Testing a blood sample for apolipoprotein E may be used as an adjunct to other diagnostic procedures; a positive test increases likelihood that the dementia is due to Alzheimer's disease.

Physicians should rule out delirium and search for coexisting conditions that worsen dementia by

Use of medication to delay symptom progression

Tacrine (Cognex) and donepezil (Aricept) are available for the treatment of Alzheimer's disease. Metrifonate and rivastigmine are in development and testing. Effects are modest: a good response to

Estrogen replacement therapy has a significant protective effect and may delay the expression of

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen have been associated with a lower incidence of dementia. Because of the risks of gastrointestinal and renal toxicity, these

Vitamin E supplementation may significantly slow the progression of moderate Alzheimer's disease.

Ginkgo biloba extract has been reported to delay symptom progression in dementia, but little is

Drug Treatments for Dementia



Typical dosage


Alzheimer's disease




Donepezil ( Aricept)

5 to 10 mg once daily

Equal efficacy and fewer side effects than tacrine; elevated hepatic transaminase levels are rare; diarrhea and abdominal pain occur occasionally.


Tacrine ( Cognex)

10 mg four times daily, increase at 6-week intervals to 40 mg four times daily

Elevated hepatic transaminase levels are common; check ALT every 2 weeks during dosage titration.


Ibuprofen ( Motrin)

400 mg two to three times daily

Gastrointestinal or renal toxicity.


Conjugated estrogens (Premarin)

0.625 mg daily

Prescribe for women; add cyclic progestin for patients with an intact uterus.


Vitamin E

800 to 2,000 IU daily

Mild antioxidant effects.

Vascular dementia


Antihypertensive medication

Maintain systolic blood pressure below 150 to 160 mm Hg

Treatment that lowers diastolic blood pressure below 85 to 90 may worsen cognitive impairment.


Enteric-coated aspirin

81 to 325 mg daily

Consider warfarin (Coumadin) if atrial fibrillation is present.


Vitamin E

800 to 2,000 IU daily

Mild anticoagulant effects.

Management of behavior problems in Alzheimer's disease

Delusions are treated with an antipsychotic agent such as

Agitation should be treated with a short-acting antianxiety agent such as

Depression is managed with a selective serotonin reuptake inhibitor, beginning at one half the