Dementia in Clinical Practice

Dementia in Clinical Practice
(Frontiers of Neurology and Neuroscience)
By P. Giannakopoulos, P. R. Hof

Publisher: S. Karger AG (Switzerland)
Number Of Pages: 184
Publication Date: 2009-02-28
ISBN-10 / ASIN: 3805590156
ISBN-13 / EAN: 9783805590150
From the Preface?
Research on dementing illnesses is in the midst of an agitated period. During the past
50 years, it has progressively matured from a primarily social service problem to the
clinicopathological definition of a wide spectrum of diseases, evaluation of measures
of cognition, analysis of brain microstructure, and, more recently, visualization of the
pathological substrates such as b-amyloid and tau protein in vivo. Despite these
impressive developments in diagnostic tools, biomarkers, and imaging modalities, we
still ignore the etiology of the more frequent clinical syndromes leading to the irreversible
loss of cognitive functions, namely Alzheimers disease, Lewy body disease,
vascular and frontotemporal dementia. Recent epidemiological work highlights the
complex relationships among these entities by demonstrating the high frequency of
mixed conditions in very old people and indicating that they may share common risk
factors. Moreover, the old and still unresolved question of the limits between normal
and pathological aging is to date complicated not only by the description of several
transitional forms of mild cognitive impairment characterized by the predominance
of brain compensation phenomena that allow for preserving cognitive performances
and social adaptation despite an often substantial biological compromise but also by
poor response to currently available substitution treatments. Paralleling the difficulty
to formulate clear pathogenetic hypotheses, an accelerated pace of compounds entering
clinical trials are now available mainly for Alzheimers disease. Most agents still
target clinical end points associated with mild to moderate forms of the disease rather
than focus on modulation of the underlying pathologies. Although there are obvious
practical but also ethical reasons for this, meaningful progress in other areas of medicine
such as cardiology and oncology has targeted and monitored improvement or
abatement of pathology as the primary end point as a successful disease-modifying
strategy.


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