The current standard of clinical care for mild to moderate Alzheimer’s Disease is treatment with cholinesterase inhibitors. Four are currently available: donepezil, tacrine, rivastigmine, and galantamine. These treatments may slow cognitive decline or may reduce the emergence of new behavioral manifestations of the disease but are not considered a cure for the disease. Nevertheless, the prevalence and importance of understanding the physiological effects of these drugs in the treatment of Alzheimer’s Disease is not to be underestimated. (more…)

An alternate approach to imaging brain function in Alzheimer’s Disease uses activation imaging, in which subjects perform a cognitive task, such as a memory test, in comparison to a control or resting state, during scanning. These methods identify brain regions that show increased cerebral blood flow (CBF), which is tightly coupled to neural activity, during ongoing mental operations. In principle, brain regions with impaired neural activity will show less CBF when engaged in a task than those unaffected and have the potential for identifying deficits more sensitively. In practice, however, activation imaging is more complicated: first, PET ligands used in activation imaging, typically H 2 [15-O], have a short half life, necessary for experiments involving multiple conditions but producing images with significantly lower signal, (more…)

Neuroimaging is widely used in the evaluation of Alzheimer’s disease (AD). Traditionally, imaging in Alzheimer’s disease has been used to exclude other diseases and neurological conditions that produce similar cognitive symptoms. Recently, however, neuroimaging has been explored for its potential in predicting clinical outcomes in subjects before the onset of Alzheimer’s disease or as surrogate markers for monitoring the course of treatment. While these experimental uses tend to be more exploratory than of current clinical application, the diagnosis of Alzheimer’s disease has unquestionably been advanced with the inclusion of neuroimaging. (more…)

There is a keen interest in developing more direct measures of Alzheimer’s Disease-specific pathology, which has led to the emergence of several new PET ligands to measure amyloid deposition. Amyloid plaques, which are composed of Ab, and neurofibrillary tangles (NFTs) are the pathological hallmarks of Alzheimer’s Disease. NFTs are correlated with the stage of Alzheimer’s Disease, and both pathological deposits appear before symptoms show themselves, perhaps decades before. This observation using amyloid imaging suggests that these deposits may be a good early marker for the disease. Based on the presence of diffuse plaques in neurologically normal individuals, it may be that Ab accumulation precedes other pathological features of Alzheimer’s Disease. (more…)

Activities of Daily Living (ADLs) is the core daily personal care activities that are necessary in order for people to be able to live independently. Loss of mental functioning is measured by other standardized tests and referred to as cognitive impairment. Activities of Daily Livings are particularly important because along with cognitive impairment, and in some cases “medical necessity,” they are the mechanism used by the insurance industry to determine qualification for long-term care benefits and may also be used to determine qualification for admission to a nursing or assisted living home facility. (more…)

Some genetic mutations appear to accelerate certain features of aging only within a single tissue. There are a very large number of these conditions, which might be referred to as unimodal progeroid syndromes. Here only three examples are considered: one that has a major impact on sun-exposed skin, one that results in an early onset of the most common form of dementia alzheimer, Alzheimer’s disease, and another that results in early-onset Parkinson’s disease. (more…)

There are a number of issues that must be considered in geriatric pain assessment. The major issues that merit attention are presence of comorbidities, mental status, depression in late life, limitations in ADLs, medications, and the importance of family and other support systems (see Depression; Social Networks, Support, and Integration). (more…)

Unfortunately, many dementias are partially or completely biologically irreversible. However, as mentioned previously, it is important to recognize that all dementias are treatable. Some of these irreversible dementias are preventable. For example, automobile accidents in civilian populations and projectile wounds in military populations are common causes of brain damage that cause dementia. Some improvements can occur in these conditions for a period of time after the initial insult, but affected individuals are left with varying degrees of impairment and often severe limitations in function. (more…)

Australia’s health policy is funded and delivered by several levels of government and is supported by private health insurance arrangements. In place are systems for the delivery of health, income support, and housing and community services to support aging people. Medicare, the national health insurance scheme, is funded and administered by the Australian (commonwealth) government and provides coverage for a range of primary care services, including visits to medical practitioners. (more…)

Alzheimer’s disease is a concept in evolution; it is considered by most to be a degenerative brain disease that was first described in 1906 and is the most common cause of dementia. Over the past 100 years, we have learned that many biological and clinical phenomena are included under the rubric of Alzheimer’s disease and that perhaps the term can best be considered a two-word eponym that reveals as much about our ignorance as about our knowledge. (more…)