August 2001

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IN THIS
ISSUE

PRACTICE PARAMETER FOR DEMENTIA

  • Diagnostic criteria have improved since 1994

  • Key issues and recommendations for management are addressed

PARKINSON'S DISEASE WITH DEMENTIA

  • PD patients have an increased risk for becoming demented

  • Patients with AD have different neuropsychiatric profiles than those with PDD

  • Cognitively impaired PD patients most likely have impaired consent capacity

  • Donepezil improves cognitive function in PD patients with dementia

VALPROIC ACID FOR AGITATION IN DEMENTIA

  • Short-term use of valproic acid shows modest efficacy in controlling agitation

  • Divalproex improved agitation, but not manic symptoms

GENETIC COUNSELLING FOR ALZHEIMER'S DISEASE

  • Accurate risk prediction is not possible, though estimates may be helpful

PSYCHIATRIC SYMPTOMS AND DEMENTIA ETIOLOGY

  • Psychiatric symptoms are common in patients with moderate to severe vascular dementia
  • Visual hallucinations are common and persistent in patients with Lewy bodies
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EDITORIAL
COMMENT

PRACTICE PARAMETER FOR DIAGNOSIS AND MANAGEMENT OF DEMENTIA
The American Academy of Neurology has published evidence-based reviews of the diagnosis (Knopman et al) and the management (Doody et al) of dementia. They should be carefully studied along with the report from the Canadian Consensus Conference on Dementia, which was referred to in the last issue of International Abstracts in Alzheimer's Disease & Other Dementias (May 2001). One key difference between the two sets of guidelines is that the US documents are written by neurologists for neurologists, whereas the Canadian document is written by a multidisciplinary group of physicians for primary care practitioners.

Practice parameter: Diagnosis of dementia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology

(NEUROLOGY 2001;56:1143-1153)


D.S. KNOPMAN, MD
S.T. DEKOSKY, MD,
J.L. CUMMINGS, MD,
H. CHUI, MD
ET AL,
VARIOUS CENTRES, USA

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Practice parameter: Management of dementia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology

(NEUROLOGY 2001;56:1154-1166)


R.S. DOODY, MD, PHD,
J.C. STEVENS, MD,
C. BECK, RN, PHD,
R.M. DUBINSKY, MD,
ET AL,
VARIOUS CENTRES, USA

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PARKINSON'S DISEASE WITH DEMENTIA
EDITORIAL
COMMENT

The high prevalence of dementia in patients with Parkinson's disease (PD) is being increasingly recognized (Aarsland, Andersen, Larsen et al), with neuropsychiatric symptoms that differ from Alzheimer's disease (Aarsland, Cumings & Larsen). This may impact long-term research with PD patients where loss of competence may be an issue (Dymek et al). Fortunately, results from a randomized placebo-controlled study in PD with dementia using donepezil are encouraging (Aarsland, Larsen, Janvin et al).

Risk of dementia in Parkinson's disease:
A community-based, prospective study

(NEUROLOGY 2001;56:730-736)


D.AARSLAND, MD, PHD,
K. ANDERSEN, MD, PHD,
J.P. LARSEN, MD, PHD,
A. LOLK, MD, PHD,
ET AL,
STAVANGER, NORWAY,
ODENSE, DENMARK

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Neuropsychiatric differences between Parkinson's disease
with dementia and Alzheimer's disease

(INT J GERIATR PSYCHIATRY 2001;16:184-191)


DAG AARSLAND,
JEFFREY L. CUMMINGS,
JAN P. LARSEN,
STAVANGER, NORWAY,
LOS ANGELES, CA

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Competency to consent to medical treatment in
cognitively impaired patients with parkinson's disease

(NEUROLOGY 2001;56:17-24)


MAUREEN P. DYMEK, PHD
PAUL ATCHISON, MD,
LINDY HARRELL, MD, PHD,
DANIEL C. MARSON, JD. PHD,
BIRMINGHAM, AL

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Donepezil treatment in Parkinson's disease with dementia:
a double-blind, placebo-controlled crossover study

(NEUROLOGY 2001;56: SUPPL. 3 - A128)

DAG AARSLAND,
JAN P. LARSEN,
CARMEN JANVIN,
STAVANGER, KNUT LAAKE, OSLO,
NORWAY		 Sorry, this abstract is unavailable


VALPROIC ACID FOR AGITATION IN DEMENTIA

EDITORIAL
COMMENT 		While antipsychotics remain the most effective treatment for agitation in dementia, investigators continue to search for other treatments which are better tolerated and more effective. Two recent studies with valproic acid demonstrated disappointing results. In a randomized double-blind placebo-controlled trial of divalproex sodium by Porsteinsson et al, there was no significant improvement compared with placebo on total behavioural ratings. Similarly, in a larger trial by Tariot et al, there was no significant difference compared with placebo on the primary outcome measure, though scores on one measure of agitation were significantly better with valproate.

Placebo-controlled study of divalproex sodium for agitation in dementia

(AM J GERIATR PSYCHIATRY 2001;9:58-66)


ANTON P. PORSTEINSSON, MD,
PIERRE N. TARIOT, MD,
ROSEMARY ERB, RN, BSN,
CHRISTOPHER COX, PHD,
ET AL,
ROCHESTER, NY

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Safety and tolerability of divalproex sodium in the treatment
of signs and symptoms of mania in elderly patients with dementia:
results of a double-blind, placebo-controlled trial

(CURR THER RES CLIN EXP 2001;62:51-67)

PIERRE N. TARIOT, MD,
LON S. SCHNEIDER, MD,
JACOBO E. MINTZER, MD,
ANDREW J. CUTLER, MD,
ET AL,
VARIOUS CENTRES, USA
FOR THE DEPAKOTE ELDERLY MANIA STUDY GROUP
 Sorry, this abstract is unavailable

GENETIC COUNSELLING FOR ALZHEIMER'S DISEASE
EDITORIAL
COMMENT

Families frequently request information on the genetic risks of developing Alzheimer's disease. In an excellent paper by Liddell et al, the genetics of Alzheimer's disease are reviewed, and specific recommendations are provided on how to discuss these risks with family members.

Genetic risk of Alzheimer's disease: advising relatives

(BR J PSYCHIATRY 2001;178:7-11)


M.B. LIDDELL,
S. LOVESTONE,
M.J. OWEN
CARDIFF, WALES

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PSYCHIATRIC SYMPTOMS AND DEMENTIA ETIOLOGY
EDITORIAL
COMMENT

There have been continued questions about the effect of dementia diagnosis on the prevalence, severity, and course of psychiatric symptoms. Two studies by Ballard et al, attempt to address some of these issues. When patients with dementia with Lewy bodies were compared with those with Alzheimer's disease, they were significantly more likely to demonstrate hallucinations, delusions and misidentifications. Visual hallucinations, as well, were more likely to be persistent over the course of follow-up. Patients with vascular dementia were more likely than those with Alzheimer's disease to experience anxiety and depression, though rates of psychosis were similar.

Anxiety, depression and psychosis in vascular dementia:
prevalence and associations

(J AFFECT DIS 2000; 59:97-106)


C. BALLARD,
D. NEILL,
J. O'BRIEN,
I.G. MCKEITH,
ET AL,
NEWCASTLE UPON TYNE, UK

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The natural history of psychosis and depression in dementia with Lewy bodies and Alzheimer's disease: persistence and new cases over 1 year of follow-up

(J CLIN PSYCHIATRY 2001;62:46-49)


CLIVE G. BALLARD, MRCPSYCH, MD,
JOHN T. OBRIEN, MRCPSYCH, DM,
ALAN G. SWANN, MRCPSYCH,
PETER THOMPSON, MRCPSYCH,
ET AL,
NEWCASTLE UPON TYNE, GATESHEAD, ENGLAND

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THE FOLLOWING PAPERS and websites were judged by the editors to also be of interest.

FRONTOTEMPORAL DEMENTIA (PICK'S DISEASE): CLINICAL FEATURES AND ASSESSMENT

THE INFLUENCE OF RIGHT FRONTOTEMPORAL DYSFUNCTION ON SOCIAL BEHAVIOUR IN FRONTOTEMPORAL DEMENTIA
WEBSITES