Dementia Update Cliffnotes

DEMENTIA
Dementia with Lewy body DLB=Decreased CSF alpha- synuclein
AD=Decreased CSF amyloid-beta 42 (earlier bio-mkr) ⬆total-tau and phospho-tau
Increased soluble amyloid precursor protein beta (sAPP) (Neuro 77;1:7/11)
DLB and AD = 80 % Diagnostic sensitivity
AD with Lewy body pathology 35-40% Diagnostic sensitivity

Brain 2010 Sept 7 2011.......
P300 < 323ms ,>5.0 mV = nml
E. Braverman, Cornell/Harvard

DRUG Treatment of Psychiatric consequences of DementingIllness
1. Impulsive Tx (stealing, sexual) : (Zoloft) sertraline 200mg/d, lamictal, VPA,divalproex,Inderal
2. Agitation /Paranoia : trazodone
3. Delusional : risperidone (ie. delusion of theft)

Mild Cognitive Impairment Treatment
MCI (Neurology 1/10/12 Vanderbilt nicotine patch 15 mg/d...cotinine is the active ingredient (from tobaccoJrnlAD) 2/14/11

CDR ( Clin. Dementia rating scale ) www.wustl.edu Wash U. St. Louis
CDR 3=severe,CDR2=mod, 1=mild,0.5 very mild

PET in diff dementia PLoS One 2011;6(3):e18111

DBS of entorhinal cortex enhances memory in MCI --( NEJM 2012;366:502-510)

✳FTD ( frontotemporal degeneration )
1. Progranulin Blood Test (A@G Pharma) ⬇Progranulin in blood dt Progranulin gene (PGRN) mutation ( Nature 2006)
2.C9ORF72 mutation(Neuron2011;72:245-56;257-68)(Lancet Neurol.3/9/12)

Alzheimer's Disease ⬆plasma Adiponectin (ArchNeurol2012Jan1)