Dementia cognitive changes

The Heart Protection and PROSPER results do draw into question preventative effects of statins on dementia. On the other hand, the CHS study raises the possibility that statins may beneficially impact the rate of cognitive changes. Cardiovascular-based studies only indirectly measure the impact on dementia since most cardiovascular studies exclude patients with dementia and cardiovascular trials employ cognitive tests that are relatively insensitive for populations that are not aheady demented. Eurthermore, assessment of cognitive decline in patients aheady suffering from cognitive deficits remains a critical component to the effective treatment of AD. 

One study used quality-adjusted life years to capture the range of health-related dimensions that may affect the quality of life of patients. This measure also provides an estimate of the value or preferences for changes in health status (Neumann et al, 1999). The study used the Health Utility Index Mark II in a sample of patients and carers, which is a generic measure of the value of health-related quality of life. However, it is clear that further research is needed to explore (a) the key determinants or dimensions of quality of life that are important to people with dementia and their carers (b) whether existing instmments to measure and value health-related quality of life are able to detect differences in quality of life that are important to people with cognitive disability and their carers and (c) whether the assessment and... 

Studies that have focused on neuritic response to the NP rather than to presence of the plaque core itself have been more successful in finding a relationship between plaque-associated dystrophic neurites and dementia [30]. These studies suggest that plaque cores per se may only be an initiating event and that the gradual effects of the plaque core on adjacent neuronal pathway architecture may actuate the ultimate disruption of function. The timeframe over which the latter occurs, and the nature of how plaque-induced changes in synaptic connectivity ultimately affect cognition, is not known. 

Dementia may be hard to differ from delirium (Table 6.1). The most important tool is a thorough medical history. Dementia has a slow progress whereas delirium is characterised by a rapid change in cognitive functions. Depression and anxiety could be mistaken for delirium, but the impaired consciousness in delirium sets it apart from affective disorders. 

Dementia is characterised by a progressive decline in cognitive function. The prevalence of dementia increases with age. With the demographical changes, the number of patients with dementia will increase. There are three major forms of dementia Alzheimer s disease, vascular dementia and a mixed dementia. Beside these, there are several less common subtypes of dementia. 

Frontotemporal dementias are characterized by gross structural changes in the frontal and anterior temporal lobes, metabolic disturbances, and involvement of certain subcortical structures as well (Ishii et al. 1998). Whereas in Alzheimer s disease the early cognitive disturbances are in memory, in frontotemporal dementias the early manifestations are in executive and behavioral function (Pfeffer et al. 1999 Varma et al. 1999). This relative cognitive distinction persists throughout the course of the two disorders (Pachana et al. 1996). Disinhibition and disorganization are common, and psychotic symptoms may be prominent in frontotemporal dementia. 

Cognitive impairments are among the most common mental changes in PD, ranging from mild impairment of selected cognitive functions to severe dementia. In a study of more than 100 PD patients, only 25% performed adequately on a range of cognitive tests. Another 25% had mild impairment,... 

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