Dementia mixed

Lopez-Arrieta JM and Birks J (2002). Nimodipine for primary degenerative, mixed and vascular dementia. Cochrane Database of Systematic Reviews, 3, CD000147. 

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. 

Degenerative Dementias Cortical and Mixed Cortical/Subcortical Types Alzheimer s Disease... 

Alzheimer s disease (AD) is the most frequent cause of dementia (50-70%), followed by vascular dementia (30 0%) and mixed dementia (15-20%). These prevalent forms of age-related neurodegeneration represent a major problem of health in developed countries, with more than 25 million people affected and probably more than 75 million people at risk during the next 20-25 years worldwide. The prevalence of dementia increases exponentially, from approx. 1% at 60-65 yr to more than 30-35% in people older than 80yr. It is very likely that in those patients older than 75-80 yr most cases of dementia are mixed in nature (degenerative plus vascular), whereas pure AD cases are very rare after 80yr (1-3). 

Cardiovascular and cerebrovascular disorders associated with lipid metabolism disturbance and atherosclerosis represent major risk factors for dementia (3,25,59). Atherosclerosis is the primary cause of heart disease and stroke in which genetic and environmental factors converge (553). More than 90% of patients older than 70-80 yr with dementia show signs of atherosclerosis in their arteries and a clear cerebrovascular component in their dementia process. It is very likely that pure AD is practically absent in octogenarians, in whom the prevalent diagnosis is vascular or mixed dementia (3,25,59), in which the APOE-4 allele also accumulates (18-20,554). 

Langa, K.M., Foster, N.L., Larson, E.B. (2004) Mixed dementia emerging concepts and therapeutic implications. JAMA, 292, 2901-2908. 

In controlled trials, all of these treatments provided mixed results at best. A few patients seemed to benefit, but most did not. In retrospect, this is probably because patients with many different types of dementia were lumped together in these older stndies. We now believe that these treatments provided no benefit to the Alzheimer s disease patient bnt may have helped those with vascular dementia. 

Alzheimer s disease (AD) along with vascular and mixed dementia is the commonest form of dementia affecting older people and accounts for 60-65% of dementia cases, whereas vascular dementia and mixed dementia account for 15-20% of the cases each (1). The Brain of individuals with AD manifest two characteristic lesions senile plaques and intracellular neurofibrillary tangles of the hyperphosphorylated tau protein (2). The amyloid fi-protein (Afi) is the principal component of the senile plaques. It is a peptide of 39-43 amino acids, derived from a larger precursor, the amyloid precursor protein (APP) (Fig. 1). 

An 84-year-old Japanese woman with mixed dementia taking bromperidol and biperiden was switched to risperidone 2 mg/day. After several weeks she began to have limb and orofacial dyskinesia and staggered while walking. The risperidone was abruptly withdrawn. During the following days the previous abnormal movements increased and extended to the trunk. There was respiratory dyskinesia with dyspnea. The symptoms resolved completely in risperidone withdrawal and treatment with haloperidol and biperiden. 

Besides their use in Alzheimer s disease, cholinesterase inhibitors have been extended to treat other dementias and related illnesses, which may include vascular dementia, dementia with Lewy Bodies, dementia associated with Parkinson s, mild cognitive impairment, and mixed dementia. Research is particularly important in this area since it is not uncommon for Alzheimer s disease to be co-morbid with other types of dementia. Therefore, it is important to devote a section briefly discussing recent flndings and the use of... 

Women are more likely to have mixed states, depressive episodes, and rapid cycling compared to men. Onset of manic episodes after the age of 60 is rare and is likely caused by a medical or neurological condition (e.g., stroke, tumor, or dementia), medications, or substance use. ... 

Mixed Alzheimer s and vascular dementia Normal pressure hydrocephalus... 

A number of small trials have demonstrated that ginkgo biloba is a powerful antioxidant. But the science remains mixed on whether it helps memory and other cognitive abilities by improving blood flow to the brain. The big question is, does ginkgo protect against dementia At least among those aged seventy-five or older, it appears not. 

Five withanolides isolated from Withania somnifera [mdAjuga bracteosa Benth. (Lamiaceae)] were shown to be novel natural cholinesterase (AChE) inhibitors with spasmolytic and calcium antagonistic properties. Thus, they represent leads or even possible drug candidates for treatment of Alzheimer s disease or related dementia (Choudhary et al. 2004, 2005). Three withanolides were found to be linear mixed-type inhibitors of AChE, the remaining two were non-competitive inhibitors, whereas all... 

Garamelli P, Laks ], Palmini AL, Nitrini R, Chaves ML, Forlenza OV, et al. Effects of galantamine and galantamine combined with nimodip-ine on cognitive speed and quality of life in mixed dementia a 24-week, randomized, placebo-controUed exploratory trial (the REMIX study). Arq Neuropsiquiatr 2014 72(6) 411-7. 

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