Grossberg_2005_CNS.Spectr_10_1

Dementia with Lewy bodies DLB Parkinson's disease and Alzheimer's disease AD are chronic neurologic disorders which affect many in the geriatric population DLB has been identified as a distinctive dementia syndrome that accounts for 15 to 25 of all elderly dementia cases The National Institutes of Health estimate that Parkinson's disease affects over 500,000 Americans with 50,000 new cases reported annually Approximately 20 to 40 of Parkinson's patients eventually develop dementia The prevalence of AD and related dementia is approximately 5.7 among those 65 years of age and older The three dementias share clinical symptoms but they are clinically distinct DLB is characterized by less tremor and asymmetry of motor symptoms and more falls Parkinson's disease is characterized by akinesia muscular rigidity and resting tremor Depending on the disease stage autonomic dysfunction olfactory disturbances depression and dementia are frequently encountered in Parkinson's disease Clinical distinction among the three conditions has clinical importance because of different therapeutic and diagnostic implications The classification of mild cognitive impairment MCI evaluates older adults who suffer from cognitive impairment or decline but do not yet meet criteria for AD by using relatively specific diagnostic criteria Due to the substantial prevalence of degenerative neurologic disorders MCI may be an important target for early screening and possible intervention Cholinesterase inhibitors ChEIs are widely used for relieving cognitive symptoms in mild-to-moderate AD The cholinergic system has been strongly implicated in the emergence of neuropsychiatric symptoms Cholinergic therapy has proven efficacy in improving cognition behavior activities of daily living and global functioning and has also been shown to be effective across disease stages The treatment has also been shown to reduce caregiver stress and to delay time to nursing home placement In Parkinson's disease with dementia and DLB cholinergic deficits are more severe than in AD and there is emerging evidence that ChEIs are efficacious in treating core symptoms of attentional disturbance and psychosis and may also benefit behavioral symptoms Treatment with ChEIs is well tolerated in most patients without any apparent worsening of extrapyramidal motor features Side effects tend to be dose-related and are most problematic during dose titration Clinically relevant responses consist not only of improvement over 3 to 6 months but also stabilization and possibly slower than expected decline Optimal treatment consists of early diagnosis effective use of medications control of comorbidities and patient and family support To limit the ongoing risk of cognitive impairment in the geriatric population continuing education on ChEI treatment is necessary for neurologists charged with diagnosing treating and managing patients suffering from DLB Parkinson's disease and AD dementia Behavioral symptoms of dementia in particular cause great distress to caregivers creating an emotional and financial burden that often prompts the caregiver to place the patient in nursing care Further research is necessary to examine whether ChEIs benefit these symptoms The geriatric population is also more susceptible to serious injury due to falls especially for those patients with DLB In addition given the high risk of severe sensitivity reactions and increased risk of cerebrovascular incidents during treatment with neuroleptics additional research on ChEI is encouraged to establish their precise role in treating DLB Parkinson's disease and ADion continuing education on ChEI treatment is necessary for neurologists charged with diagnosing treating and managing patients suffering from DLB Parkinson's disease and AD dementia Behavioral symptoms of dementia in particular cause great distress to caregivers creating an emotional and financial burden that often prompts the caregiver to place the patient in nursing care Further research is necessary to examine whether ChEIs benefit these symptoms The geriatric population is also more susceptible to serious injury due to falls especially for those patients with DLB In addition given the high risk of severe sensitivity reactions and increased risk of cerebrovascular incidents during treatment with neuroleptics additional research on ChEI is encouraged to establish their precise role in treating DLB Parkinson's disease and AD.