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Today's topic is going to be dementia.
Dementia is one of the most important public
health topics that we deal with and is
an interesting mix of important pathophysiology and frontiers
to new treatments that are currently being developed.
It really sits at the heart of what we do in neuroscience.
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Once again, here are my titles and no conflicts of interest.
The learning objectives
for this session are the following.
Learn how to define dementia and name its most common etiologies.
Be able to name the most common
neurodegenerative conditions and describe their clinical presentation.
Discuss current treatments for dementia.
And then finally detail some reversible causes
of cognitive impairment that should be recognized.
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So dementia is defined as a decline in cognitive
function that impairs the ability to perform activities of daily living.
Activities of daily living would include bathing, dressing, being
able to care for your finances, cooking, et cetera.
Now, when we think of dementia we think of it as a chronic problem.
Obviously, I could give somebody a drug that would impair their
ability to perform activities of daily living for a few hours,
for instance if somebody had general anesthesia,
but we're talking about a chronic condition.
Now any of the cognitive domains can be involved, and we'll
talk about what those are, but memory is the most common.
The most common dementia illnesses lead to memory being impaired.
And while most commonly it is neurodegenerative
conditions that are the cause of dementia.
Sometimes to dementia
can be caused by easily reversible etiologies
and we'll focus on these because it's important
for a physician to be able to
identify these reversible etiologies and treat them rapidly.
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Now there's a couple other terms to define.
One of which is mild cognitive impairment.
Mild cognitive impairment or MCI is a diagnosis that you can think of
to some extent, as a milder form of dementia.
It exists when a measurable clinical problem exists.
But it does not lead to problems with activities of daily living.
Now some of these patients will progress over time to develop dementia.
For instance, in some cases this is a pre-stage to dementia and it will worsen.
In other instances, mild cognitive impairment
will remain stable.
Or, if caused by a reversible etiology,
mild cognitive impairment may then return to normal.
But MCI or mild cognitive impairment is an important term to be familiar with.
Let's contrast that with normal aging.
So, what does it mean to just normally get older?
What should the cognitive changes that we expect.
Well, subtle slowing or decline in memory skills or
in cognitive speed is really common in elderly populations.
And doesn't necessarily represent a pathologic condition.
However, the difference between this condition, slowing problems with
memory and older age and MCI or dementia remains somewhat difficult to
define, even among experts and has been an important focus of research in this area
in the past few decades.
Interestingly, as you'll hear about there are new techniques
that visualize dementia or neurodegenerative
pathology during a patient's lifetime.
And as we're able to see their, these changes
during a lifetime, rather than just being able to
see them at the time of death, we've learned
that some patients who have just mild changes as
they get older, actually have underlying neurodegenerative
conditions that are in the ultra early stages.
So we continue to work to define what is normal
aging, and what are the earliest stages of these neurodegenerative conditions.
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Daniel Lowenstein, MDProfessor and Vice Chair, Department of Neurology
S. Andrew Josephson, MDAssociate Professor
Wade Smith, MDProfessor
