Memory loss - clinical focus on practical neurology

These are excerpts from a review in the Medical Journal of Australia (MJA):

Older people with mild cognitive impairment are at increased risk of progressing to dementia, but no tests are helpful in assessing this risk. Medications are not beneficial in mild cognitive impairment.

Physical activity and treatment of hypertension decrease the risk of dementia.

In people with Alzheimer’s disease, a cholinesterase inhibitor or memantine (an N-methyl- D-aspartate receptor antagonist) provides symptomatic relief. Medications do not change progression of the illness.

Behavioural and psychological symptoms are common in Alzheimer’s disease.

Atypical antipsychotics reduce agitation and psychosis but increase the risk of cardiovascular events.

Antidepressant role in managing depression with mild cognitive impairment is uncertain but they may increase the risk of delirium and falls.

References:

Memory loss. Leon A Flicker, Andrew H Ford, Christopher D Beer and Osvaldo P Almeida. Med J Aust 2012; 196 (2): 114-117.

Image source: Hippocampus, from Wikipedia, public domain.

Evaluation of driving risk in dementia - practice parameter update

For patients with dementia, the following characteristics are useful for identifying
patients at increased risk for unsafe driving:

- Clinical Dementia Rating scale (Level A)
- caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)
- history of crashes or traffic citations (Level C)
- reduced driving mileage or self-reported situational avoidance (Level C)
- Mini-Mental State Examination scores of 24 or less (Level C)
- aggressive or impulsive personality characteristics (Level C)


Evaluation of driving risk in dementia (click to enlarge the image).

The following characteristics are not useful for identifying patients at increased risk for unsafe driving:

- patient’s self-rating of safe driving ability (Level A)
- lack of situational avoidance (Level C)

References:
Practice Parameter update: Evaluation and management of driving risk in dementia. Neurology 2010;74:1316–1324 (PDF)

Misleading Headline and Story on Anxiety and Dementia

"Staying Calm 'Prevents Dementia," is the headline on a BBC article today. Seems like an innocuous headline but in fact it is both wrong and misleading.As a group, older people who scored as "calm and relaxed" in their answers to a survey had a 50% lower risk of developing dementia over the next six years, the BBC reported. (There's another no-no: giving a relative risk figure without giving the