Clinical Manual of Alzheimer Disease and Other Dementias

471 Pages·2012·4.39 MB·English

by  Myron F.

Clinical Manual of
Alzheimer Disease and
Other Dementias
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Clinical Manual of
Alzheimer Disease and
Other Dementias
Edited by
Myron F. Weiner, M.D.
Clinical Professor of Psychiatry and
Neurology and Neurotherapeutics
Aradine S. Ard Chair in Brain Science
Dorothy L. and John P. Harbin Chair in Alzheimer’s Disease Research
University of Texas Southwestern Medical Center at Dallas, Texas
Anne M. Lipton, M.D., Ph.D.
Diplomate in Neurology
American Board of Psychiatry and Neurology
Washington, DC
London, England
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Copyright © 2012 American Psychiatric Association
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Library of Congress Cataloging-in-Publication Data
Clinical manual of Alzheimer disease and other dementias / edited by Myron F. Weiner,
Anne M. Lipton. — 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58562-422-5 (pbk. : alk. paper)
I. Weiner, Myron F., 1934– II. Lipton, Anne M., 1966– III. American Psychiatric
Association.
[DNLM: 1. Alzheimer Disease. 2. Dementia. WT 155]
616.8′31–dc23 2011042750
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
To Doris Svetlik
for her selfless devotion to the clinical care
of patients with dementia
and
Marsha Ard and John Harbin
for their support of Dr. Weiner’s research on the treatment
and management of Alzheimer disease and related illnesses
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Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . .xxxi
Myron F. Weiner, M.D.
Anne M. Lipton, M.D., Ph.D.
PART I
Assessment and Diagnosis
1
Neuropsychiatric Assessment and
Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Myron F. Weiner, M.D.
Robert Garrett, M.D.
Mary E. Bret, M.D.
DSM-IV-TR Cognitive Disorders . . . . . . . . . . . . . . . . . . . .4
Normal Cognitive Aging . . . . . . . . . . . . . . . . . . . . . . . . . .4
The Complaint of Cognitive Impairment. . . . . . . . . . . . .9
Mild Cognitive Impairment. . . . . . . . . . . . . . . . . . . . . . .10
Dementia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Delirium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Amnestic Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Other Cognitive Disorders . . . . . . . . . . . . . . . . . . . . . . .20
Psychiatric Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Speech and Language. . . . . . . . . . . . . . . . . . . . . . . . . . .30
Clinical Techniques and Tools for Diagnosing
Cognitive Dysfunction. . . . . . . . . . . . . . . . . . . . . . . . . .32
Characterizing Dementing Illnesses. . . . . . . . . . . . . . . .38
Quantifying Cognitive Impairment. . . . . . . . . . . . . . . . .39
Key Clinical Points. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
2
Medical and Neurological Evaluation
and Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Anne M. Lipton, M.D., Ph.D.
Craig D. Rubin, M.D.
Setting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Neurological Examination. . . . . . . . . . . . . . . . . . . . . . . .53
Laboratory Studies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Special Diagnostic Procedures. . . . . . . . . . . . . . . . . . . .56
Other Diagnostic Procedures. . . . . . . . . . . . . . . . . . . . .57
How Much Evaluation Is Enough?. . . . . . . . . . . . . . . . .60
How Often Are Evaluations Indicated? . . . . . . . . . . . . .61
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Key Clinical Points. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
3
Neuropsychological Assessment. . . . . . . . . . . .65
C. Munro Cullum, Ph.D., A.B.P.P.
Laura H. Lacritz, Ph.D., A.B.P.P.
Effect of Aging on Cognitive Function. . . . . . . . . . . . . .66
Comprehensive Neuropsychological Evaluation
for Dementia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Neuropsychological Evaluation of Cognitive Domains. . .68
Neuropsychological Screening Batteries
for Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
Interpretation of Neuropsychological Results. . . . . . . .80
Neuropsychological Profiles in Dementia. . . . . . . . . . .80
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
Key Clinical Points. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
4
Neuroimaging . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Norman L. Foster, M.D.
Rational Use of Neuroimaging in Dementia Care . . . .89
Structural Neuroimaging. . . . . . . . . . . . . . . . . . . . . . . . .92
Molecular Neuroimaging . . . . . . . . . . . . . . . . . . . . . . .102
Special Situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114
Emerging Neuroimaging Methods. . . . . . . . . . . . . . . .119
New Neuroimaging Applications. . . . . . . . . . . . . . . . .121
Key Clinical Points. . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126
5
Alzheimer Disease . . . . . . . . . . . . . . . . . . . . . .127
David S. Geldmacher, M.D.
Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
Clinical History and Course of Illness . . . . . . . . . . . . .128
Mental Status Findings . . . . . . . . . . . . . . . . . . . . . . . . .136
Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
Key Clinical Points. . . . . . . . . . . . . . . . . . . . . . . . . . . . .154
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155
Further Reading. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .158
6
Mild Cognitive Impairment . . . . . . . . . . . . . . .159
Yonas E. Geda, M.D, M.Sc.
Ronald C. Petersen, Ph.D., M.D.
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160
Progression of MCI to Dementia . . . . . . . . . . . . . . . . .160
Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Subtypes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .162
Neuropsychiatric Features . . . . . . . . . . . . . . . . . . . . . .163
Neuroimaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165
Neuropathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166
Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167