CONTINUUM Lifelong Learning in Neurology最新文献_第9页

SELF-ASSESSMENT AND CME. 自我评估和继续教育。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/CON.0000000000001513

引用次数: 0

Issue Overview. 问题概述。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/01.CON.0001095704.07466.fa

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Lewy Body Dementia. 路易体痴呆。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/CON.0000000000001496

James E Galvin

{"title":"Lewy Body Dementia.","authors":"James E Galvin","doi":"10.1212/CON.0000000000001496","DOIUrl":"10.1212/CON.0000000000001496","url":null,"abstract":"Objective: Lewy body dementia (LBD) is an umbrella term describing two closely related conditions: Parkinson disease dementia (PDD) and dementia with Lewy bodies (DLB). LBD is the second most common cause of neurodegenerative dementia but is often underrecognized in clinical practice. This review covers the key epidemiologic, clinical, cognitive, behavioral, and biomarker features of LBD and discusses current treatment options.Latest developments: Indicative biomarkers of LBD improve the ability to make a diagnosis and include single-photon emission computed tomography (SPECT) of the dopamine system (brain) and the noradrenergic system (cardiac), and polysomnography. α-Synuclein-specific biomarkers in spinal fluid, skin, plasma, and brain imaging are in active development with some available for clinical use. Prodromal stages of PDD and DLB have been contextualized, and diagnostic criteria have been published. An emerging theme is whether an integrated staging system focusing on protein aggregation, rather than clinical symptoms, may advance research efforts.Essential points: LBD is a common cause of cognitive impairment in older adults but is often subject to significant delays in diagnosis and treatment, increasing the burden on patients and family care partners. Understanding key features of disease and the use of biomarkers will improve recognition. Earlier detection may also facilitate the development of new therapeutics and enrollment in clinical trials.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"30 6","pages":"1673-1698"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Atypical Presentations of Alzheimer Disease. 阿尔茨海默病的非典型表现。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/CON.0000000000001504

David Jones, Victoria Pelak, Emily Rogalski

{"title":"Atypical Presentations of Alzheimer Disease.","authors":"David Jones, Victoria Pelak, Emily Rogalski","doi":"10.1212/CON.0000000000001504","DOIUrl":"10.1212/CON.0000000000001504","url":null,"abstract":"Objective: This article provides a comprehensive review of the distinct features of four atypical Alzheimer disease (AD) variants: dysexecutive AD, behavioral variant AD, posterior cortical atrophy, and the logopenic variant of primary progressive aphasia. It also elucidates their clinical presentations, underlying pathophysiologic pathways, diagnostic indicators, and management requirements.Latest developments: Recent research has revealed that these atypical AD forms vary not only in clinical manifestations but in their functional neuroanatomy spanning a common pathophysiologic spectrum. Imaging techniques, such as MRI, fludeoxyglucose positron emission tomography (FDG-PET), and tau PET, have identified distinct abnormalities in specific brain regions associated with each variant. This same variability is less tightly coupled to amyloid imaging. Emerging diagnostic and therapeutic strategies should be tailored to each variant's unique features.Essential points: Atypical forms of AD often present with symptoms that are predominantly nonmemory related, distinguishing them from the more common memory-centric presentation of the disease. Two distinct clinical and pathologic entities, dysexecutive AD and behavioral variant AD, have replaced the outdated term frontal AD. Posterior cortical atrophy is another variant that mainly affects higher-order visual functions, which can lead to misdiagnoses because of its atypical symptom profile. Logopenic primary progressive aphasia is marked by difficulties in word retrieval, a challenge that may not be readily apparent if the person compensates by using circumlocution. Modern diagnostic techniques, such as MRI, PET, and biomarker analysis, have proven crucial for the accurate diagnosis and differentiation of these atypical AD variants. In treating these forms, it is critical to use tailored therapeutic interventions that combine pharmacotherapy with nonpharmacologic strategies to effectively manage the disease.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"30 6","pages":"1614-1641"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12175143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Treatment of Alzheimer Disease. 老年痴呆症的治疗。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/CON.0000000000001503

David S Geldmacher

{"title":"Treatment of Alzheimer Disease.","authors":"David S Geldmacher","doi":"10.1212/CON.0000000000001503","DOIUrl":"10.1212/CON.0000000000001503","url":null,"abstract":"Objective: Symptom-oriented treatment has been the mainstay of Alzheimer disease (AD) pharmacotherapy for decades. This article reviews the evidence basis for symptomatic treatments for AD and the emerging data on amyloid-lowering therapies with possible disease-slowing effects.Latest development: Amyloid-lowering monoclonal antibody therapies entered clinical use in 2021. In July 2023, lecanemab became the first of these to gain full US Food and Drug Administration (FDA) approval and limited Medicare payment coverage. Donanemab gained similar approval status in July 2024. The approved agents remove amyloid plaque from the brain and appear to slow clinical disease progression but can produce significant adverse events known as amyloid-related imaging abnormalities with cerebral edema or effusion and with cerebral hemorrhages. Extensive safety monitoring is therefore required, including scheduled MRI scans. Also in 2023, brexpiprazole became the first agent specifically approved by the FDA for agitation associated with AD. Suvorexant, an orexin receptor antagonist, previously was approved for the treatment of insomnia in people with mild and moderate AD.Essential points: There is robust evidence for the use of acetylcholinesterase inhibitors for patients with mild, moderate, and severe dementia due to AD, including outcomes beyond changes in cognitive screening test scores. More limited studies support the use of memantine in moderate and severe stages. These agents have a primary effect of delaying decline in cognition and function and postponing the emergence of adverse behaviors. Pharmacotherapy for behavioral and psychological symptoms is less predictable, and most clinical trials have had negative results. Anti-amyloid therapies provide the first FDA-approved option to alter AD pathology, but an understanding of overall utility and value to patients remains in its infancy.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"30 6","pages":"1823-1844"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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CONTRIBUTORS. 贡献者。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/CON.0000000000001498

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Diagnosing Alzheimer Disease. 诊断阿尔茨海默病。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/CON.0000000000001507

Gregory S Day

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SELF-ASSESSMENT AND CME. 自我评估和继续教育。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/CON.0000000000001513

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Table of Contents. 目录表。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/CON.0000000000001511

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Care Partner Burden and Support Services in Dementia. 痴呆症患者的护理伙伴负担和支持服务。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-12-01 DOI: 10.1212/CON.0000000000001502

Angelina J Polsinelli

{"title":"Care Partner Burden and Support Services in Dementia.","authors":"Angelina J Polsinelli","doi":"10.1212/CON.0000000000001502","DOIUrl":"10.1212/CON.0000000000001502","url":null,"abstract":"Objective: Informal care partners are essential to the care of people living with dementia, but they often experience significant burden and receive minimal training, support, and resources. This article provides an overview of care partner experiences, factors contributing to burden, and methods for reducing burden of caregiving in dementia.Latest developments: The US Department of Health and Human Services National Plan to Address Alzheimer's Disease and the World Health Organization Global Action Plan for dementia have identified support for dementia care partners as a top priority for research and policy in recognition of care partners' instrumental but underresourced role in dementia care. The psychological, financial, social, and physical costs of caregiving, particularly without necessary knowledge, skills, and resources, can lead to care partner burden. Reassuringly, multicomponent interventions can mitigate burden and other negative consequences of caregiving, especially when they are theoretically grounded, inclusive, and culturally relevant.Essential points: Health care providers play a vital role in the early identification of care partner burden through brief, regular assessments. With earlier identification and subsequent intervention (eg, education, skills-based training, local and national resources), the experience of burden and negative health outcomes can be mitigated and quality of life for people living with dementia and their care partners can be improved.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"30 6","pages":"1845-1862"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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