Frequency of Dementia Syndromes with a Potentially Treatable Cause in Geriatric In-Patients

Abstract

The present longitudinal study investigated the frequency of dementia syndromes with causes that are potentially treatable. Researchers retrospectively analyzed clinical laboratory, neuroimaging, and neuropsychologic findings of the diagnostic routine of a one year period (January 2009 to December 2009). 160 in-patients with severe acquired cognitive deficits at the Department of Geriatric, Evangelisches Krankenhaus Gottingen-Weende were featured in the study. The Mini-Mental State Examination (MMSE) and the Consortium to Establish a Registry for Alzheimer’s disease Assessment Battery were utilized in the diagnosis process. GraphPad Prism software was used for statistical assessment and data was presented means ± standard deviations (SD). Depressive pseudodementia was the most prevalent condition among newly diagnosed patients, followed by Vitamin B12 deficiency then NPH and alcoholism.

 

Frequency of Dementia Syndromes with a Potentially Treatable Cause in Geriatric In-Patients: Analysis of a 1-Year Interval

Dementia is the greatest health challenge the world is experiencing today. The disorder affects approximately 50 million people in the world and the deaths caused by dementia have doubled since 2000, ranking it fifth among the biggest killers in the world (WHO, 2017). The disease is a collective name for brain disorders that affect functions such as reasoning, memory, executive functions, and visual and language abilities among others. Since the major risk factor of dementia is age, the disease’s incidents are projected to balloon in the coming years because of longevity – people are living longer. Due to the immense burden that the condition imposes on the patients and the society, it is important to have a deeper understanding in order to develop more effective treatments. The present study examined the frequency of dementia syndromes with causes that are potentially treatable.

According to the diagnosis of dementia syndrome, approximately 60% of the typical histopathological picture displays neurofibrillary tangles and amyloid deposits. 15% of the dementia cases are characterized by severe vascular abnormalities (Djukie et al., 2015). Only symptomatic treatment is available for these forms of dementia. Also, magnetic resonance tomography or cranial computer imaging reveals a potentially curable non-ischemic and non-degenerative cause in approximately 5% of demented patients. Potentially causal treatment of dementia syndromes can be indicated by cerebral imaging and laboratory findings. Djukie et al. conducted a longitudinal study to investigate the frequency of potentially causally treatable syndromes of dementia (2015). The study qualifies as longitudinal because it follows the same sample population over a long period and makes repeated observations. The study can also be categorized as a cohort design because it involves members of a population that represented the interest subject and who share common characteristics. This study features a geriatric population suffering from dementia. Depressive pseudodementia, intracranial mass lesions, Vitamin B12 and foliate deficiency, and metabolic encephalopathy are among the most common causally treatable dementia syndromes.

The researchers retrospectively analyzed clinical laboratory, neuroimaging, and neuropsychologic findings of the diagnostic routine of a one year period (January 2009 to Decemmber 2009). 166 demented in-patients with severe acquired cognitive deficits at the Department of Geriatric, Evangelisches Krankenhaus Gottingen-Weende were featured in the study. The population consisted of 123 women and 43 men. Nueropsychiatric examination was performed to determine spatial, temporal, mood and sleep disorders, psychotic symptoms, situative and personal orientation, and lassitude (Djukie et al., 2015). To select demented patients, the researchers looked for interference of normal daily activities for the duration of six months. The Mini-Mental State Examination (MMSE) was used to assess cognitive functions of the patients. The Consortium to Establish a Registry for Alzheimer’s disease Assessment Battery was also utilized in the diagnosis process. GraphPad Prism software was used for statistical assessment and data was presented means ± standard deviations (SD). Spearman’s rank correlation coefficient (rs) was used to evaluate correlations between laboratory findings and MMSE score.

160 of 166 patients aged 82.9±6.4 were studied because six of them were diagnosed with delirium. Alzheimer’s disease was the most prevalent cause of dementia, accounting 73.7% of the causes while probable mixed dementia accounted for 11.1%. Parkinson dementia and probable vascular dementia accounted for the rest of 7.1% (Djukie et al., 2015). 31% of 99 patients with already known dementia and 18.2% of the remaining 66 patients with newly diagnosed dementia displayed causally treatable syndromes of the disease. Consistent with the hypothesis, depressive pseudodementia was the most prevalent condition among newly diagnosed patients, followed by Vitamin B12 deficiency, then NPH and alcoholism. For diseases which only symptomatic treatment is available, identification of causally treatable condition is helpful. Therefore, there’s need for a rapid and thorough screening of dementia patients in order to detect all potentially treatable causal conditions. For instance, adequate doses of antidepressants can cure depressive pseudodementia, which has proved to be the major cause reversible dementia.

Potential Validated Treatment Options for Dementia

It has been recently discovered that Deep Brain Stimulation (DBS) may modulate memory circuit activities. Alzheimer’s disease (AD) and Parkinson’s disease (PDD) are the most common subtypes of dementia disease. Extensive research has demonstrated that dysfunction in memory circuits causes of AD and PDD (Lv et al., 2018). Patients with AD and PDD experience decreased activity in the default-mode network in the cortical and related regions, which affects memory and cognition. DBS is a surgical procedure in which electrodes are attached to the brain. The electrodes then deliver impulses to intended region of the brain. Targeting of critical nodes in the memory circuit can be performed through NBM and fornix stimulation. Cognitive decline in AD and PDD is triggered by protein aggregation that is caused by low regulation of NBM cholinergic input (Lv et al., 2018). Electoral stimulation helps to regulate the ascending basal forebrain projections of the NBM, which augments cholinergic stimulation and in turn, boost cognitive function. Lv et al. cites various studies including Durschmid et al. (2017), Kuhn et al. (2015), and Baldermann et al. (2017), have demonstrated the effectiveness of NBM stimulation (2015). The fornix, which is a white matter in limbic circuits, plays a crucial role in memory functioning. The successful stimulation of the fornix and hypothalamus in improving memory has been reported by several studies including Smith et al. (2012) and Lozano et al. (2016) (as cited in Lv et al., 2015).

Disease-modifying therapy (DMT) is another potential treatment for AD. A DMT, according to Cummings & Fox,

“ is an intervention that produces an enduring change in the clinical progression of AD by interfering in the underlying pathophysiological mechanisms of the disease process that leads to cell death.” (2017).

The modifying effect may include delay of AD milestone, increase in drug-placebo difference in the course of time, and alterations in cognitive slope decline. Clinical trial designs have featured randomized withdrawal and delayed start. These clinical trials have demonstrated significant impact on cognitive and functional measures of patients with mild to moderate AD (Cummings & Fox, 2017). Behavioral and psychological symptoms of dementia can also be treated by nonpharmacological practices like multisensory stimulation, massage, reminiscence therapy, validation therapy, bright light therapy, and music therapy. The therapies, which have been accepted by patients at different levels, have shown little to significant effect on dementia (Scales et al., 2018).

The present study, which involved geriatric demented patients, aimed at examining the frequency of causally reversible dementia syndrome. Depressive pseudodementia, Vitamin B12, and NPH were the most frequent causally treatable conditions for dementia. Although the identification of causally reversible dementia syndrome may not always lead to full recovery, the findings may be helpful to primary contact persons of demented individuals including general practitioners. The research on potential treatment options like DBS and DMT is underway to demonstrate their effectiveness in dementia treatment. The efficacy of nonpharmacological options like multisensory stimulation and massage is also being studied.

 

References

Cummings, J. & Fox, N. (2017, April 25). Defining Disease Modifying Therapy for Alzheimer’s disease. The Journal of Prevention of Alzheimer’s Disease, 4(2), 109-115. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653310/

Djukie, M., Wedekind, D. & Franz, A. (2015, Aug). Frequency of dementia syndromes with a potentially treatable cause in geriatric in-patients: an analysis of a 1-year interval. European Archives of Psychiatry and Clinical Neuroscience, 265(5), 429-438. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25716929

Lv, Q., Du, A., Wei, W., Li, Y., Liu, G. & Wang, X.P. (2018, May 29). Deep Brain Stimulation: A potential treatment for dementia in Alzheimer’s disease (AD) and Parkinson’s disease dementia (PDD). Frontiers in Neuroscience, 12. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986883/

Scales, K., Zimmerman, S. & Miller, S.J. (2018, Jan 18). Evidence-based nonpharmacological practice to address behavioral and psychological symptoms of dementia. The Gerontologist, 58(1). Retrieved from https://doi.org/10.1093/geront/gnx167

WHO. (2017, Dec 12). Dementia. WHO. Retrieved from https://www.who.int/news-room/fact-sheets/detail/dementia