ITEMS IN FPM WITH MESH TERM:
ABSTRACT: Increasingly, atypical antipsychotic drugs are prescribed for elderly patients with symptoms of psychosis and behavioral disturbances. These symptoms often occur in patients with Alzheimer's disease, other dementias, or Parkinson's disease. As the average age of Americans increases, the prevalence of Alzheimer's disease and Parkinson's disease will rise accordingly. Although nonpharmacologic treatments for behavioral disturbances should be tried first, medications often are needed to enable the patient to be adequately cared for. Current guidelines recommend using risperidone and olanzapine to treat psychosis in patients with Alzheimer's dementia. Quetiapine and clozapine are recommended for treatment of psychosis in patients with Parkinson's disease. Additional research is needed for a recently approved agent, ziprasidone. To minimize side effects, these medications should be started at low dosages that are increased incrementally. Drug interactions, especially those involving the cytochrome P450 system, must be considered. Clozapine's potentially lethal side effects limit its use in the primary care setting. Informed use of atypical antipsychotic drugs allows family physicians to greatly improve quality of life in elderly patients with dementia and behavior disturbances.
Quality of Life in Older Persons with Dementia Living in Nursing Homes - FPIN's Clinical Inquiries
Postmenopausal Hormone Replacement Therapy for the Primary Prevention of Chronic Conditions - U.S. Preventive Services Task Force
Screening for Dementia - Putting Prevention into Practice
Hormone Therapy for the Prevention of Chronic Conditions in Postmenopausal Women - Putting Prevention into Practice
Dietary Fatty Acids - Article
ABSTRACT: Fatty acids can be divided into four general categories: saturated, monounsaturated, polyunsaturated, and trans fats. Saturated fatty acids and trans fats are associated with an increased risk of coronary heart disease. Monounsaturated fatty acids and polyunsaturated fatty acids are associated with a decreased risk of coronary heart disease, although these associations are not uniformly supported in the literature. Omega-3 fatty acids, which are a type of polyunsaturated fatty acid, have been studied as potential therapy for a variety of medical conditions because of their suspected anti-inflammatory properties. Omega-3 fatty acids have also been shown to provide some benefit to patients with cystic fibrosis, and may have a protective effect against dementia. Physicians should counsel patients about the importance of avoiding hydrogenated oils and foods containing trans fats because of their association with coronary heart disease in observational studies.
Gingko Biloba - Article
ABSTRACT: Ginkgo biloba is commonly used in the treatment of early-stage Alzheimer's disease, vascular dementia, peripheral claudication, and tinnitus of vascular origin. Multiple trials investigating the efficacy of ginkgo for treating cerebrovascular disease and dementia have been performed, and systematic reviews suggest the herb can improve the symptoms of dementia. Ginkgo is generally well tolerated, but it can increase the risk of bleeding if used in combination with warfarin, antiplatelet agents, and certain other herbal medications. Clinical issues of safety, dosing, use in the perioperative period, and pharmacology are addressed in this review.
ABSTRACT: Referring a patient to a neuropsychologist for evaluation provides a level of rigorous assessment of brain function that often cannot be obtained in other ways. The neuropsychologist integrates information from the patient’s medical history, laboratory tests, and imaging studies; an in-depth interview; collateral information from the family and other sources; and standardized assessment instruments to draw conclusions about diagnosis, prognosis, and response to therapy. Family physicians can use this information in the diagnosis and treatment of patients with depression, dementia, concussion, and similar conditions, as well as to address concerns about decision-making capacity. Certain assessment instruments, such as the Mini-Mental State Examination and Patient Health Questionnaire–9, are readily available and easily performed in a primary care office. Distinguishing among depression, dementia, and other conditions can be challenging, and consultation with a neuropsychologist at this level can be diagnostic and therapeutic. The neuropsychologist typically helps the patient, family, and primary care team by establishing decision-making capacity; determining driving safety; identifying traumatic brain injury deficits; distinguishing dementia from depression and other conditions; and detecting malingering. Neuropsychologists use a structured set of therapeutic activities to improve a patient’s ability to think, use judgment, and make decisions (cognitive rehabilitation). Repeat neuropsychological evaluation can be invaluable in monitoring progression and treatment effects.
American Psychiatric Association Issues a Practice Guideline on Dementia - Special Medical Reports