Behavioural symptoms-such as psychosis, agitation, depression, and wandering-are common and impose tremendous strain on caregivers. Diagnosis is challenging because of the lack of biological markers, insidious onset, and need to exclude other causes of dementia. (Mental Health, 1)
Dementia is a prominent healthcare issue for primary care physicians and specialist services. Over 90% of patients with dementia experience a "behaviour disturbance," often referred to as behavioural or psychological signs in dementia in accordance with the recommendation of the International Psycho geriatric Association. These symptoms are distressing to patients and troublesome to carers and often precipitate admission to residential facilities. What is the evidence that any of the several drugs that are currently used to treat these symptoms are effective
Managing the behavioural and psychological signs of dementia is a major problem for healthcare professionals. Narcoleptic drugs are the mainstay of pharmacological treatment, although their use is justified largely on the basis of clinical anecdote, and they have many harmful side effects. These include Parkinsonism, drowsiness, tardive dyskinesia, falls, accelerated cognitive decline, and severe narcoleptic sensitivity reactions. It is therefore not surprising that the chief medical officer has recommended judicious use of these agents in patients with dementia.
In 1990 Schneider published a landmark study showing the paucity of large, placebo controlled, double blind trials of narcoleptic agents in treating behavioural and psychological signs in dementia. Since then research in the subject has increased, but most treatment studies have used an open or active comparison design, a major methodological flaw given the high placebo response rates (40%). Two large multi-centre studies with risperidone have recently been completed, showing a significant advantage over placebo for overall reduction of behaviour disturbances, although in one of the studies psychotic symptoms did not improve significantly. In addition, psychosis and aggression responded preferentially to different doses. (Ballard CG, 21)
While assessment and diagnosis of Alzheimer's disease it should be remembered that declines in cognitive functioning have been identified both as part of the normal process of aging and as an indicator of Alzheimer's disease. DSM-IV first designated this as "age-related cognitive decline" and, more recently, as "mild cognitive impairment" (MCI). MCI characterizes those individuals who have a memory problem but do not meet the generally accepted criteria for Alzheimer's disease such as those issued by the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association or DSM-IV. MCI is important because it is known that a certain percentage of patients will convert to Alzheimer's disease over a period of time probably in the range of 15 to 20 percent per year. (Mental Health, 1)
Alzheimer's disease would appear to typically start in the entorhinal cortex, spread to other parts of the hippocampus and than progress to the temporal cortex, parietal cortex, and frontal cortex. What the functional magnetic resonance imaging does is to provide a better look at smaller parts of the