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Dx Dementia Treatment:


The Merck Manual Home Edition states "Commonly, dementia occurs as a brain disorder with no other cause (called a primary brain disorder), but it can be caused by many disorders. Most commonly, dementia is Alzheimer disease, a primary brain disorder. About 60 to 80% of older people with dementia have Alzheimer disease. Other common types of dementia include vascular dementia, Lewy body dementia, and frontotemporal dementia (such as Pick disease). People may have more than one of these dementias (a disorder called mixed dementia)".

"Disorders that can cause dementia include the following:
Parkinson disease (a common cause)
Brain damage due to a head injury or certain tumors
Huntington disease
Prion diseases, such as Creutzfeldt-Jakob disease
Progressive supranuclear palsy
Radiation therapy to the head
Human immunodeficiency virus (HIV) infection

Most of the conditions that cause dementia cannot be reversed, but some can be treated and may be called reversible dementia."

Medications Used in the Treatment:
1. Typical Antipsychotics: fluphenazine/ chlorpromazine
2. Ergot derivatives: Ergoloid mesylates

We [the editorial staff] agree with HW Fillit, M.D. in JAMA Internal Medicine   2002;162(17): 1934-42 who states "At present, most observational evidence, which is supported by neurobiological research findings on the action of estrogen, indicates that ERT/HRT mitigates the degeneration that may lead to AD. The lack of evidence of a role of estrogen in the treatment of AD suggests that ERT/HRT should be initiated as early as possible after menopause, before the onset or the progression of the disease. Thus, the relationship of postmenopausal hormone therapy to AD is somewhat parallel to its relationship to osteoporosis in that, in both cases, ERT/HRT seems to have a role in primary prevention."

*[Editor]: More in depth explanations about the benefits of bio-identical (natural) hormonal replacement for peri- and menopausal women can be found in the Video about CME Menopause:>The Benefits of Hormone Replacement for Women Before, During and After Menopause. *[Editor] An excellent review from Ghent recognize that "anti-psychotic agents are often used to treat neuro-psychiatric symptoms (NPS) in dementia, although the literature is skeptical about their long-term use for this indication. Their effectiveness is limited and there is concern about adverse effects, including higher mortality with long-term use.....and provided evidence that most individuals with dementia, except for the most difficult to control, could reduce or be weaned off their anti-psychotic medications."

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