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CONTINUUM: Lifelong Learning in Neurology:
doi: 10.1212/01.CON.0000429318.28656.8a
Issue Overview

Issue Overview

Free Access

Continuum: Lifelong Learning in Neurology— Dementia, Volume 19, Issue 2, April 2013

Issue Overview

Dementia, April 2013;19(2)

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.

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Learning Objectives

Upon completion of the Continuum: Lifelong Learning in Neurology Dementia issue, participants will be able to:

▸ Recognize the key features for the diagnosis of Alzheimer disease, vascular dementia, and frontotemporal dementia

▸ Apply the newly proposed criteria for the diagnosis of Alzheimer disease

▸ Identify the appropriate use of CSF and imaging biomarkers in clinical dementia diagnosis

▸ Use appropriate pharmacologic and nonpharmacologic approaches for the management of patients with dementia

▸ Summarize the latest research advances in the diagnosis and treatment of dementia

▸ Recognize the diagnostic and treatment challenges of dementia in the oldest old

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Core Competencies

The Continuum Dementia issue covers the following core competencies:

▸ Patient Care

▸ Medical Knowledge

▸ Practice-Based Learning and Improvement

▸ Interpersonal and Communication Skills

▸ Professionalism

▸ Systems-Based Practice

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Disclosures

CONTRIBUTORS

Claudia Kawas, MD, Guest Editor

Professor of Neurology and Neurobiology & Behavior, University of California, Irvine, Irvine, California

*Dr Kawas serves on the data monitoring committees for Eli Lilly and Company and Quintiles Inc, and receives a research grant from Avid Radiopharmacuticals.

†Dr Kawas reports no disclosure.

Ammar A. Alobaidy, MD

Behavioral Neurology Fellow, University of Toronto, Toronto, Canada; Senior Specialist in Neurology, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman

*Dr Alobaidy reports no disclosure.

† Dr Alobaidy discusses the use of medications for the treatment of behavioral and psychiatric symptoms of dementia, none of which carry indications from the US Food and Drug Administration. The text cites reviews of clinical trials in frontotemporal degeneration as applicable, as well as case reports, but clinicians are urged to specify that any such use of medications should be openly discussed with patients and substitute decision makers as off-label prescriptions.

Virginia D. Buckles, PhD

Research Professor of Neurology and Executive Director of The Charles F. and Joanne Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St Louis, Missouri

*†Dr Buckles reports no disclosure.

Szófia S. Bullain, MD

Clinical Instructor and Geriatric Neurology Fellow, Department of Neurology, University of California, Irvine, Irvine, California

*Dr Bullain has received a travel scholarship from the Orange County Chapter of the Alzheimer’s Association to attend an international conference and receives grant support and other salary support from the National Institute on Aging.

† Dr Bullain reports no disclosure.

Anna D. Burke, MD

Geriatric Psychiatrist and Dementia Specialist, Banner Alzheimer’s Institute, Phoenix, Arizona

*Dr Burke reports no disclosure.

† Dr Burke discusses the unlabeled use of atypical antipsychotics, antidepressants, and anticonvulsants for the treatment of agitation in dementia.

Tiffany Chow, MD

Associate Professor of Neurology and Geriatric Psychiatry, University of Toronto, Toronto, Canada; Senior Scientist, Baycrest Rotman Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada

*Dr Chow has served as an independent medical examiner and medicolegal consultant to Lesser & Associates.

†Dr Chow discusses the use of medications for the treatment of behavioral and psychiatric symptoms of dementia, none of which carry indications from the US Food and Drug Administration. The text cites reviews of clinical trials in frontotemporal degeneration as applicable, as well as case reports, but clinicians are urged to specify that any such use of medications should be openly discussed with patients and substitute decision makers as off-label prescriptions.

Giovani Coppola, MD

Assistant Professor, Departments of Psychiatry and Neurology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California

*Dr Coppola receives or anticipates receiving grants, personal compensation, or other support from the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation, John Douglas French Alzheimer’s Association Foundation, Muscular Dystrophy Association, NIH, Takeda Pharmaceutical Company Limited, and Tau Consortium.

†Dr Coppola reports no disclosure.

María M. Corrada, ScM, ScD

Associate Adjunct Professor of Neurology, University of California, Irvine, Irvine, California

*Dr Corrada receives research support from the Alzheimer’s Association and the National Institute on Aging.

†Dr Corrada reports no disclosure.

Douglas Galasko, MBBCh

Professor, Department of Neurosciences, University of California, San Diego, San Diego, California; Chief, Neurology Service, VA Medical Center, San Diego, California

*Dr Galasko serves as a consultant for Elan Corporation and serves on the data and safety monitoring boards of Elan Corporation and Janssen Pharmaceuticals, Inc. Dr Galasko serves as an editor-in-chief of Alzheimer’s Research and Therapy.

†Dr Galasko reports no disclosure.

Philip B. Gorelick, MD, MPH, FAAN

Medical Director, Hauenstein Neuroscience Center, Saint Mary’s Health Care, Grand Rapids, Michigan; Professor, Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan

*Dr Gorelick has received personal compensation for activities with AstraZeneca/Quinteles; BrainsGate; Dendreon Corporation; Daiichi Sanko Co, Ltd; F. Hoffmann-La Roche Ltd/PAREXEL International Corporation; Forest Laboratories, Inc/Watermark Medical; and Takeda Pharmaceutical Company Limited. Dr Gorelick’s employer receives compensation for Dr Gorelick’s research work from Lundbeck and for Dr Gorelick’s service on the speakers’ bureau of Boehringer Ingelheim.

†Dr Gorelick discusses the unlabeled use of treatment of cardiovascular risk factors in the prevention of cognitive impairment and the unlabeled use of cholinesterase inhibitors for the treatment of vascular cognitive impairment.

Geri R. Hall, PhD, ARNP, GCNS, FAAN

Advanced Practice Nurse, Banner Alzheimer’s Institute, Phoenix, Arizona

*Dr Hall has served as an expert witness for a legal case regarding a resident care facility.

†Dr Hall reports no disclosure.

John Hart Jr, MD

Professor, University of Texas at Dallas, Dallas, Texas; Medical Science Director, University of Texas at Dallas Center for Brain Health, Dallas, Texas; Professor of Neurology and Psychiatry at the University of Texas Southwestern Medical Center, Dallas, Texas

*Dr Hart has served on the speakers bureau for Forest Laboratories, Inc, and as a medicolegal consultant.

†Dr Hart reports no disclosure.

Tina Hoang, MSPH

Staff Research Associate, Northern California Institute for Research and Education, San Francisco VA Medical Center, San Francisco, California

*†Ms Hoang reports no disclosure.

Keith A. Johnson, MD

Associate Professor of Radiology, Harvard Medical School, Boston, Massachusetts

*Dr Johnson serves as a consultant for Avid Radiopharmaceuticals, Bayer AG, Elan Corporation/Janssen Pharmaceuticals, Inc, GE Health Care, and Pfizer Inc. Dr Johnson has received honoraria and payment of travel expenses from Pfizer Inc; serves as an associate editor for the Journal of Neuroimaging; receives book royalties from Lippincott Williams & Wilkins; and receives research support from Alzheimer’s Association, Avid Pharmaceuticals, Bristol-Myers Squibb Company, Janssen Alzheimer Immunotherapy, NIH, and Pfizer Inc.

†Dr Johnson discusses the unlabeled potential future use of amyloid imaging in preclinical and prodromal stages of Alzheimer disease.

Oscar Lopez, MD

Director, University of Pittsburgh Alzheimer’s Disease Research Center, Professor of Neurology and Psychiatry, Chief, Behavioral and Cognitive Neurology Division, University of Pittsburgh, Pittsburgh, Pennsylvania

*Dr Lopez serves as a consultant for Lundbeck, Mertz, Lilly, and Baxter.

†Dr Lopez reports no disclosure.

Marc R. Nuwer, MD, PhD, FAAN

Chief of Clinical Neurophysiology, Hospital Department Head of Clinical Neurophysiology and Neurology, Brain Research Institute, University of California, Los Angeles, Los Angeles, California

*Dr Nuwer serves as a medical reviewer for SleepMed.

†Dr Nuwer reports no disclosure.

David Nyenhuis, PhD, ABPP

Director of Neuropsychology, Hauenstein Neuroscience Center, Saint Mary’s Health Care, Grand Rapids, Michigan; Associate Professor, Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan

*†Dr Nyenhuis reports no disclosure.

Aimee L. Pierce, MD

Assistant Clinical Professor, University of California, Irvine School of Medicine, Irvine, California

*Dr Pierce has received personal compensation for survey participation from LeadPhysician.

†Dr Pierce discusses the unlabeled use of donepezil, galantamine, and rivastigmine for the treatment of mild cognitive impairment, and the unlabeled use of quetiapine for the treatment of dementia-related psychosis.

Laura B. Powers, MD, FAAN

Dr Powers is retired from private practice.

*Dr Powers serves as ICD-9-CM Advisor for the Coding Subcommittee of the AAN Medical Economics and Management Committee and serves in an editorial capacity for Neurology: Clinical Practice.

*†Dr Powers reports no disclosure.

John M. Ringman, MD, MS

Associate Clinical Professor, Mary S. Easton Center for Alzheimer’s Disease Research at UCLA, University of California, Los Angeles, Los Angeles, California

*Dr Ringman serves as a consultant for Avanir Pharmaceuticals, Inc; Phloronol, Inc; Takeda Pharmaceutical Company Limited; and StemCells, Inc. Dr Ringman serves as site investigator for clinical trials sponsored by Alzheimer’s Disease Cooperative Study, Bristol-Myers Squibb Company, Elan Corporation; Genentech, Inc; Janssen Alzheimer Immunotherapy; Medivation, Inc; and Pfizer Inc.

†Dr Ringman reports no disclosure.

Lon S. Schneider, MD, MS

Professor of Psychiatry, Neurology, and Gerontology, Keck School of Medicine, University of Southern California, Los Angeles, California

*Dr Schneider has served on the scientific advisory boards of or has consulted for AC Immune; Accera, Inc; Allon Therapeutics, Inc; AstraZeneca; Baxter; Biogen Idec; Biotie Therapies; California Department of Justice; Elan Corporation; Eli Lilly Corporation; EnVivo Pharmaceuticals; Hoffmann-La Roche, Inc; Janssen Pharmaceuticals, Inc; Johnson & Johnson Services, Inc; Lundbeck, Merck & Co, Inc; Phloronol, Inc; Piramal Life Sciences; Takeda Pharmaceutical Company Limited; TauRx Ltd; Toyama Chemical Company, Ltd; and Zinfandel Pharmaceuticals, Inc. Dr Schneider and the University of Southern California have received research support from Baxter; Eli Lilly Corporation; Genentech, Inc; and TauRx Therapeutics. Dr Schneider has received grants from the NIH and the State of California.

†Dr Schneider discusses the unlabeled use of donepezil, galantamine, rivastigmine, and memantine. Information on drugs is provided for general purposes only and not relied on for prescribing. Before prescribing any of the drugs discussed, the physician should be knowledgeable about the full prescribing information that can be obtained from the manufacturers.

B. Joy Snider, MD, PhD

Associate Professor of Neurology, Washington University, St Louis, Missouri

*Dr Snider receives research support from Eli Lilly and Company for a clinical drug trial and anticipates serving as a site principal investigator and coinvestigator on such trials in the future.

†Dr Snider reports no disclosure.

Reisa A. Sperling, MD

Professor of Neurology, Harvard Medical School, Boston, Massachusetts; Director, Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, Massachusetts General Hospital, Boston, Massachusetts

*Dr Sperling serves as a consultant for Bayer AG; Biogen Idec; Bristol-Myers Squibb Company; Eisai Co, Ltd; Janssen Pharmaceuticals, Inc; Eli Lilly and Company; Merck & Co, Inc; Neurophage Pharmaceuticals; Pfizer Inc; Hoffman-La Roche Inc; and Satori Pharmaceuticals. Dr Sperling receives research support from Alzheimer’s Association, American Health Assistance Foundation, Bristol-Myers Squibb Company, Fidelity Foundation, Massachusetts Alzheimer’s Disease Research Center, and National Institute on Aging.

†Dr Sperling discusses the unlabeled potential future use of amyloid imaging in preclinical and prodromal stages of Alzheimer disease.

Pierre N. Tariot, MD

Director, Codirector Alzheimer’s Prevention Initiative, Banner Alzheimer’s Institute, Phoenix, Arizona; Research Professor of Psychiatry, University of Arizona College of Medicine, Phoenix, Arizona

*Dr Tariot has served as a consultant for Abbott Laboratories; AC Immune; Adamas Pharmaceuticals, Inc; Allergan, Inc; AstraZeneca; Avanir Pharmaceuticals, Inc; Avid Radiopharmaceuticals; Boehringer Ingelheim; Bristol-Myers Squibb Company; Eisai Co, Ltd; Elan Corporation; Eli Lilly and Company; Genentech, Inc; GlaxoSmithKline; MedAvante, Inc; Medivation, Inc; Merck & Co, Inc; Novartis AG; Otsuka Pharmaceutical Co, Ltd; Pfizer Inc; Sanofi-Aventis; Toyama Pharmaceutical Association; and Worldwide Clinical Trials, Inc. Dr Tariot holds stock options in Adamas Pharmaceuticals, Inc, recently forfeited options in MedAvante, Inc, and is a contributor to a patent titled “Biomarkers of Alzheimer’s Disease.” Dr Tariot receives research support from Abbott Laboratories; Alzheimer’s Association; Arizona Department of Health Services, AstraZeneca; Avid Radiopharmaceuticals; Bristol-Myers Squibb Company; Elan Corporation; Eli Lilly and Company; Genentech, Inc; GlaxoSmithKline; Medivation, Inc; Merck & Co, Inc; National Institute on Aging; National Institute of Mental Health; Pfizer Inc; and Toyama Pharmaceutical Association.

†Dr Tariot discusses the unlabeled use of cholinesterase inhibitors and memantine for people with dementia, as well as the unlabeled use of antipsychotics, antidepressants, and anticonvulsants. Information on drugs is provided for general purposes only and not relied on for prescribing. Before prescribing any of the drugs discussed, the physician should be knowledgeable about the full prescribing information that can be obtained from the manufacturers.

Jack W. Tsao, MD, DPhil, FAAN

Professor of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland

*Dr Tsao holds stock in Illumina and Biogen.

†Dr Tsao describes preliminary findings with genetic testing.

Kyle B. Womack, MD

Assistant Professor of Neurology and Neurotherapeutics and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas

*Dr Womack has received research support from Allon Therapeutics, Inc, and Bayer AG.

†Dr Womack reports no disclosure.

Kristine Yaffe, MD

Roy and Marie Scola Endowed Chair in Psychiatry; Professor of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, San Francisco, California

*Dr Yaffe serves on the data and safety monitoring boards for the National Institute on Aging and Takeda Pharmaceutical Company Limited; and receives grant support from the NIH, Alzheimer’s Association, American Health Assistance Foundation, the California Department of Public Health, and the US Department of Defense.

†Dr Yaffe reports no disclosure.

MULTIPLE-CHOICE QUESTION WRITERS

Douglas J. Gelb, MD, PhD, FAAN

Professor of Neurology, University of Michigan, Ann Arbor, Michigan

*†Dr Gelb reports no disclosure.

D. Joanne Lynn, MD, FAAN

Associate Dean for Student Life and Clinical Professor, Department of Neurology, The Ohio State University College of Medicine, Columbus, Ohio

*Dr Lynn holds stock or stock options greater than 5% of the company or more than $10,000 in value in Bristol-Myers Squibb Company and Hospira, Inc. Dr Lynn receives research support from Acorda Therapeutics; Allergan, Inc; Novartis AG; EMG Serono, Inc/Pfizer Inc; and Mt Sinai Medical Center.

*†Dr Lynn reports no disclosure.

*Relationship Disclosure

†Unlabeled Use of Products/Investigational Use Disclosure

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Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. Inis designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished faculty who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive CME and self-assessment offerings, including a self-assessment pretest, multiple-choice questions with preferred responses, and a patient management problem. For detailed instructions regarding Continuum CME and self-assessment activities, visit aan.com/continuum/cme.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

© 2013 American Academy of Neurology

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