Dr Elizabeth C. Finger has brought together a remarkable group of world-class experts to help each of us answer the many clinically relevant questions that arise daily in our assessment and care of patients with [dementia].
This issue of Continuum is devoted to the diagnosis and management of our patients with dementia. To accomplish this goal, Dr Elizabeth C. Finger has brought together a remarkable group of world-class experts to help each of us answer the many clinically relevant questions that arise daily in our assessment and care of patients with these illnesses.
The issue begins with the article by Drs Murray Grossman and David J. Irwin, who provide their comprehensive approach to the examination and assessment of patients with a suspected neurodegenerative dementia—an approach we can all emulate in our practices. Dr Ronald C. Petersen discusses mild cognitive impairment, including the evolution and continued relevance of this diagnostic construct and the importance of its clinical recognition as a predementia state of neurodegenerative disorders (not just Alzheimer disease [AD]) as well as treatable nondegenerative conditions. Dr Liana G. Apostolova next reviews the current state of the art in diagnosis and management of our patients with AD.
Dr Stephen N. Gomperts reviews the most current diagnostic and pathophysiologic considerations in the management of dementia with Lewy bodies and Parkinson disease dementia, which together form the Lewy body dementias. The diagnosis and management of frontotemporal dementia is the focus of the subsequent article by Dr Finger, who, similarly to each of the other authors in this issue, addresses the questions that many of us have as we encounter patients who may have these disorders, especially as we attempt to differentiate the various forms of frontotemporal dementia from the other dementing disorders. Dr Eric Smith next reviews vascular cognitive impairment, a common and potentially treatable cause (or contributor) to cognitive impairment, and emphasizes that the condition often coexists with other pathologic causes of dementia.
Dr Michael D. Geschwind next reviews the state of the art in the diagnosis and management of the many causes of rapidly progressive dementias in an article that serves as a companion to his recent contribution to the Neuroinfectious Disease issue of Continuum that focused on Jakob-Creutzfeldt disease. Fittingly, the next article by Dr Andrew McKeon focuses on the diagnosis and management of the remarkably quickly evolving spectrum of autoimmune encephalopathies and dementias.
Dr Deborah L. Renaud reviews the clinical, genetic, and imaging characteristics of the adult-onset leukoencephalopathies, which, although individually rare, are conditions that need to be considered by adult neurologists in the appropriate clinical and imaging context and are important to include in our Continuum curriculum (so that we will recognize them when they do walk into our offices).
Drs Michael A. Williams and Jan Malm provide their modern approach to the diagnosis and treatment of idiopathic normal pressure hydrocephalus and the important role neurologists play in diagnosis and follow-up of this treatable cause of cognitive (and gait and urinary) dysfunction. In the final review article in this issue, Dr Chiadi U. Onyike discusses the complex interface between the psychiatric and neurologic aspects of dementia.
In the Ethical Issues article, Drs Serge Gauthier, Pedro Rosa-Neto, and Joseph S. Kass discuss the ethical considerations that may arise in the use of (theoretical) next-generation AD drugs in symptomatic and at-risk patients. In the Practice Issues article, Dr Amy E. Sanders discusses the important issue of caregiver stress and the patient with a dementing disorder. Drs Bruce H. Cohen and Peter D. Donofrio then review the many considerations that neurologists need to be aware of with regard to diagnosis and Evaluation and Management coding when seeing patients with dementia.
As with all issues of Continuum, a number of opportunities exist for CME. By taking the Postreading Self-Assessment and CME Test, written by Drs Douglas J. Gelb and Joseph E. Safdieh, after reading the issue, you may earn up to 12 AMA PRA Category 1 CreditsTM toward self-assessment and CME. The Patient Management Problem, written by Dr Finger, describes the case of a 57-year-old man who presents with progressive memory problems, executive dysfunction, and navigational difficulty. By following this case and answering multiple-choice questions corresponding to diagnostic and management decision points along the course of his disorder, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
I want to thank Dr Finger for all of the work she put into the creation of this expertly written and organized issue of Continuum and for her remarkable devotion and responsiveness to all of the critical details that arise from the conception of an issue until its publication. I would also like to thank each of our internationally expert authors for providing state-of-the art information to help us answer the important clinical questions that arise in our encounters with patients with dementing illnesses.
—Steven L. Lewis, MD, FAAN