Preface Alzheimer and the Dementias
John M. Ringman, MD, MS Editor
It is a very exciting time to be working with patients presenting with cognitive impairment and other symptoms indicating the presence of neurodegenerative illness. Though medical treatments for this group of disorders are currently limited, in the last 20 years, there has been an explosion of knowledge regarding their pathogenesis, which has led to new, more specific, diagnostic techniques and a refinement of our ability to test putative disease-modifying agents. It is an honor to edit the current issue of Neurologic Clinics in which experts have summarized current knowledge in diverse aspects of these conditions for the practicing neurologist and other clinicians. Here, leaders in the field update the reader on scientific progress underlying disease mechanisms in Alzheimer disease (AD) and characterize both early- and late-onset forms of AD, cognitive impairment associated with cerebrovascular disease, in the context of Lewy body disease, and the frontotemporal lobar degenerations (FTLDs). Overviews of the approach to cognitive assessment in general and the clinical and cognitive assessment of Hispanics, a growing segment of the US population, are presented. The specific and growing roles of neuroimaging in the assessment of cognitively impaired patients are also discussed. We believe readers will find that this issue enhances their approach to patients and families suffering from this devastating group of diseases. Of course, additional important topics in dementia have been necessarily omitted. It is particularly difficult to comprehensively discuss our rapidly evolving knowledge regarding the genetic influences in AD and other neurodegenerative diseases. The reader should be aware that our growing knowledge of the diverse number of genetic variants. For a review, readers are referred to a recent article authored by leaders of the Alzheimer’s Disease Genetic Consortium1 and to Web sites in which AD risk variants are frequently updated (http://www.alzgene.org) and autosomal dominant mutations for AD and FTLD are catalogued (http://www.molgen.ua.ac.be/admutations/). To date, the most clinically relevant genetic influence in late-onset AD is the ε4 allele of the APOE gene, but there is still not consensus on the utility of such testing in most
Neurol Clin 35 (2017) ix–x http://dx.doi.org/10.1016/j.ncl.2017.02.001 0733-8619/17/ª 2017 Published by Elsevier Inc.
contexts. As this situation is evolving, it is important to explore the utility, feasibility, and social context of such testing, an area under active study.2 The current volume does not include a section devoted to treatment of the cognitive or behavioral symptoms of the dementias. The reader is referred to recent reviews regarding such pharmacological and non-pharmacological interventions.3,4 Finally, in light of our current inability to halt or significantly reverse the diverse cognitive and behavioral manifestations of dementing illnesses, a comprehensive and multidisciplinary approach to such patients is indicated. The interested reader is referred to current guidelines regarding management5 and reviews focusing on caregivers6 and end-of-life care.7 With such multidisciplinary approaches, teams of health care providers can make a significant impact on persons and families affected by this growing public health crisis. John M. Ringman, MD, MS Department of Neurology Keck School of Medicine of USC Center for the Health Professionals 1540 Alcazar Street, Suite 209F Los Angeles, CA 90033, USA E-mail address: [email protected]
1. Naj AC, Schellenberg GD. Alzheimer’s Disease Genetics C. Genomic variants, genes, and pathways of Alzheimer’s disease: an overview. Am J Med Genet B Neuropsychiatr Genet 2017;174:5–26. 2. Roberts JS, Christensen KD, Green RC. Using Alzheimer’s disease as a model for genetic risk disclosure: implications for personal genomics. Clin Genet 2011;80: 407–14. 3. Ihl R, Bunevicius R, Frolich L, et al. World Federation of Societies of Biological Psychiatry guidelines for the pharmacological treatment of dementias in primary care. Int J Psychiatry Clin Pract 2015;19(1):2–7. 4. Gauthier S, Cummings J, Ballard C, et al. Management of behavioral problems in Alzheimer’s disease 2010;22:346–72. 5. Segal-Gidan F, Cherry D, Jones R, et al. California Workgroup on Guidelines for Alzheimer’s Disease M. Alzheimer’s disease management guideline: update 2008. Alzheimers Dement 2011;7:e51–9. 6. Parkinson M, Carr SM, Rushmer R, et al. Investigating what works to support family carers of people with dementia: a rapid realist review. J Public Health (Oxf) 2016. [Epub ahead of print]. 7. Murphy E, Froggatt K, Connolly S, et al. Palliative care interventions in advanced dementia. Cochrane Database Syst Rev 2016;(12):CD011513.