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How Neuroscience Explains Age-related Changes in Cognition: Implications for the Early Diagnosis of Dementia
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Criteria for Alzheimer’s disease and preclinical dementia have been proposed recently, which include potential biomarkers of the illness.
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9/1/2010
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Prevention of Dementia and Cognitive Decline: Notes from the NIH-State-of-the-Science Conference
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The National Institutes of Health-State-of-the-Science Conference on “Preventing Alzheimer’s Disease and Cognitive Decline” sought to review the available evidence and provide carefully reasoned recommendations.
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6/23/2010
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Proposed Revisions for the Diagnostic Categories of Dementia in the DSM-5
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The DSM-5 proposes four major changes for the cognitive disorders listed in the DSM-IV-TR as delirium, dementia, and amnestic disorders. These include dropping the term “dementia” entirely, adding a new diagnostic category titled “minor neurocognitive disorder,” and explicitly categorizing the syndromes of psychosis and depression previously described for Alzheimer’s disease but not mentioned in the DSM-IV.
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4/28/2010
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Do the Longevity Genes Prevent Dementia?
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The most common heritable dementias, familial Alzheimer’s disease and Huntington’s disease, exhibit an early age of onset and have a well described genetic profile. Genetic testing can inform family members of their risk status with near certainty.
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3/9/2010
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Sex and Mental Health in Old Age
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Sexual activity declines in late life but the cause has as much to do with illness and social circumstances as with the physiology of aging.
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1/8/2010
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Mental Health Services for Holocaust Survivors: Notes from the 2009 Professional Exchange to Israel
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The development of dementia and depression, the progressive loss of family members and of self reliance, and the possibility of nursing home placement are major threats to many older people.
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12/11/2009
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Notes from the 13th Annual Einstein Symposium on the Comprehensive Approach to Dementia
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On March 5, 2009, >250 healthcare practitioners gathered at the New York Academy of Medicine to participate in the 13th Annual Einstein Symposium on the Comprehensive Approach to Dementia. What follows is a synopsis of the presentations.
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6/2/2009
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Parkinson’s Disease and Dementia
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Parkinson’s disease affects as many as 1 million Americans and with advanced age is complicated by dementia in a majority of cases. However, the recognition of cognitive impairment in Parkinson’s disease is made complicated by the predominance of motor symptoms and a neuropsychiatric profile that differs from the more common dementia of the Alzheimer’s type.
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4/3/2009
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“Cadaver Conference Day”: A Psychiatrist in the Gross Anatomy Course
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Numerous medical schools in the United States and abroad have determined that anatomy taught through cadaver dissection is untenable. Concerns for cost effectiveness, educational efficacy, the shortage of trained anatomist teachers, the increasing demand for cadavers, and pressure to convert dissection rooms to research laboratories, all argue for minimizing or eliminating cadaver dissection.
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1/7/2009
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Recent Advances in Dementia Research
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Recent reports from the 2008 International Conference on Alzheimer’s Disease and numerous articles indicate substantial progress in the diagnosis and treatment of Alzheimer’s disease. However, the progress was partially a result of two well-designed anti-amyloid studies with disappointing results.
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10/30/2008
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Geriatric Psychiatry and Cardiology: New Perspectives on Heart, Brain, Mood, and Cognition
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The influence of depressive disorders on cardiac morbidity and mortality is widely accepted and bolstered by an array of established mechanisms through which mood disorders might be the antecedent or aftermath of heart disease. However, interventions to reduce the influence have not had dramatic impact. A close examination of recent studies may explain why.
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8/25/2008
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Advances in the Treatment of Late-Life Psychotic Depression
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The evidence base supporting the treatment of psychotic depression among older adults is scant. Although the consensus regarding the best therapeutic opinion favors electroconvulsive therapy, most patients, their families, and practitioners will exhaust medication alternatives first.
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6/26/2008
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Targets for Telephone-Based Behavioral Health Interventions
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A growing body of evidence supports the efficacy and cost effectiveness of psychotherapy and disease management for mental illness provided over the telephone. However, telephone behavioral health care is not reimbursable under present Center for Medicare and Medicaid Services standards.
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4/29/2008
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Bipolar Disorder in Late Life: Depression
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Treatment of bipolar depression is both a challenge and a paradox. It is a challenge because persistent disability and recurrence are common, and a paradox because antidepressants appear to be counterproductive.
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2/25/2008
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Bipolar Disorder in Late Life: Mania
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Pharmacologic and psychosocial treatment options for mania have improved substantially as evidenced by the volume of expert opinion, guidelines, meta-analyses and reports from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study
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12/27/2007
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From Symptom Palliation to Disease Modification: Implications for Dementia Care
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Present treatments for dementia are largely palliative, providing symptomatic but temporary improvement. In contrast, agents that promise disease modification offer the hope of prevention, arrest, or deceleration of decline. However, enthusiasm for these new agents must be tempered by acknowledgment of their inevitable limitations within the present standard dementia care
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10/29/2007
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Prevention of Depression: Immediate Need But Distant Horizon
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Depression is a leading cause of disability-adjusted life years lost and projected to be more so within a generation. Mood disorders were implicated in 10% of all hospitalizations in 2004. Despite major advances in depression-care management, there is little expectation that health policy will generate the necessary number of mental health providers to meet the need.
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8/29/2007
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Insomnia in Late Life: New Perspectives on an Old Problem
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Insomnia is a pervasive complaint among older Americans, so much so that many assume advanced age is inevitably linked wih disturbed sleep. Nevertheless, a growing body of evidence indicates that disease burden, medication effect, inactivity, and poor sleep habits rather than age are the major contributors to sleep disorders. As a result, proper diagnosis and modification in patient sleep habits can frequently prevent the need for pharmacologic intervention.
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6/25/2007
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Exercise, Aging, and Mental Health
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he evidence supporting the physical and mental health benefits of exercise across the life span is compelling. Similarly, studies of successful efforts to promote increased physical activity have evolved across the range of older adult venues both community and institutionally based. However, changes in activity habits are not easily achieved. Aging successfully is to a large extent the result of how hard one works at it.1 What follows is a brief review of the benefits of physical activity for mental health in late life with specific recommendations on effective exercise prescriptions for older adults.
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3/27/2007
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Reducing the Risk of Late-Life Suicide Through Improved Depression Care
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On September 14th, 2006, the United States Senate Special Committee on Aging conducted a hearing titled, “Generation at Risk: Breaking the Cycle of Senior Suicide,” in which chairman Smith called late-life suicide an epidemic. Both Senator Gordon H. Smith and colleague Senator Herb Kohl emphasized the contribution of mental illness, specifically depression, as a preventable cause of suicide among older Americans.
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12/27/2006
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The Sequenced Treatment Alternatives to Relieve Depression Studies: How Applicable are the Results for Older Adults?
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Reports emerging from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study promise an enormous advance in the treatment of depression both in primary care and mental health settings. The results would seem to apply, with minor reservations, to older adults with depressive disorders. A brief review of the study subjects, measures, methods, and outcomes follows to describe the strengths and limitations.
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10/27/2006
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The Assessment of Executive Dysfunction: Importance for Diagnosis and Prognosis
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Executive cognitive function is an interrelated set of abilities that includes cognitive flexibility, concept formation, and self-monitoring. Frontal subcortical brain changes associated with vascular disease, late-onset depression, frontal dementia, or advanced Alzheimer’s disease (AD) are among the most common causes of executive dysfunction in late life. With impaired executive dysfunction, instrumental activities of daily
living, such as paying bills, shopping, medication management, and driving, may be beyond the person’s capacity despite only mild memory impairments. The person’s capacity to exercise self-control and to direct others to provide care may also be diminished.1 Executive dysfunction is one element in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition2 criteria for the diagnosis of dementia and occurs in all dementing diseases. Executive dysfunction may be a more robust predictor of nursing home admission than memory impairment.3
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10/19/2006
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Addressing Medical Futility Without
the Hippocratic Pitfall of Paternalism
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The improvement of life-saving treatments has lead to an expansion of both choice and conflict. Since the end of World War II, the balance of power in medicine has shifted from physician to patient to managed care organization and from paternalism to bureaucratic parsimony,1 and created an entirely new set of disputes in the field.2 The concept of medical futility is one such area where dispute is likely and where
psychiatrists have a role to play.
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10/1/2006
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Naturally Occurring Retirement Communities: An Expanding Opportunity for Health Promotion and Disease Prevention
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Although mental illness may be the major threat to the independence of seniors, health-promoting environments found in some naturally occurring retirement communities may be a low-cost community-based means of sustaining both the health and well being of older Americans. Efforts to link biomedical and psychosocial services within naturally occurring retirement communities (NORCs) have been promoted to help seniors age in their homes, with optimal health and independence.
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8/6/2006
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Missing Elements in the Treatment of Depression and Dementia
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Pharmacologic treatments for depression and dementia have advanced substantially. Nonetheless, the full realization of their therapeutic promise remains unfulfilled, and in some cases is controversial. What follows is a brief review of recent innovations which, if proven efficacious, may move existing and emerging therapies incrementally closer to full effectiveness.
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6/7/2006
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Addressing the Unmet Promise of Antidepressant Trials in Older Adults
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Progress toward reducing the burden of depressive disorders among seniors remains incremental despite advances in symptom assessment, pharmacology, psychotherapy, and service delivery. The pace with which treatment is advancing seems to be decelerating
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2/23/2006
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