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This is a memory disturbance without delirium or dementia It is usually associated with thiamine deficiency and chronic alcohol use (eg, Korsakoff s syndrome) There is an impairment in the ability to learn new information or recall previously learned information
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D Substance-Induced Hallucinosis
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This condition is characterized by persistent or recurrent hallucinations (usually auditory) without the other symptoms usually found in delirium or dementia Alcohol or hallucinogens are often the cause There does not have to be any other mental disorder, and there may be complete spontaneous resolution
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E Personality Changes Due to a General Medical Condition (Formerly Organic Personality Syndrome)
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This syndrome is characterized by emotional lability and loss of impulse control along with a general change in personality Cognitive functions are preserved Social inappropriateness is common Loss of interest and lack of concern with the
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cholinergic deficiency in Alzheimer s disease, research has focused on drugs to increase cholinergic activity by inhibiting cholinesterase Tacrine was the first reversible cholinesterase inhibitor approved by the FDA Three better-tolerated FDAapproved cholinesterase inhibitors are donepezil (5 10 mg at night), rivastigmine (3 6 mg twice daily), and galantamine (8 12 mg twice daily) Donepezil and galantamine doses need adjustment for liver disease, and the galantamine dose should be adjusted for renal failure They are thought to be efficacious in the short-term preservation of cognitive function and activities of daily living in mild to moderate dementia and, unlike tacrine, are not thought to be hepatotoxic Gastrointestinal side effects are common but may be least frequent with donepezil Further research continues to clarify the long-term efficacy of these medications on cognition and behavior None of the cholinesterase inhibitors to date are thought to slow disease progression An N-methyl-D-aspartate (NMDA) receptor antagonist, memantine, is the first medication approved by the FDA for the treatment of moderate to severe Alzheimer s disease Memantine may improve performance and cognition in some patients and has been used as an augmenting agent with the cholinesterase inhibitors Aggressiveness and rage states in central nervous system disease can be reduced with lipophilic -blockers (eg, propranolol, metoprolol) in moderate doses Since the serotonergic system has been implicated in arousal conditions, drugs that affect serotonin have been found to be of some benefit in aggression and agitation Included in this group are lithium, trazodone, buspirone, and clonazepam Dopamine blockers (eg, the neuroleptic drugs such as haloperidol) have been used for many years to attenuate aggression Atypical neuroleptics may have a role in selected geriatric patients; however, there are reports of increased mortality in some studies related to the use of atypical neuroleptics in this population There are also recent reports of reduced agitation in Alzheimer s disease from carbamazepine, 100 400 mg/d orally (with slow increase as needed) Emotional lability in some cases responds to small doses of imipramine (25 mg orally one to three times per day) or fluoxetine (5 20 mg/d orally); depression, which often occurs early in the course of Alzheimer s dementia, responds to the usual doses of antidepressant drugs, preferably those with the least anticholinergic side effects (eg, SSRIs and MAO inhibitors) Cerebral vasodilators were originally used on the assumption that cerebral arteriosclerosis and ischemia were the principal causes of the dementias Although there is a slight reduction of blood flow in primary degenerative dementia (probably as a result of the basic disorder), there is no evidence that this is a major factor in this group of disorders or that vasodilators are of value Ergotoxine alkaloids (ergoloid mesylates: Hydergine, others) have been studied with mixed results; improvement in ambulatory self-care and depressed mood has been noted, but there has been no improvement of cognitive functioning on any standardized tests Hyperbaric oxygen treatment has not produced significant improvement Stimulant drugs (eg, methylphenidate) do not change cognitive function but can improve affect and mood, which helps the caretakers cope with the problem Failing sensory functions should be supported as necessary, with hearing aids, cataract surgery, etc
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