Vol 5 n° 1 - Dementia
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Neuropsychiatric disorders constitute the largest class of illness causing disability to mankind and, within these, the dementias have emerged as a subgroup of the great- est epidemiological magnitude. The current issue of Dia- logues in Clinical Neuroscience endeavors to present per- spectives on key issues in the diagnosis and treatment of the dementias. In the State of the art, Ramit Ravona-Springer, Michael Davidson, and Shlomo Noy (page 7) discuss the polemics of the distinction between Alzheimer’s disease (AD) and vascular dementia. They suggest various cardiovascular mechanisms that may contribute to the overlap between the dementias, and discuss the implications for diagno- sis and treatment. Two Basic research articles appear in this issue. The first article, which is contributed by Ya-Ping Tang and Elliot S. Gershon (page 17), reviews genetic studies in AD. It extensively covers the role of the three genes (APP, PS1, and PS2) that have been incriminated as being causative of AD. It also postulates the various polymorphic mech- anisms that are emerging as significant in the pathogen- esis of AD. In the Basic research second article, Christoph Hock (page 27) depicts the role of abnormal protein aggre- gates in the biochemistry of dementia. He speculates on the therapeutic targets that are likely to result from the decryption of the processes of protein deposition in the brain. The efficacious treatment of AD is one of the most chal- lenging tasks of modern medicine. In his Pharmaco- logical aspects article, Alistair Burns (page 35) delin- eates the role of the array of anticholinesterases as well as  alternative  agents,  such  as  N-methyl-D-aspartate (NMDA) receptor antagonists, in alleviating the cognitive impairment that is the hallmark of AD. The decision tree in the diagnosis of dementia by Julie Loebach Wetherell and Dilip V. Jeste in the Poster (page 44) brings to the busy clinician’s office the algorithm for sifting through the diagnostic uncertainties that con- found the dementias. The issue thus integrates epi- demiological, methodological, genetic, biochemical, diagnostic, and therapeutic aspects of the dementias in a manner that should be useful to researchers and clin- icians alike. Five articles in Clinical research cover diagnostic and historical aspects of dementia. In the first, Franz Müller- Spahn (page 49) highlights the behavioral disturbances that are prominent in dementia and discusses the com- plex  interaction  between  the  cognitive  deficits  and behavioral abnormalities. The article covers the underly- ing biochemical mechanisms, diagnostic issues, and therapeutic strategies in the management of these dis- orders. Christian Gilles negotiates through the hazy territory of mild cognitive deficits (page 61). The article lends clari- ty to the blur between optimal and pathological aging, and contributes toward the goal of offering early treat- ment to patients whose dementias are in early stages of progression. Keith A. Wesnes and John E. Harrison critically review the instruments used in diagnosing dementias and the implicit regulatory considerations (page 77). They advo- cate the use of automated cognitive tests in early diag- nosis. Structural and functional imaging has become an inte- gral element in the diagnosis of AD. Daniel E. Wollman and Isak Prohovnik examine the sensitivity and specifici- ty of various neuroimaging modalities (page 89). They focus on the greater accuracy of neuroimaging com- pared with clinical diagnosis, and discuss the limitations as well as indications of resorting to the imaging tech- nologies. Finally, Hanns Hippius and Gabriele Neundörfer narrate Alois Alzheimer’s role in the eponymous disorder (page 101). The tale incorporates the elements of curiosity, clinical excitement, politics, and delayed recognition, which are frequently the ingredients of many epic con- tributions in medicine. 5 I n   t h i s   i s s u e . . . Rajesh M. Parikh, MD