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Possibilities for the prevention and treatment of cognitive impairment and dementia

  • David Burke (a1), Ian Hickie (a2), Michael Breakspear (a3) and Jürgen Götz (a4)

Summary

The human brain has a remarkable capacity for plasticity, but does it have the capacity for repair and/or regeneration? On the basis of controversial new evidence we speculate that the answer may be ‘yes', and suggest that clinicians should therefore approach cognitive impairment and dementia with a new, cautious optimism.

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Copyright

Corresponding author

Dr David Burke, St Vincent's Hospital, 299 Forbes Street, Darlinghurst, NSW 2010. Australia. Tel: +612 8382 1800; fax: +612 8382 1802; email: dburke@stvincents.com.au

Footnotes

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Declaration of interest

None.

Footnotes

References

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Possibilities for the prevention and treatment of cognitive impairment and dementia

  • David Burke (a1), Ian Hickie (a2), Michael Breakspear (a3) and Jürgen Götz (a4)
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eLetters

Delirium as a preventable factor for dementia

David J Meagher, Psychiatrist
20 June 2007

Sir,

Burke and colleagues (2007) provide a stimulating overview of emerging ideas for prevention and treatment of cognitive impairment and dementia. They highlight the potential value of medical interventions for smoking, hypertension, and depression. A further population that warrant consideration due to the elevated risk for dementia are patients experiencing delirium. Although delirium can represent the first visible evidence of a previously silent dementia, substantial emerging evidence suggests that it is more than just a harbinger of pre-existing cognitive impairment and may contribute to dementia by aggravating course and accelerating the progression of cognitive impairment. These observations are supported by the markedly elevated frequency of subsequent dementia inpatients that experience delirium, including a range of studies where formal testing prior to delirium did not reveal cognitive impairment (see Trzepacz and Meagher, 2007 for review). Although the mechanisms for this overlap remain unclear, gathering evidence points to similar neurophysiological, neurochemical, and neuroinflammatory disruptions in these conditions (de Rooij et al, 2007). Other work indicates that carefully tailored drug and non-pharmacological management can reduce delirium severity and is associated with better six-month cognitive outcomes (Pitkala et al, 2006). Delirium is thus emerging as another important target for efforts to improve cognitive outcomes in older patients but better detection and greater consensus as to optimal management is needed if we are to prevent the transition into dementia that follows many cases of delirium.

Burke D, Hickie I, Breakspear M. Gotz J (2007). Possibilities for theprevention and treatment of cognitive impairment and dementia. British J psychiatry 190:371-2.

De Rooij SE, van Munster BC, Kerevaar JC, Levi M (2007). Cytokines and acute phase response in delirium. J Psychosomatic Res 62:521-5.

Pitkala K, Laurila JV, Strandberg TE, Tilvis RS (2006). Multicomponent intervention for elderly inpatients with delirium: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci 61:176-81.

Trzepacz PT, Meagher DJ. Delirium. Textbook of Neuropsychiatry (fifthEdition). Eds Yudofsky S, Hales R. American Psychiatric Press, 2007.
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Conflict of interest: None Declared

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