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Diagnosis and treatment of cognitive impairment

Diagnose und Behandlung kognitiver Störungen

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Abstract

As a result of the aging population dementia is a growing challenge, especially in healthcare. Nevertheless, cognitive disorders are often not systematically evaluated, especially during hospital stays for other reasons; however, cognitive impairment is associated with a number of geriatric syndromes, including falls, delirium, dysphagia and lack of adherence to treatment plans. This article considers the current state of diagnosis and treatment of dementia. Non-pharmacological therapeutic approaches as well as current and future pharmacological treatment options are discussed. The drugs of choice for the symptomatic treatment of cognitive deficits in Alzheimer’s disease and Parkinson-associated dementia are cholinesterase inhibitors and memantine; there is no specific pharmacological treatment for other types of dementia. Prevention and treatment of cardiovascular risk factors can potentially retard the progression of possibly all forms of dementia.

Zusammenfassung

Demenzen sind durch die demographische Entwicklung eine wachsende Herausforderung. Trotzdem werden kognitive Störungen oft nicht systematisch evaluiert, insbesondere bei Krankenhausaufenthalten anderer Ursache. Kognitive Beeinträchtigung geht jedoch mit einer Reihe geriatrischer Syndrome, wie z. B. Stürze, Delir, Dysphagie, mangelnder Compliance und Einhaltung von Behandlungsplänen, einher. Dieser Artikel setzt sich mit dem aktuellen Stand von Diagnostik und Therapien bei Demenzen auseinander. Es werden sowohl nichtpharmakologische Therapieansätze als auch derzeitige und zukünftige pharmakologische Behandlungsmöglichkeiten erörtert. Die Wirkstoffe der Wahl zur symptomatischen Behandlung bei der Alzheimer-Demenz und bei Parkinson-assoziierten Demenzen sind Cholinesteraseinhibitoren und Memantin. Eine spezifische pharmakologische Behandlung bei den anderen Demenzformen besteht nicht. Die konsequente Therapie und Einstellung von kardiovaskulären Risikofaktoren dürfte das Fortschreiten von möglicherweise allen Demenzformen verlangsamen.

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Authors and Affiliations

  1. Clinic for Neurogeriatrics and Neurological Rehabilitation, RKU, University and Rehabilitation Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany

    Christine A. F. von Arnim MD & Jill Holbrook

  2. Department of Neurology, University of Kiel, Kiel, Germany

    Thorsten Bartsch & Philipp Bergmann

  3. Geriatrics, Johanniter Krankenhaus, Bonn, Germany

    Andreas H. Jacobs

  4. University Clinic of Geriatric Medicine, Oldenburg University, Oldenburg, Germany

    Tania Zieschang

  5. Ageing Clinical Research, Dpt. II Internal Medicine, University Hospital of Cologne, Cologne, Germany

    M. Cristina Polidori

  6. Geriatric Medicine, University Duisburg-Essen, Essen, Germany

    Richard Dodel

Authors
  1. Christine A. F. von Arnim MD
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  2. Thorsten Bartsch
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  3. Andreas H. Jacobs
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  4. Jill Holbrook
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  5. Philipp Bergmann
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  6. Tania Zieschang
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  7. M. Cristina Polidori
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  8. Richard Dodel
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Corresponding author

Correspondence to Christine A. F. von Arnim MD.

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Conflict of interest

C.A.F. von Arnim received honoraria from serving on the scientific advisory board of Nutricia GmbH (2014) and Honkong University Research Council (2014) and has received funding for travel and speaker honoraria from Nutricia GmbH (2014–15), Lilly Deutschland GmbH (2013–2016), Desitin Arzneimittel GmbH (2014), Biogen (2016–2018), Roche (2017–2018) and Dr. Willmar Schwabe GmbH &Co. KG (2014–2015). T. Bartsch, A.H. Jacobs, J. Holbrook, P. Bergmann, T. Zieschang, M.C. Polidori and R. Dodel declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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von Arnim, C.A.F., Bartsch, T., Jacobs, A.H. et al. Diagnosis and treatment of cognitive impairment. Z Gerontol Geriat 52, 309–315 (2019). https://doi.org/10.1007/s00391-019-01560-0

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  • DOI: https://doi.org/10.1007/s00391-019-01560-0

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