[Dementia. Outlook on current developments].

Abstract

The results of recent neuropathologic and genetic studies in Alzheimer's disease led to a renewed interest in differentiations within the dementia syndrome. New disease-entities can be distinguished (Lewy Body Dementia, Frontal Lobe Dementia) and other criteria have been put forward for vascular dementia. Hachinski's Ischemic Score, for many years the diagnostic criterium for vascular dementia, has been cancelled. Instead a CT- or MRI scan must demonstrate the vascular pathology in the brain. For clinical practice, the differentiation between cortical and subcortical dementia is still important. For reasons of management it appears useful to distinguish between early-onset and late-onset Alzheimer's disease. The amyloid cascade hypothesis for the pathogenesis of Alzheimer's disease is credible for the early-onset as well as the late-onset type, because results from epidemiological as well as from neurobiological studies might be fit in. Moreover, this hypothesis is promising from the point of view of developing specific therapies. Finally, the breakdown of the dementia syndrome in separate disease-entities stimulated interest in the psychiatric symptoms in these patients and activated the development of rational and symptomatic therapeutics.