Memory Loss Alzheimers Disease and Dementia A Practical Guide For Clinicians 3Rd Edition Andrew E Budson MD Full Chapter

Memory Loss, Alzheimer's Disease and
Dementia: A Practical Guide for

Clinicians 3rd Edition Andrew E.
Budson Md
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Memory Loss, Alzheimer’s
Disease, and Dementia
A Practical Guide for Clinicians
THIRD EDITION
Andrew E. Budson, MD
Neurology Service, Section of Cognitive & Behavioral Neurology, Veterans
Affairs Boston Healthcare System, Boston, MA
Alzheimer’s Disease Research Center & Department of Neurology, Boston
University School of Medicine, Boston, MA
Harvard Medical School, Boston, MA
The Boston Center for Memory, Newton, MA
Paul R. Solomon, PhD

Department of Psychology, Program in Neuroscience, Williams College,
Williamstown, MA
The Boston Center for Memory, Newton, MA
Table of Contents
Title page
Any screen, Any time, Anywhere
Copyright
Praise for the First Edition
Praise for the Second Edition
Preface to the Third Edition
How To Use This Book
Acknowledgments
Disclosures
About the Authors
Video Table of Contents

Section I: Evaluating the Patient With Memory Loss or
Dementia
1. Why Diagnose and Treat Memory Loss, Alzheimer’s Disease, and

Dementia?
Helping the Patient
Helping the Family or Other Caregiver
Saving Money
Planning for the Future
Quality Versus Quantity
References
2. Evaluating the Patient With Memory Loss or Dementia
Talking With The Family
In the Clinic
At the Bedside
History
Review of Systems
Medical History
Allergies to Medications
Social History
Family History
Physical Examination
Cognitive Tests and Questionnaires
Screening in the Clinic
Laboratory Studies
Structural Imaging Studies
Functional Imaging Studies
Tests that Suggest Alzheimer’s Disease
Summary
References
3. Subjective Cognitive Decline, Mild Cognitive Impairment, and

Dementia
A Three-Step Approach
The Spectrum of Cognitive Changes
Is Dementia Present?
Is Mild Cognitive Impairment Present?
Is Subjective Cognitive Decline Present?
Which Clinical Syndrome is Present?
What is the Underlying Pathology?
References
Section II: Differential Diagnosis of Memory Loss and
Dementia
4. Alzheimer’s Disease
Prevalence, Prognosis, and Definition
Alzheimer’s Pathology
Neurochemistry
Diagnostic Criteria
Risk Factors, Pathology, and Pathophysiology
Common Signs, Symptoms, and Stages
Things to Look for in the History
Things to Look for on the Physical and Neurological Examination
Pattern of Impairment on Cognitive Tests
Laboratory Studies
Molecular and Functional Imaging Studies
Differential Diagnosis
Treatments
References
5. Primary Age-Related Tauopathy

Prevalence, Pathology, Genetics, and Definition
Clinical Features, History, and Pattern of Impairment on Cognitive

Tests
Laboratory Studies
Functional and Molecular Imaging Studies
Treatments
References
6. Limbic-predominant Age-related TDP-43 Encephalopathy
Clinical Diagnosis
Pathology, Pathophysiology, and Genetics
Laboratory Studies

Treatments
References
7. Vascular Cognitive Impairment and Vascular Dementia
Criteria
Laboratory Studies
Treatments (see also Table 7.1)
References
8. Dementia With Lewy Bodies

Criteria and Diagnosis
Laboratory, Sleep, and Electroencephalography Studies
Treatments (Table 8.2)
References
9. Primary Progressive Aphasia and Apraxia of Speech
Prevalence, Definition, and Pathology
Criteria
Common Signs, Symptoms, and Stages (Table 9.2)

Structural and Functional Imaging Studies
Treatments
References
10. Behavioral Variant Frontotemporal Dementia
Criteria
Common Signs, Symptoms, and Stages (Video 10.1)
Laboratory Studies
Treatments
References
11. Posterior Cortical Atrophy

Prevalence, Definition, and Pathology
Criteria
Treatments
References
12. Progressive Supranuclear Palsy
Terminology
Criteria and Diagnosis
Things to Look for in The History
Things to Look for on The Physical and Neurological Examination
Pattern of Impairment on Cognitive Tests (Videos 12.6–12.8Video

12.6Video 12.7Video 12.8)
Laboratory Studies
Treatments
References
13. Corticobasal Degeneration and Corticobasal Syndrome
Criteria

(Videos 13.6 and 13.7)
Laboratory Studies
Treatments
References
14. Normal Pressure Hydrocephalus
Criteria
Lumbar Puncture
Other Studies
Differential Diagnosis and Comorbid Disorders
Treatments
References
15. Chronic Traumatic Encephalopathy
Prevalence, Definition, Pathology, and Pathophysiology
Criteria

Treatments
References
16. Creutzfeldt–Jakob Disease
Criteria
Clinical Presentation
Laboratory Studies and Electroencephalography
Treatments
References
17. Other Disorders That Cause Memory Loss or Dementia
Depression and Anxiety

Medication Side Effects
Disrupted Sleep
Hormones?
Metabolic Disorders
Diabetes
Alcohol Abuse and Alcoholic Korsakoff’s Syndrome
Lyme Disease
Subdural and Epidural Hematomas
Vitamin B12 Deficiency
Seizures
Human Immunodeficiency Virus–associated Neurocognitive

Disorder
Brain Sagging Syndrome
Hashimoto’s Encephalopathy (Steroid-Responsive

Encephalopathy Associated with Autoimmune Thyroiditis)
References
Section III: Treatment of Memory Loss, Alzheimer’s

18. Goals for the Treatment of Memory Loss, Alzheimer’s Disease, and
Dementia
Talking About Treatments for Alzheimer’s Disease
Strategies to Treat the Symptoms of Alzheimer’s Disease
Treating Cognition and Treating Behavior
References
19. Cholinesterase Inhibitors
Cholinesterase Inhibitors In Alzheimer’s Disease
Should I Prescribe A Cholinesterase Inhibitor?
Is The Medication Working?
Which Cholinesterase Inhibitor Should I Prescribe?
What Is The Best Dose?
When Should the Medications be Taken?
Does it Help to Switch Medications?
How do i Discuss with the Patient Whether the Cholinesterase

Inhibitor is Working?
Cholinesterase Inhibitors in Late-Stage Disease
Huperzine A
Cholinesterase Inhibitors in Other Disorders
References
20. Memantine
Mechanism of Action
Which Patients Should Take Memantine?
Efficacy of Memantine
Safety and Tolerability of Memantine
Should I Prescribe Generic Memantine or Namenda XR?
Titrating Memantine
Combining Memantine with Cholinesterase Inhibitors
Memantine in the Mild Stage of Alzheimer’s Disease
Memantine in Other Dementias
References
21. Vitamins, Herbs, Supplements, and Antiinflammatories
Vitamin D
Vitamin E
B Complex Vitamins: Folic Acid, B6, B12
Ginkgo Biloba
DHA (Fish Oil)
Antiinflammatories
Prevagen
References
22. Nonpharmacological Treatment of Memory Loss, Alzheimer’s
Helpful Habits
External Memory Aids
Power of Pictures
Magic of Music
Mediterranean-Style Diets
Social and Cognitively Stimulating Activities
Aerobic Exercise
References
23. Future Treatments of Memory Loss, Alzheimer’s Disease, and

Dementia
Strategies to Treat the Symptoms of Alzheimer’s Disease
Disease-Modifying Treatments
The Future of Alzheimer’s Disease Therapy
References
Section IV: Behavioral and Psychological Symptoms of

Dementia
24. Evaluating the Behavioral and Psychological Symptoms of

Dementia
What Constitutes Behavioral and Psychological Symptoms of
Dementia?
The Benefits of Treating Behavioral and Psychological Symptoms

of Dementia
Measuring Behavioral and Psychological Symptoms of Dementia
Evaluating Behavioral and Psychological Symptoms of Dementia:

Pragmatic Guidelines for the Clinician
Formulating a Treatment Plan for Behavioral and Psychological

Symptoms: Pragmatic Guidelines for the Clinician
References
25. Caring for and Educating the Caregiver
Caring for the Caregiver
Three Predictable Transition Points Where the Caregiver Needs

Help
References
26. Nonpharmacological Treatment of the Behavioral and

Psychological Symptoms of Dementia
Some General Principles For Treating Behavioral And

Psychological Symptoms In Dementia: The 3RS
Dealing With Specific Behavioral And Psychological Symptoms

Of Dementia: Behavioral Techniques
References
27. Pharmacological Treatment of the Behavioral and Psychological
Symptoms of Dementia
General Principles of Pharmacotherapy for the Behavioral and

Psychological Symptoms of Dementia
Pharmacotherapy for Depression
Pharmacotherapy for Anxiety
Pharmacotherapy for Pseudobulbar Affect (Pathologic Laughter

and Crying)
Pharmacotherapy for Insomnia
Pharmacotherapy for Psychosis
Pharmacotherapy for Agitation
Behavioral and Psychiatric Crises
References
Section V: Additional Issues
28. Life Adjustments for Memory Loss, Alzheimer’s Disease, and

Dementia
Mild Cognitive Impairment and Alzheimer’s Disease Dementia In

the Very Mild and Mild Stages
Alzheimer’s Disease Dementia in the Moderate to Severe Stages
References
29. Legal and Financial Issues in Memory Loss, Alzheimer’s Disease,
and Dementia
Legal Planning
Financial Planning
30. Special Issues in Memory Loss, Alzheimer’s Disease, and

Dementia
The Patient Who Does Not Want to Come to the Appointment
The Patient Who Does Not Want You to Talk to Their Family
Talking to Adult Children of Patients about Their Risk of

Alzheimer’s Disease And What they can do About it
References
Appendix A. Cognitive Test and Questionnaire Forms, Instructions,

and Normative Data for Evaluating Memory Loss, Alzheimer’s
Mental Status Tests
Screening Instruments that Combine Single Tests
Informant (Caregiver)-Completed Screening Questionnaires
Appendix B. Screening for Memory Loss, Alzheimer’s Disease, and

Dementia
To Screen or Not to Screen?
Screening in Primary Care Practice

Appendix C. Memory Dysfunction in Alzheimer’s Disease and Other
Causes of Mild Cognitive Impairment and Dementia
Episodic Memory
Semantic Memory
Procedural Memory
Working Memory
Concluding Comment
Index
Any screen, Any time, Anywhere
Copyright
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Ste 1800
Philadelphia, PA 19103-2899
MEMORY LOSS, ALZHEIMER’S DISEASE, AND DEMENTIA,

THIRD EDITION ISBN: 978-0-323795449
Copyright © 2022 by Elsevier, Inc. All rights reserved.
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protected under copyright by the Publisher (other than as may be
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Notice
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Praise for the First Edition
The cohesive text is an appealing blend of personal experience and
clinical anecdotes, and is supported by a firm command of the rapidly
changing clinical literature. The writing is crisp, lucid and, above all,
practice-oriented … Budson and Solomon are especially adroit in
identification of controversies, knowledge gaps, and areas in which
diagnostic criteria are ill-defined or difficult to apply (e.g., fluctuating
cognition in dementia with Lewy bodies). Readers are not abandoned
without guidance; ambiguities are resolved by confident descriptions
of personal approaches to specific situations … The book is an
incredible compilation of practical advice.
Lancet Neurology,
March 2012
From the point of view of the busy clinician working in the trenches
but looking for a practical and cutting-edge guide, Doraiswamy said
he cannot think of a better book, noting, ‘This is the clinical book of
the year in our field.
Alzheimer’s Research Forum review,
December 2011
Few books provide both a comprehensive review and a step-by-step
guide. I strongly recommend this book to all those who treat patients
with memory loss—physicians, social workers, psychologists, nurses
—at every level of training and experience.
P. Murali Doraiswamy, MD
Professor & Head,
Division of Biological Psychiatry, Duke University,
and co-author of The Alzheimer’s Action Plan
Memory Loss: A Practical Guide for Clinicians provides the assessment,
diagnostic and therapeutic insights clinicians need to provide
exemplary care to memory impaired patients. Don’t go to the clinic
without it.
Jeffrey L. Cummings, MD
Director, Cleveland Clinic Lou Ruvo Center for Brain Health,
The Andrea L. and Joseph F. Hahn MD Chair of Neurotherapeutics
Designed for easy reference to satisfy the real time needs of
clinicians in hectic clinical settings, I’m sure this volume will be dog-
eared in short order given its clear no-nonsense style.
Neil W. Kowall, MD
Professor of Neurology and Pathology,
Boston University School of Medicine,
Director, Boston University Alzheimer’s Disease Center,
Chief, Neurology Service,
Boston VA Healthcare System
This book summarizes complex material in a manner that benefits
clinical practitioners at all levels. This is an excellent addition to the
library of professionals serving older adults.
Maureen K. O’Connor, PsyD, ABCN,
Chief, Neuropsychology Service,
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
This is a very good addition to the books on dementias. With this
book, the authors provide a resource for clinicians who will be caring
for the more than 5 million individuals with memory loss, whether
their degree is in medicine, psychology, nursing, social work, or
therapies. Primary care providers, nurses, psychologists, and students
will find this book a very practical, clinically oriented guide that helps
them know what to do when sitting in the office with a patient
complaining of memory loss. Specialists will find this book a wealth of
up-to-date information regarding the latest diagnostic tools and
treatments for their patients with memory loss.
Eric Gausche, MD, University of Illinois
at Chicago College of Medicine
4 Star-Doody Rating, March 2013
Praise for the Second Edition
I do not know of any other publication that deals with memory loss
and dementia in as comprehensive yet practical a manner.
Howard S. Kirshner, MD
Cognitive and Behavioral Neurology,
March 2016
This superb, anticipated second edition of an outstanding
educational/training tool is essential reading for virtually all
physicians on the diagnosis and treatment of this rapidly growing
patient population. Written and edited by nationally recognized
clinician-educators in the field, this update is a very welcome addition
to the neurology and psychiatry literature.
Michael Joel Schrift, DO, MA
Northwestern University Feinberg School of Medicine)
Doody’s Score: 95—4 Stars!
Preface to the Third Edition
Andrew E. Budson, MD and Paul R. Solomon, PhD
What an exciting—and challenging—time it is to be a clinician treating
individuals with memory loss, Alzheimer’s disease, and dementia. In
the 5 years since the second edition of this book there have been
myriad new developments. To help you understand these new
developments and their implications, we have written three entirely
new chapters in addition to updating and rewriting almost every
other chapter, including:
• Chapter 2: Evaluating the Patient with Memory Loss or

Dementia—updated with FDA approved tau PET scans,
• Chapter 3: Subjective Cognitive Decline, Mild Cognitive
Impairment, and Dementia—updated with subjective cognitive
decline and the new National Institute on Aging-Alzheimer’s
Association (NIA-AA) Research Framework for syndromal staging
of cognitive continuum,
• Chapter 4: Alzheimer’s disease—updated with the new AT(N)
(amyloid, tau, neurodegeneration) biomarker profile,
• Chapter 5: Primary Age-Related Tauopathy—new chapter,
• Chapter 6: Limbic-predominant Age-related TDP-43
Encephalopathy—new chapter,
• Chapter 7: Vascular cognitive impairment and vascular
dementia—updated with new diagnostic criteria,
• Chapter 8: Dementia with Lewy bodies—updated with new
diagnostic criteria, now including mild cognitive impairment with
Lewy bodies,
• Chapter 9: Primary Progressive Aphasia and Apraxia of
Speech—updated with new semantic variant videos,
• Chapter 11: Posterior Cortical Atrophy—new chapter,
• Chapter 12: Progressive Supranuclear Palsy—updated with new
diagnostic criteria,
• Chapter 14: Normal Pressure Hydrocephalus—updated with the
Evans index and disproportionately enlarged subarachnoid
space hydrocephalus,
• Chapter 16: Creutzfeldt-Jakob Disease—updated with new
diagnostic criteria,
• Chapter 17: Other Disorders That Cause Memory Loss or
Dementia—updated with brain sagging syndrome,
• Chapter 22: Nonpharmacological Treatment of Memory Loss,
Alzheimer’s Disease, and Dementia—updated with new evidence
for Mediterranean-style diets,
• Chapter 23: Future Treatments of Memory Loss, Alzheimer's
Disease, and Dementia—updated with the latest therapies, and
• Chapter 27: Pharmacological Treatment of the Behavioral and
Psychological Symptoms of Dementia—updated with
pimavanserin (Nuplazid) and prazosin.
Now, more than ever, frontline clinicians need a practical guide. We

have worked to ensure that—despite the added complexity of the
field—our book remains accessible to all clinicians who are and will
be caring for the more than 44 million individuals throughout the
world with memory loss, mild cognitive impairment, or dementia.
Our book is written for generalists and specialists, students and
experienced clinicians—whether their degrees are in medicine,
psychology, nursing, social work, or the therapies. Primary care
providers, nurses, social workers, therapists, psychologists, and
students will find this book a very practical, clinically oriented guide
that helps them know what to do when sitting in the office or by the
bedside with a patient complaining of memory loss or exhibiting
dementia behaviors. Specialists—including psychiatrists, neurologists,
neuropsychologists, geriatricians, and others—will find in this book a
wealth of up-to-date information regarding the latest diagnostic
criteria, tools, and treatments for their patients with memory loss,
mild cognitive impairment, and dementia.
Note that we have continued to take advantage of technology in
using videos to illustrate various aspects of disorders that cannot
easily be translated into words, such as tremors, speech and language
difficulties, and gait problems. These videos can be viewed in the
online, tablet, and smartphone versions of the book.
As was true for the prior editions, this book is based upon the most
recent peer-reviewed published studies in the literature, combined
with our opinions reflecting our experience in treating more than 5000
patients with memory loss and dementia over approximately 40,000
patient visits. Where our opinions are supported by the literature, we
have provided appropriate references, and where our opinions differ
from the literature, we have done our best to point this discrepancy
out. There are, of course, large areas of clinical practice for which there
are no randomized, double blind, placebo-controlled trials to guide
one. It is here that our training and experience proves most valuable.
How To Use This Book
Everyone should read Chapters 1–8, which cover the evaluation and
the most common causes of memory loss and dementia. Other
chapters can then be read when there are relevant issues, such as other
diagnoses (Section II, Chapter 9–Chapter 17), medications and other
therapies for memory loss (Section III, Chapters 18–23), and the
behavioral and psychological symptoms of dementia (Section IV,
Chapters 24–27). Finally, Section V (Chapters 28–30) discusses driving,
legal, financial, and other important issues. The web appendices
provide additional useful information on cognitive tests and
questionnaires (Appendix A), an expanded discussion on screening for
memory loss (Appendix B), and a basic understanding of the different
clinically relevant memory systems in the brain (Appendix C).
A note on abbreviations
Because we want this book to be accessible to a wide variety of
audiences from diverse fields—each with their own standard jargon—
we have endeavored to eliminate almost all abbreviations. Although
this decision has made many sentences longer, we hope that these
longer sentences will, on the whole, be more easily understood.
Acknowledgments
This book is dedicated first to our patients and their caregivers; we are
indebted for all that they have taught us. We also dedicate this third
edition to those who supported, encouraged, and inspired us in more
ways than we can list: Jessica and Todd Solomon; Danny, Leah,
Sandra, and Richard Budson; and—of course—to Elizabeth Vassey
and Amy Null. We thank you all.
Special thanks go to Thor Stein, MD, PhD and Ann C. McKee, MD,
for providing the neuropathology figures, as well as Ana Vives-
Rodriguez, MD and Chadrick E. Lane, MD for their invaluable
reviews.
Disclosures
Disclosures (current and/or during the past two years):
Dr. Budson receives grant support from the National Institute on
Aging, National Institutes of Health (NIH), and from the Veterans
Affairs Research & Development Service. He also receives or has
received grant support from and/or has consulted for the following
pharmaceutical companies: Acadia, Avanir, Biogen, EPI
pharmaceuticals, Eisai, Eli Lilly, Cognito, and Cortexyme.
Dr. Solomon receives or has received grant support from Abbott,
Acadia, AstraZeneca, Avanir, Biogen, Cognito, Cortexyme, Avid
Radiopharmaceuticals, Eisai, EnVivo EPIX, Eli Lilly, Pfizer, TV
Therapeutics, Sonexa, FORUM Pharmaceuticals, and Hoffmann-La
Roche. He consults or has consulted for Abbott, Astellas, Avid,
Biogen, Cognito, Eisai, EPIX, Pfizer, and Toyoma.
Note: The content of this book has been derived from the patients
that Dr. Budson and Dr. Solomon have seen separately and together in
the Boston Center for Memory, Newton, Massachusetts, and in The
Memory Clinic in Bennington, Vermont, along with literature reviews
conducted solely for the purpose of this book. These reviews and the
writing of this book have been conducted during early mornings, late
nights, weekends, and vacations. Dr. Budson’s contribution to this
book was conducted outside of both his VA tour of duty and his
Boston University/NIH research time.
About the Authors
Dr. Budson received his bachelor’s degree at Haverford College where
he majored in both chemistry and philosophy. After graduating cum
laude from Harvard Medical School, he was an intern in internal
medicine at Brigham and Women’s Hospital. He then attended the
Harvard-Longwood Neurology Residency Program, for which he was
chosen to be chief resident in his senior year. He next pursued a
fellowship in behavioral neurology and dementia at Brigham and
Women’s Hospital, after which he joined the neurology department
there. He participated in numerous clinical trials of new drugs to treat
Alzheimer’s disease in his role as the Associate Medical Director of
Clinical Trials for Alzheimer’s Disease at Brigham and Women’s
Hospital. Following his clinical training he spent 3 years studying
memory as a post-doctoral fellow in experimental psychology and
cognitive neuroscience at Harvard University under Professor Daniel
Schacter. While continuing in the Neurology Department at Brigham
and Women’s Hospital, in 2000 he began work as Consultant
Neurologist for The Memory Clinic in Bennington, Vermont. After 5
years as Assistant Professor of Neurology at Harvard Medical School,
he joined the Boston University Alzheimer’s Disease Center and the
Geriatric Research Education Clinical Center (GRECC) at the Bedford
Veterans Affairs Hospital. During his 5 years at the Bedford GRECC
he served in several roles, including the Director of Outpatient
Services, Associate Clinical Director, and later the overall GRECC
Director. From March 2009 through February 2010 he served as
Bedford’s Acting Chief of Staff. In March 2010 he moved to Boston as
the Deputy Chief of Staff of the Veterans Affairs Boston Healthcare
System, where he is currently the Associate Chief of Staff for
Education, Chief of the Section of Cognitive & Behavioral Neurology,
and Director of the Center for Translational Cognitive Neuroscience.
He is also the Director of Outreach, Recruitment, and Engagement at
the Boston University Alzheimer’s Disease Center, Professor of
Neurology at Boston University School of Medicine, and Lecturer in
Neurology at Harvard Medical School. Dr. Budson has had
government research funding since 1998, receiving a National
Research Service Award, a Career Development Award, a Research
Project (R01) grant, and several VA Merit grants. He has given over
650 local, national, and international grand rounds and other
academic talks, including at the Institute of Cognitive Neuroscience,
Queen Square, London, UK; Berlin, Germany; and the University of
Cambridge, England, UK. He has published over 100 papers in peer
reviewed journals, including The New England Journal of Medicine,
Brain, and Cortex, and is a reviewer for more than 50 journals. He was
awarded the Norman Geschwind Prize in Behavioral Neurology in
2008 and the Research Award in Geriatric Neurology in 2009, both
from the American Academy of Neurology. He serves on the medical
scientific advisory board and board of directors for the
Massachusetts/New Hampshire Chapter of the Alzheimer’s
Association. His current research uses the techniques of experimental
psychology and cognitive neuroscience to understand memory and
memory distortions in patients with Alzheimer’s disease and other
neurological disorders. In his Memory Disorders Clinic at the
Veterans Affairs Boston Healthcare System he treats patients while
teaching students, residents, and fellows, in addition to seeing
patients at the Boston Center for Memory in Newton, Massachusetts.
Dr. Solomon received his PhD. in Psychology from the University of
Massachusetts, Amherst. He was a postdoctoral fellow in the
Laboratory of Richard F. Thompson in the Department of
Psychobiology at the University of California at Irvine. He is currently
Professor of Psychology and founding Chairman of the Neuroscience
Program, Williams College. Dr. Solomon teaches in the areas of
neuropsychology and behavioral neuroscience and conducts research
on the neurobiology of memory disorders. He is particularly
interested in the memory deficits associated with Alzheimer’s disease.
He is the author of 10 books, has also contributed chapters to 20 edited
volumes, and has co-authored and presented more than 200 research
papers. His work has been published in Science, Scientific American,
Journal of the American Medical Association, and The Lancet. He has
delivered more than 400 invited colloquia, symposia, grand rounds,
lectures, and presentations. He has been the recipient of research
grants from the National Science Foundation, the National Institute on
Aging, the National Institute of Mental Health, and the United States
Environmental Protection Agency, as well as private foundations and
pharmaceutical research divisions. Dr. Solomon has received
numerous awards, including a Distinguished Teaching Award from
the University of Massachusetts, a National Research Service Award
from the National Institutes of Health, a National Needs Postdoctoral
Fellowship from the National Science Foundation, and a clinical
research award from the American Association of Family Physicians.
He has been elected a Fellow of the American Association for the
Advancement of Science, the American Psychological Association and
the American Psychological Society. He is listed in Who’s Who in
America, American Men and Women of Science, Who’s Who in Education,
and Who’s Who in Frontier Science and Technology. Dr. Solomon has
served on the editorial boards of several journals and serves as an
external reviewer for numerous journals and granting agencies. He
has lectured widely at colleges and universities on age-related
memory disorders and at medical centers and hospitals on the
diagnosis and treatment of Alzheimer’s disease. He has also appeared
frequently to discuss pharmacotherapy for Alzheimer’s disease on
national television, including The Today Show, Good Morning America,
The CBS Morning Show, and CBS, ABC, and NBC Evening News. His
work on screening for Alzheimer’s disease has been featured on
Dateline NBC. In addition to his academic undertakings, Dr. Solomon
is a licensed psychologist in Massachusetts and Vermont. He is also
founder and Clinical Director of the Memory Clinic in Bennington,
Vermont, the Boston Center for Memory, and President of Clinical
Neuroscience Research Associates. He has served as the first Director
of Training for the Southwestern Vermont Psychology Consortium.
He serves on the advisory board of the Massachusetts Alzheimer’s
Association and the Northeastern New York Alzheimer’s Association.
Video Table of Contents
Video 2.1: Neurological exam, example 1 (selected elements) in a
patient with progressive supranuclear palsy, 16
Video 2.2: Neurological exam, example 2 (selected elements) in a
patient with corticobasal degeneration, 16
Video 2.3: Extra-ocular movements, 17
Video 2.4: Mild parkinsonian resting tremor, 17
Video 2.5: Mild action tremor, 17
Video 2.6: Frontal release signs, 18
Video 2.7: Palmomental reflex, 18
Video 2.8: Montreal Cognitive Assessment, patient 1, part 1, 19
Video 2.14: Category fluency test, 20
Video 9.1: Patient with semantic variant primary progressive
aphasia speaks about his problem with names, 118
aphasia speaks about parts of his body and clothing, 118
aphasia speaks about Christmas, 118
aphasia speaks about other words, 118
Video 9.5: Primary progressive aphasia, nonfluent/agrammatic
variant, patient describes his main problem, 120
variant, spontaneous speech part 1, 120
variant, spontaneous speech part 2, 120
variant, Montreal Cognitive Assessment test part 1, 120
variant, Montreal Cognitive Assessment test part 2, 120
Video 9.10: Primary progressive aphasia nonfluent/agrammatic
variant. Additional language testing, 120
Video 9.11: Primary progressive aphasia nonfluent/agrammatic
variant, writing a sentence, 120
Video 9.12: Patient with primary progressive aphasia
nonfluent/agrammatic variant, performing the Boston naming
test, 120
Video 9.13: Patient with primary progressive aphasia
nonfluent/agrammatic variant performing pyramids and palm
trees test, 120
Video 9.14: Primary progressive apraxia of speech, examples
from Montreal Cognitive Assessment testing, 120
Video 9.15: Primary progressive apraxia of speech, spontaneous
speech and speech exam, 120
Video 9.16: Controlled oral word fluency test, 123
Video 9.17: Category fluency test, 123
Video 10.1: Frontal behavior, 129
Video 12.1: Extra-ocular movements in progressive supranuclear
palsy, 150
Video 12.2: Progressive supranuclear palsy with apraxia of
speech, spontaneous speech and speech exam, 151
Video 12.3: Progressive supranuclear palsy gait, 151
Video 12.4: Progressive supranuclear palsy pull-test, 151
Video 12.5: Progressive supranuclear palsy demonstrating
apraxias, 151
Video 12.6: Progressive supranuclear palsy cognitive exam, part
1, 151
2, 151
3, 151
Video 13.1: Praxis examination in a patient with corticobasal
syndrome, part 1, 160
Video 13.4: Stereognosis examination in a patient with
corticobasal syndrome, 160
Video 13.5: Graphesthesia examination in a patient with
corticobasal syndrome, 160
Video 13.6: Elements of the neurological examination in a patient
with corticobasal syndrome, 162
Video 13.7: A patient with corticobasal syndrome removing her
sweater, shoes, and socks, 162
Video 15.1: Chronic traumatic encephalopathy, 177
SECTION I
Evaluating the Patient With
Memory Loss or Dementia
OUTLINE
1 Why Diagnose and Treat Memory Loss, Alzheimer’s Disease,

and Dementia?
2 Evaluating the Patient With Memory Loss or Dementia
3 Subjective Cognitive Decline, Mild Cognitive Impairment, and
Dementia
Why Diagnose and Treat Memory
Loss, Alzheimer’s Disease, and
Dementia?
Quick Start: Why Diagnose And Treat Memory

Loss, Alzheimer’s Disease, and Dementia?
• Current treatments can help improve or maintain the patient’s

cognitive and functional status by “turning back the clock” on
memory loss.
• Families and other caregivers are helped by treatments that
maintain or improve functional status and neuropsychiatric
symptoms.
• Using current treatments saves money, as shown by pharmaco-
economic studies.
• New, disease-modifying treatments are being developed and
may be available soon.
• Accurate diagnosis helps define prognosis, facilitating future
planning.
• Improving the quality (not quantity) of life is the goal.
A 72-year-old woman comes into the clinic at the urging of her son.
She has noticed some difficulties finding words for the past 6 months,
but denies problems with memory or other aspects of her thinking.
Her son reports that his mother has had memory problems that began
five years ago, and have been gradually worsening. He notes that his
mother used to have an excellent memory, and would keep her
calendar, grocery, and other lists in her head. Now she needs to write
everything down or she is totally lost. She used to send out birthday
cards to her grandchildren every year, but over the past two years has
either forgotten to do this or sends them out at the wrong time. In
addition to memory problems, he agrees that she also has word-
finding difficulties, and often has trouble finishing sentences. From a
functional standpoint, she is also having difficulty. She is living with
her husband, and he has gradually been taking over household
responsibilities that she used to do, such as going to the grocery store.
She continues to cook, but there are now just a few meals that she
prepares, and these have become much simpler than they used to be.
The first question that needs to be addressed in this book is: What
should be done about this 72-year-old woman? Why is it important to
diagnose and treat memory loss? Although the answer to this
question may seem obvious to some, in the current healthcare climate
it is very reasonable. There are four basic answers to this question: (1)
to help the patient, (2) to help the family and other caregivers, (3) to
save money, and (4) to plan for the future.
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para aqui el trabajo, mas en ser
un mal que no os podeys quexar
dél, porque en la hora que os
quexaredes, os ternan por loco, o
desatinado. Cosa la más contraria
al descanso que puede ser: que
ya cuando los çelos son de otro
pastor que la sirua, en quexar de
los fauores que le haze y en oyr
desculpas, passays la vida, mas
este otro mal es de manera que
en un punto la perdereys, sino
teneys cuenta con uuestro
desseo. Diana entonçes
respondio: Dexa essas razones,
Sireno, que ninguna neçesidad
tienes de querer, ni ser querido. A
trueque de no tenella de querer
(dixo Sireno) me alegro en no
tenella de ser querido. Estraña
libertad es la tuya (dixo Diana).
Mas lo fue tu oluido (respondio
Sireno), si miras bien en las
palabras que a la partida me
dixiste, mas como dizes, dexemos
de hablar en cosas passadas, y
agradezcamos al tiempo y a la
sábia Feliçia las presentes, y tú,
Syluano, toma tu flauta y
templemos mi rabel con ella, y
cantaremos algunos versos:
aunque coraçon tan libre como el
mio, ¿qué podra cantar, que dé
contento a quien no le tiene? Para
esto yo te dare buen remedio,
dixo Syluano. Hagamos cuenta
que estamos los dos de la
manera que esta pastora nos
traya al tiempo que por este prado
esparzimos nuestras quexas. A
todos paresçio bien lo que
Syluano dezia, aunque Seluagia
no estaua muy bien en ello, mas
por no dar a entender çelos
donde tan gran amor amor
conosçia, calló por entonçes y los
pastores començaron a cantar
desta manera:
SYLUANO Y SIRENO
Si lagrimas no pueden
ablandarte,
(cruel pastora) ¿qué hara mi
canto,
pues nunca cosa mia vi
agradarte?
¿Qué coraçon aurá que
suffra tanto,
que vengas a tomar en burla y
risa,
vn mal que al mundo admira y
causa espanto?
¡Ay çiego entendimiento,
que te auisa
amor, el tiempo y tantos
desengaños,
y siempre el pensamiento de
una guisa!
Ah pastora cruel, ¿en tantos
daños,
en tantas cuytas, tantas sin
razones
me quieres ver gastar mis
tristes años?
De vn coraçon que es tuyo,
¿ansi dispones?
vn alma que te di, ¿ansi la
tratas,
que sea el menor mal suffrir
passiones?
SIRENO
Vn ñudo ataste amor, que
no desatas,
es çiego, y çiego tú, y yo más
çiego,
y çiega aquella por quien tú
me matas.
Ni yo me vi perder vida y
sossiego:
ni ella vee que muero a causa
suya,
ni tú, que estó abrasado en
biuo fuego.
¿Qué quieres crudo amor,
que me destruya
Diana con ausençia? pues
concluye
con que la vida y suerte se
concluya.
El alegria tarda, el tiempo
huye,
muere esperança, biue el
pensamiento,
amor lo abreuia, alarga y lo
destruye.
Verguença me es hablar en
un tormento
que aunque me aflija, canse y
duela tanto,
ya no podria sin él biuir
contento.
SYLUANO
O alma, no dexeys el triste
llanto,
y vos cansados ojos,
no os canse derramar
lagrimas tristes:
llorad pues uer supistes
la causa prinçipal de mis
enojos.
SIRENO
La causa prinçipal de mis
enojos,
cruel pastora mia,
algun tiempo lo fue de mi
contento:
ay triste pensamiento,
quan poco tiempo dura vna
alegria.
SYLUANO
Quan poco tiempo dura vna
alegria
y aquella dulce risa,
con que fortuna acaso os ha
mirado:
todo es bien empleado
en quien auisa el tiempo y no
se auisa.
SIRENO
En quien auisa el tiempo y
no se auisa,
haze el amor su hecho,
mas ¿quién podra en sus
casos auisarse,
o quién desengañarse?
ay pastora cruel, ay duro
pecho.
SYLUANO
Ay pastora cruel, ay duro
pecho,
cuya dureza estraña
no es menos que la graçia y
hermosura,
y que mi desuentura,
¡quán a mi costa el mal me
desengaña!
SYLUANO
Pastora mia, más blanca y
colorada
que blancas[1269] rosas por
abril cogidas,
y más resplandesçiente,
que el sol, que de oriente
por la mañana assoma a tu
majada
¿cómo podré biuir si tú me
oluidas?
no seas mi pastora rigurosa,
que no está bien crueldad a
vna hermosa.
SIRENO
Diana mia, más
resplandesçiente,
que esmeralda, y diamante a
la vislumbre,
cuyos hermosos ojos
son fin de mis enojos,
si a dicha los rebuelues
mansamente,
assi con tu ganado llegues a la
cumbre
de mi majada gordo y
mejorado,
que no trates tan mal a vn
desdichado.
SYLUANO
Pastora mia, quando tus
cabellos
a los rayos del sol estás
peynando,
no vees que lo escuresçes,
y a mi me ensoberuesçes
que desde acá me estoy
mirando en ellos,
perdiendo ora esperança, ora
ganando?
assi gozes, pastora, esa
hermosura,
que des vn medio en tanta
desuentura.
SIRENO
Diana cuyo nombre en esta
sierra
los fieros animales trae
domados,
y cuya hermosura,
sojuzga a la ventura,
y al crudo amor no teme y
haze guerra
sin temor de occasiones,
tiempo, hados,
assi gozes tú tu hato y tu
majada,
que de mi mal no biuas
descuydada.
SYLUANO
La fiesta, mi Sireno, es ya
passada,
los pastores se uan a su
manida,
y la cigarra calla de cansada.
No tardará la noche, que
escondida
está, mientra que Phebo en
nuestro cielo
su lumbre acá y allá trae
esparzida.
Pues antes que tendida por
el suelo
veas la escura sombra, y que
cantando
de ençima deste aliso está el
mochuelo,
Nuestro ganado vamos
allegando,
y todo junto alli lo lleuaremos,
a do Diana nos está
esperando.
SIRENO
Syluano mio, vn poco aqui
esperemos,
pues aun del todo el sol no es
acabado
y todo el dia por nuestro le
tenemos.
Tiempo ay para nosotros, y
el ganado
tiempo ay para lleualle al claro
rio,
pues oy ha de dormir por este
prado;
y aqui cesse, pastor, el cantar
mio.
En quanto los pastores cantauan,

estaua la pastora Diana con el
rostro sobre la mano, cuya manga
cayendose un poco, descubria la
blancura de un braço, que a la de
la nieue escuresçia, tenía los ojos
inclinados hacia el suelo,
derramando por ellos vnas
espaçiosas lagrimas, las quales
dauan a entender de su pena más
de lo que ella quisiera dezir: y en
acabando los pastores de cantar
con vn sospiro, en compañia del
qual paresçia auersele salido el
alma se leuantó, y sin despedirse
dellos, se fue por el valle abaxo,
entrançando sus dorados
cabellos, cuyo tocado se le quedó
preso en vn ramo al tiempo que
se leuantó. Y si con la poca
manzilla que Diana de los
pastores auia tenido, ellos no
templaran la mucha que della
tuuieron, no bastara el coraçon de
ninguno de los dos a podello
suffrir. Y ansi, unos con otros, se
fueron a recoger sus ouejas, que
desmandadas andauan, saltando
por el verde prado.
Fin del sexto libro.

NOTAS:
[1266] Le en la edición de Milán.
[1267] Afición en la edición de Milán.
[1268] M., Si yo no estuviese firme.
[1269] Ambas, por errata patente, en la edición de Milán y en
otras.
LIBRO SEPTIMO
DE LA DIANA DE
GEORGE DE
MONTEMAYOR
Despues que Felismena vuo

puesto fin en las differençias de la
pastora Amarilida y el pastor
Filemon, y lo dexó con proposito
de jamas hazer el vno cosa de
que otro tuuiese occasion de
quexarse, despedida dellos, se
fue por el valle abaxo por el qual
anduuo muchos dias, sin hallar
nueua que algun contento le
diesse, y como todauia lleuaua
esperança en las palabras de la
sábia Feliçia, no dexaua de
passalle por el pensamiento, que
despues de tantos trabajos se
auia de cansar la fortuna de
perseguilla. Y estas
ymaginaçiones la sustentauan en
la grauissima pena de su desseo.
Pues yendo vna mañana por en
medio de vn bosque, al salir de
vna assomada que por ençima de
vna alta sierra paresçia, vio
delante si vn verde y amenissimo
campo, de tanta grandeza, que
con la vista no se le podia
alcançar el cabo, el qual doze
millas adelante, yua a fenesçer en
la falda de vnas montañas, que
quasi no se paresçian: por medio
del deleytoso campo corria vn
caudaloso rio, el qual hazia vna
muy graçiosa ribera, en muchas
partes poblada de salzes, y
verdes alisos, y otros diuersos
arboles: y en otras dexaua
descubiertas las cristalinas aguas
recogiendose a vna parte vn
grande y espaçioso arenal que de
lexos más adornaua la hermosa
ribera. Las mieses que por todo el
campo paresçian sembradas,
muy çerca estauan de dar el
desseado fruto, y a esta causa
con la fertilidad de la tierra
estauan muy cresçidos, y
meneados de vn templado viento
hazian vnos verdes, claros, y
obscuros, cosa que a los ojos
daua muy gran contento. De
ancho tenía bien el deleytoso y
apazible prado tres millas en
partes, y en otras poco más, y en
ninguna auia menos desto. Pues
baxando la hermosa pastora por
su camino abaxo, vino a dar en vn
bosque muy grande de verdes
alisos, y azebuches assaz
poblado, por enmedio muchas
casas tan sumptuosamente
labradas, que en gran admiraçion
le pusieron. Y de subito fue a dar
con los ojos en vna muy hermosa
çiudad, que desde lo alto de vna
sierra que de frente estaua, con
sus hermosos edifiçios, venia
hasta tocar con el muro en el
caudaloso rio que por medio del
campo passaua. Por ençima del
qual estaua la más sumptuosa y
admirable puente, que en el
vniuerso se podia hallar. Las
casas y edifiçios de aquella
çiudad insigne eran tan altos, y
con tan gran artifiçio labrados,
que paresçia auer la industria
humana mostrado su poder. Entre
ellos auia muchas torres y
piramides, que de altos se
leuantauan a las nuues. Los
tenplos eran muchos, y muy
sumptuosos, las casas fuertes,
los superbos muros, los brauos
baluartes, dauan gran lustre a la
grande y antigua poblaçion, la
qual desde alli se diuisaba toda.
La pastora quedó admirada de
ver lo que delante los ojos tenía, y
de hallarse tan çerca de poblado,
que era la cosa que con gran
cuydado huya[1270]. Y con todo
esso se assento vn poco a la
sombra de vn oliuo, y mirando
muy particularmente, lo que
aueys oydo, viendo aquella
populosa çiudad, le vino a la
memoria la gran Soldina su patria
y naturaleza, de adonde los
amores de don Felis la trayan
desterrada: lo qual fue ocasion
para no poder passar sin
lagrimas, porque la memoria del
bien perdido, pocas vezes dexa
de dar ocasion a ellas. Dexado
pues la hermosa pastora aquel
lugar, y la çiudad a mano
derecha, se fue su passo a passo
por vna senda que junto al río
yua, hazia la parte, donde sus
cristallinas aguas con vn manso y
agradable ruydo, se yban a meter
en el mar Oçeano. Y auiendo
caminado seys millas por la
graçiosa ribera adelante, vio dos
pastoras, que al pie de vn roble a
la orilla del rio passauan la fiesta:
las quales aunque en la
hermosura tuuiessen vna
razonable mediania, en la graçia y
donayre auia vn estremo
grandissimo: el color del rostro
moreno, y graçioso: los cabellos
no muy ruuios, los ojos negros:
gentil ayre y graçioso en el mirar:
sobre las cabeças tenian sendas
guirnaldas de verde yedra, por
entre las hojas entretexidas
muchas rosas y flores. La manera
del vestido le paresçio differente
del que hasta entonçes auia visto.
Pues leuantandose la vna con
grande priessa a echar vna
manada de ouejas, de vn linar
adonde se auian entrado, y la otra
llegado a dar a beuer a vn rebaño
de cabras al claro rio se boluieron
a la sombra del vmbroso fresno.
Felismena que entre vnos
juncales muy altos se auia
metido, tan çerca de las pastoras,
que pudiesse oyr lo que entre
ellas passaua, sintio que la
lengua era Portuguesa, y
entendio que el reyno en que
estaua, era Lusitania, porque la
una de las pastoras dezia con
graçia muy estremada en su
misma lengua a la otra,
tomandose de las manos: Ay
Duarda, quan poca razon tienes
de no querer a quien te quiere
más que a si: quánto mejor te
estaria, no traer mal a vn
pensamiento tan occupado en tus
cosas. Pesame que a tan
hermosa pastora la falte piedad,
para quien en tanta neçesidad
está della. La otra, que algo más
libre paresçia, con çierto desden,
y vn dar de mano, (cosa muy
natural de personas libres),
respondia: ¿quieres que te diga,
Armia? si yo me fiare otra uez de
quien tan mal me pagó el amor
que le tuue, no terná él la culpa
del mal que a mi desseo me
sucçediere. No me pongas
delante los ojos seruiçios que
esse pastor algun tiempo me aya
hecho, ni me digas ninguna razon
de las que él se da para
mouerme, porque ya passó el
tiempo en que sus razones le
ualian. Él me prometio de casarse
comigo, y se casó con otra. ¿Qué
quiere aora? ¿o qué me pide esse
enemigo de mi descanso? ¿dize
que pues su muger es finada, que
me case con él? No querra Dios
que yo a mí misma me haga tan
gran engaño: dexalo estar, Armia,
dexalo: que si él a mi me dessea
tanto como dize, esse desseo me
dara uengança dél. La otra le
explicaua con palabras muy
blandas, juntando su rostro con el
de la essenta Duarda, con muy
estrechos abrazos: ay pastora, y
cómo te está bien todo quanto
dizes; nunca desseé ser hombre,
sino aora para quererte más que
a mí. Mas dime, Duarda ¿porqué
has tú de querer, que Danteo biua
tan triste vida? El dize que la
razon con que dél te quexas, essa
misma tiene para su disculpa.
Porque antes de que se casasse,
estando contigo vn dia junto al
soto de Fremoselle te dixo:
Duarda, mi padre quiere casarme,
¿qué te paresçe que haga? y que
tú respondiste muy
sacudidamente: ¿Cómo, Danteo,
tan vieja soy yo o tan grande
poder tengo en ti, que me pidas
paresçer y liçençia para tus
casamientos? Bien puedes hazer
lo que tu voluntad y la de tu padre
te obligare, porque lo mismo haré
yo: y que esto fue dicho con vna
manera tan estraña de lo que
solia como si nunca te vuiera
passado por el pensamiento
quererle bien. Duarda le
respondio: ¿Armia, eso le llamas
tú disculpa? Si no te tuuiera tan
conosçida, en este punto perdia
tu discreçion grandissimo credito
comigo. ¿Qué auia yo de
responder a vn pastor que
publicaua que no auia cosa en el
mundo, en quien sus ojos
pussiese sino en mí?, quanto
más, que no es Danteo tan
ignorante que no entendiesse en
el rostro y arte con que yo esso lo
respondi, que no era aquello lo
que yo quesiera respondelle.
¡Qué donayre tan grande fue
toparme el vn dia antes que esso
passasse junto a la fuente, y
dezirme con muchas lagrimas:
porqué, Duarda, eres tan ingrata
a lo que te desseo, que no te
quieres casar comigo, a hurto de
tus padres: pues sabes que el
tiempo les ha de curar el enojo
que desso reçibieren? Yo
entonçes le respondi: contentate,
Danteo, con que yo soy tuya, y
jamas podré ser de otro, por cosa
que me sucçeda. Y pues yo me
contento con la palabra que de
ser mi esposo me as dado, no
quieras que a trueque de esperar
un poco de tiempo más, haga vna
cosa que tan mal nos está; y
despedirse él de mi con estas
palabras, y al otro dia dezirme
que su padre le queria casar, y
que le diesse liçençia: y no
contento con esto, casarse dentro
de tres dias. Paresçe te pues,
Armia, que es ésta algo suffiçiente
causa, para yo vsar de la libertad,
que con tanto trabajo de mi
pensamiento tengo ganada?
Estas cosas (respondio la otra)
façilmente se dizen y se passan
entre personas que se quieren
bien, mas no se han de lleuar por
esto tan a cabo, como las lleuas.
Las que se dizen (Armia) tienes
razon, mas las que se hazen, ya
tú lo vees, si llegan al alma de las
que queremos bien. En fin,
Danteo se casó, pesame mucho
que se le lograsse poco tan
hermosaa pastora: y mucho más
de ver que no ha vn mes que la
enterró, y ya començan a dar
bueltas sobre él pensamientos
nueuos. Armia le respondia:
Matóla Dios: porque en fin Danteo
era tuyo, y no podria ser de otra.
Pues si esso es ansi (respondio
Duarda) que quien es de vna
persona, no puede ser de otra, yo
la hora de aora me hallo mia, y no
puedo ser de Danteo. Y dexemos
cosa tan escusada como gastar el
tiempo en esto. Mejor será que se
gaste en cantar vna cançion, y
luego las dos en su misma
lengua, con mucha gracia,
començaron a cantar lo siguiente:
Os tempos se mudarão
a vida se acabará:
mas a fe sempre estara,
onde meus olhos estão.
Os dias, y os momentos,
as horas, con suas mudanças,
inmigas son desperanças,
y amigas de pensamentos:
os pensamentos estão
a esperança acabará,
a fe, me não deixará
por honrra do coraçon.
He causa de muytos danos

duuidosa confiança
que a vida sen esperança
ja não teme desenganos,
os tempos se vem e vão,
a vida se acabará,
mas a fe não quererá,
hazer me esta semrazão.
Acabada esta cançion, Felismena

salio del lugar a donde estaua
escondida y se llegó adonde las
pastoras estauan, las quales
espantadas de su graçia y
hermosura, se llegaron a ella, y la
reçibieron con muy estrechos
abraços, preguntandole de que
tierra era y de adonde uenia. A lo
qual la hermosa Felismena no
sabia responder, mas antes con
muchas lagrimas les preguntaua,
qué tierra era aquella en que
morauan. Porque de la suya la
lengua daua testimonio ser de la
prouinçia de Vandalia, y que por
çierta desdicha uenia desterrada
de su tierra. Las pastoras
portuguesas con muchas lagrimas
la consolauan, doliendose de su
destierro, cosa muy natural de
aquella naçion, y mucho más de
los habitadores de aquella
prouinçia. Y preguntandoles
Felismena, qué çiudad era
aquella que auia dexado hazia la
parte donde el rio, con sus
cristallinas aguas apressurando
su camino, con gran impetu
uenia, y que tambien desseaua
saber, qué castillo era aquel que
sobre aquel monte mayor que
todos estaua edificado y otras
cosas semejantes. Y una de
aquellas, que Duarda se llamaua,
le respondio, que la çiudad se
llamaua Coymbra, vna de las más
insignes y prinçipales de aquel
reyno, y aun de toda la Europa,
ansi por la tierra comarcana a
ella, la qual aquel caudaloso rio,
que Mondego tenía por nombre,

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Memory Loss Alzheimers Disease and Dementia A Practical Guide For Clinicians 3Rd Edition Andrew E Budson MD Full Chapter

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Memory Loss, Alzheimer's Disease and

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A Practical Guide for Clinicians

Paul R. Solomon, PhD

Any screen, Any time, Anywhere

Praise for the First Edition

Praise for the Second Edition

Preface to the Third Edition

How To Use This Book

About the Authors

Video Table of Contents

1. Why Diagnose and Treat Memory Loss, Alzheimer’s Disease, and

Helping the Patient

Helping the Family or Other Caregiver

Planning for the Future

Quality Versus Quantity

2. Evaluating the Patient With Memory Loss or Dementia

Talking With The Family

Cognitive Tests and Questionnaires

Screening in the Clinic

Structural Imaging Studies

Functional Imaging Studies

Tests that Suggest Alzheimer’s Disease

3. Subjective Cognitive Decline, Mild Cognitive Impairment, and

The Spectrum of Cognitive Changes

Is Mild Cognitive Impairment Present?

Is Subjective Cognitive Decline Present?

Which Clinical Syndrome is Present?

What is the Underlying Pathology?

Prevalence, Prognosis, and Definition

Risk Factors, Pathology, and Pathophysiology

Common Signs, Symptoms, and Stages

Things to Look for in the History

Things to Look for on the Physical and Neurological Examination

Pattern of Impairment on Cognitive Tests

Structural Imaging Studies

Molecular and Functional Imaging Studies

5. Primary Age-Related Tauopathy

Clinical Features, History, and Pattern of Impairment on Cognitive

Things to Look for on the Physical and Neurological Examination

Structural Imaging Studies

Functional and Molecular Imaging Studies

6. Limbic-predominant Age-related TDP-43 Encephalopathy

Prevalence, Prognosis, and Definition

Pathology, Pathophysiology, and Genetics

Common Signs, Symptoms, and Stages

Things to Look for in the History

Things to Look for on the Physical and Neurological Examination

Pattern of Impairment on Cognitive Tests

Structural Imaging Studies

7. Vascular Cognitive Impairment and Vascular Dementia

Prevalence, Prognosis, and Definition

Risk Factors, Pathology, and Pathophysiology

Common Signs, Symptoms, and Stages

Things to Look for in the History

Things to Look for on the Physical and Neurological Examination

Pattern of Impairment on Cognitive Tests

Structural Imaging Studies

Functional and Molecular Imaging Studies

Treatments (see also Table 7.1)

8. Dementia With Lewy Bodies

Criteria and Diagnosis

Risk Factors, Pathology, and Pathophysiology