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Managing Behavioral Manifestations of Neurodegenerative Dementias

— The field of cognitive behavioral neurology often goes overlooked, says Christian Camargo

MedpageToday

A case-based lecture presented at the American Academy of Neurology annual meeting aimed to address common behavioral manifestations in neurodegenerative dementias, help physicians identify behavioral problems that arise specifically in frontotemporal degeneration, and select effective management strategies for behavioral dysfunction in neurodegeneration.

In this exclusive 51˶ video, Christian Camargo, MD, of the University of Miami Miller School of Medicine, explains why he felt this talk was so important and urges fellow practitioners to .

Following is a transcript of his remarks:

A lot of times in the field of cognitive behavioral neurology, there's a great emphasis on the cognitive side and perhaps not so much on the behavioral side. So cognitive side, of course, being sort of the memory part, we think about how people forget the names of things. People forget the stories that were just told to them or where they left their keys, right?

But let's be honest, if we think about what's the most debilitating symptoms, both from what we can imagine and what often our patients tell us, it's really a lot of times more the behavioral things. The hallucination is likely going to happen in the middle of the night, right? Or the agitation and the aggression that can accompany moderate or late stage Alzheimer's dementia.

So that talk was extremely insightful. Off the top of my head, I don't remember the name of the presenters [Jagan Pillai, MD, PhD; Gabriel Leger, MD; and Dylan Wint, MD], but [two were from] the Cleveland Clinic, both from the facility in Cleveland, Ohio, as well as from the Lou Ruvo Center [for Brain Health].

And I thought that they did a fantastic job in going over the behavioral side of not just the classic dementias that involve behavior, like behavioral variant final temporal dementia, where it's literally in the name, but also the behavioral manifestations of very common dementias like Alzheimer's disease and vascular dementia, which are exceedingly more common that we can all encounter. And also addressing how to approach family members about these.

And there's a very practical section at the very end about how to manage these both pharmacologically and non-pharmacologically. And as an institution, we're beginning to incorporate more advanced practice providers. There was a very nice section at the very end where they were discussing the clinical evidence as well as the scientific basis for why certain therapies are used and why they're not used.

And I thought that was very effective, both as a nice refresher for those of us that are very experienced in it. Just remind ourselves that sometimes we do things, even though there may not be a very strong, robust scientific basis for it. But also for individuals who are either just out of training or who may not be as specialized as we are, but to have a basis of, oh this is sort of the initial approach.

And again, this is towards the behavioral side, because again, that's really oftentimes the most disabling. And when we're talking about things like healthcare costs, burden on families and on the healthcare system itself, that is a critical thing.

So I thought that was a very important topic and I just wish it was more attended. Although to be honest, the room was already probably close to full, so I don't know that it could have been [even more attended]. So I just hope people go back and watch that lecture.

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    Greg Laub is the Senior Director of Video and currently leads the video and podcast production teams.