tag:blogger.com,1999:blog-4993425214981019244.post2906157394236546642..comments2013-07-12T19:46:04.875-07:00Comments on Sachdev on Neuropsychiatry: HAS THE TERM ‘DEMENTIA’ OUTLIVED ITS USEFULNESS?Perminder Sachdevhttp://www.blogger.com/profile/13069013579203929113noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-4993425214981019244.post-46252277870230705262010-01-29T16:57:03.284-08:002010-01-29T16:57:03.284-08:00Hi Perminder: I agree strongly with you on many fr...Hi Perminder: I agree strongly with you on many fronts here. Building resilience and creating cognitive reserve are not the same as preventing the conditions which constitute the dementias. As you say, its merely pushing the individual further up the ladder, from which it takes longer to fall. Similarly, one can arrive at a Korsakoff's as his original patients did, namely nutritional deficiency, alcohol related excitotoxicty, or from a stroke of the ACA or the usual thiamine route, and many causes might bring the brain to the same endpoint, yielding not necessary syndromes, but constellations of symptoms in the neurobehavioral spectrum. Clumping symptoms together in the DSM IV has yielded the same problems, namely there is more intra-diagnosis variation then inter-category variance. So anxiety and depression are then poorly differentiated as syndromes, more easily as symptom constellations, and the differentiation there is has not led to differentiated drug treatments. OCD and ADD may be two sides to the same coin basal ganglia regulatory feedback loops, hence the treatments in drug terms might be the same when dealing with certain neurotransmitter systems, but the behavioral treatments differ widely. My own interest is building resilience in terms of movement, nutrition, and mindset to build cognitive reserve, but doing so by integrating what might flow from the optimal body, namely BDNF, VEGF etc and that is pretty much generic, rather than pathology based. Best, Roy SugarmanAnonymoushttps://www.blogger.com/profile/02160699511407898584noreply@blogger.com