New CME Series

Treating and Caring for the Patient With Moderate-to-Severe Alzheimer’s Disease

  • Effective Communication Strategies to Help Patients and Caregivers Cope With Moderate-to-Severe Alzheimer’s Disease
  • Managing Patients With Moderate-to-Severe Alzheimer’s Disease: Expectations, Treatments, and Prognosis

The Impact of Oral Medications on the Treatment of Multiple Sclerosis

  • Current Standards of Treatment in MS and the Role of Oral Agents
  • Switching Therapies in MS: What Are the Options?
  • Recognizing and Overcoming Potential Barriers to Oral Medications for MS
  • Identifying and Addressing Unmet Therapeutic Needs in MS

See all Neurology Reports

FEATURED ARTICLES

Read about the case of Mr A, a 51-year-old former musician with chronic alcoholism and multiple inpatient rehabilitation stays for addiction counseling and detoxification. The authors discuss interventions for alcohol use disorders and provide guidelines for physicians when treating these patients.

Review 2 patient cases that illustrate a looming problem and potential association for individuals with long-term posttraumatic stress disorder (PTSD)—the development of dementia. Both patients were veterans who had years of treatment for PTSD. They developed dementia before age 65 years and had Parkinson-like motor symptoms.

Do you tailor your treatment plan for patients with MS according to their disease course? Here, get an overview of the benefits and adverse effects of the available disease-modifying agents for MS, and discover how to select appropriate relapse treatment.

See all Alzheimer's Disease

ALZHEIMER'S DISEASE

This review follows the progress of rivastigmine over the years, from the basics of its pharmacology, mechanism of action, chemical properties and key historic clinical milestones with oral capsules, to the rationale for transdermal delivery and more recent evidence and practical guidance on the clinical use of rivastigmine transdermal patch in dementia management, particularly Alzheimer’s disease.

How do you prepare caregivers to handle the loss of function in patients with Alzheimer's disease? Read this Neurology Report to discover ways to provide realistic expectations of the disease and the goals of treatment and to select appropriate treatments to slow functional decline and manage troublesome behavioral and psychological symptoms.

The Alzheimer’s disease epidemic is here, with about 5 million Americans currently afflicted. This evidence-based review presents a practical blueprint for the diagnosis and management of Alzheimer’s Disease in primary care.

See all Autism

AUTISM

Autistic disorder is characterized by qualitative impairments in reciprocal social interaction, verbal and nonverbal communication, among other characteristics.

Autism is a neurodevelopmental disorder with childhood onset characterized by atypical developments.

See all Dementia

DEMENTIA

Should antipsychotics be used for patients with dementia in long-term care? What about antidepressants? An expert answers these and other questions. Take a look and comment.

One of the most difficult patients to manage is the individual with agitated dementia. Still, there is no clear clinical strategy for treating the agitated, acting-out, demented patient. Dr Meyers summarizes what is known and describes her experience with Mr A, a 71-year-old man who lived in a residential care facility and had hit his roommate “with fists and a belt.”

Don’t be too quick to reach for your prescription pad to handle disruptive behaviors in patients with dementia. Instead, Dr Tariot recommends using behavioral interventions. Learn more and comment on the Let’s Talk blog.

See all Headache

HEADACHE

A vast array of idiopathic somatic complaints are common among depressed persons across the lifespan.

Headaches account for a high percentage of office visits to primary care physicians.

See all Movement Disorders

MOVEMENT DISORDERS

Comprehensive Behavior Intervention for Tics (CBIT) is a safer and effective alternative to antipsychotics for the treatment of Tourette’s disorder. This report describes the case of a 5-year-old child with Tourette’s disorder who benefited from the components of CBIT.

Tardive dyskinesia is a well-known side effect of conventional antipsychotics. Fluvoxamine may be an effective treatment for neuropsychiatric disorders via sigma-1 receptor agonism. Here, Albayrak and colleagues report 5 cases in which fluvoxamine was beneficial for both postpsychotic depressive disorder and tardive dyskinesia in patients with schizophrenia.

Read about the case of a 60-year-old woman who developed a disabling intention tremor in her hands, head, and jaw 2 months after aripiprazole was added to lamotrigine treatment.

See all Multiple Sclerosis

MULTIPLE SCLEROSIS

Current disease-modifying treatments in multiple sclerosis (MS) are mainly effective in relapsing forms of MS and do not restore function. Read this Neurology Report to discover unmet needs for treatments of progressive MS and MS symptoms, and learn about the development of neuroprotective agents.

In this Primary Care Companion case, diagnose and manage Ms A, an 84-year-old woman whose cognitive changes began about 1 year ago. She is increasingly repetitive, no longer able to manage her finances, and occasionally misses medication doses. Ms A still drives short distances, keeps up her self-care, and enjoys playing bridge with friends, but she has been irritable with her daughter.

Breakthrough disease is common, even in patients with good adherence to their medications. Review this Neurology Report to explore ways to assess and manage adherence, monitor disease course through clinical and MRI measures, and make timely treatment adjustments in your patients with multiple sclerosis.

See all Other

OTHER

Have any patients come to you with vision problems that their eye doctors can't solve? See this Primary Care Companion interactive case report to learn about how these symptoms may be indicative of a variant of Alzheimer's disease or a precursor. Diagnostic tests and potential treatments are discussed.

Recent school shootings call attention to a troubling phenomenon—young men committing violent crimes. Dr Jantz attributes much of this shocking behavior to the way that boys are treated at their earliest, formative ages. Normal boyhood behavior is labeled as unruly and unacceptable, and families and schools just don’t understand their brain chemistry. So, what can we do? Find out and comment on our blog.

Read this true patient case and commentary to review the story of Mr A, a 35-year-old veteran with debilitating multiple sclerosis who is facing the emotional consequences of his illness while residing at a nursing home unit.

See all Pain

PAIN

What’s your perception of borderline personality disorder? In this review article, examine 2 symptom manifestations among patients with borderline personality in primary care and general medical settings—namely pain sensitivity and multiple somatic complaints. In addition to reviewing the research of others, the authors highlight their own investigations into these 2 areas.

Patients with fibromyalgia have reported experiencing discouragement, rejection, suspicion, and stigma during their encounters with health care professionals. What’s the impact of these experiences on health outcomes? Review results from a study that assessed fibromyalgia patients’ self-reported quality of life and pain based on perceptions of physician attitudes, trust in physicians, perceptions of medical professionals, type of treatment, and various demographic variables.

About 50% of patients with bipolar disorder also have a pain disorder. Carbamazepine is the only drug that has guideline-supported robust efficacy in the management of each condition separately. Here, Dr Rahman and colleagues present carbamazepine’s history and discuss other treatment options for chronic pain and bipolar disorder.

See all Parkinson's Disease

PARKINSON'S DISEASE

The authors of this Letter to the Editor report 4 cases of long-term chronic pain that improved dramatically following administration of aripiprazole, a partial dopamine agonist.

Read about the case of Mr A, a 41-year-old patient with Parkinson’s disease who presented in a mental health clinic after experiencing new-onset compulsive behavior with the dopamine agonist ropinirole. For the past few months, he was having intense sexual desires, an increase in appetite, and had started gambling.

This Letter to the Editor describes the case of Ms A, a 64-year-old patient in a skilled nursing facility whose psychotic symptoms completely remitted with a combination of aripiprazole and divalproex. She also experienced improvement in Parkinson’s disease symptoms, specifically tremor and akinesia.

See all Sleep

SLEEP

Do you screen for restless legs syndrome (RLS) in your patients with sleep disturbances? Check out this Neurology Report to learn how misconceptions about RLS can hinder its correct diagnosis and discover how diagnostic criteria and associated features can improve your ability to recognize this condition.

How well are sleep problems being managed in your patients with PTSD? Insomnia, nightmares, sleep apnea, and sleep movement disorders are common in these patients. Read this journal CME activity to find out about diagnosing and managing these conditions so that you can better help your patients with PTSD.

Sleep problems are associated with concentration problems, mood disorders, and driving accidents. In this activity, understand how the sleep cycle should function, what processes can be affected by sleep problems, and what systems are involved in enhancing sleep or blocking wakefulness.

See all Stroke

STROKE

Have you ever wondered how people cope with the devastating sequelae of strokes?

We read with interest the recenetly published discussion concerning the use of atypical antipsychotic medications in the primary care setting.

Is it reasonable to assume that just about everyone becomes depressed following a stroke?

SUBSTANCE ABUSE/ALCOHOLISM

See all Substance Abuse/Alcoholism

A growing number of older adults are being admitted for first-time treatment of substance abuse. In this article, Dr Yarnell reviews the latest literature related to cocaine abuse in later life, as well international guidelines for addiction. She also presents three cases of cocaine use in patients over the age of 50, who were all seen by one provider within a 10-day span in 2013.

The authors of this article investigated the possible anticraving efficacy of high-frequency deep transcranial magnetic stimulation of the bilateral dorsolateral prefrontal cortex in 3 patients with comorbid long-term DSM-IV-TR dysthymic disorder and alcohol use disorder.

Synthetic cannabinoid use continues to increase. The authors of this Letter to the Editor report the case of a woman presenting with severe synthetic cannabinoid physical dependence, smoking “mojo” every 15 minutes during the day and awakening every 45 minutes in full withdrawal to smoke it overnight.