Outpatient Medicine Update-Neurology Update

Video Transcription

Video Summary

The presentation reviews dementia and stroke prevention through a patient case and current evidence. A 74-year-old man with progressive memory and financial-management problems scored 19 on the Montreal Cognitive Assessment. Normal labs and brain MRI, together with a positive amyloid PET scan, supported mild cognitive impairment with amyloid burden.<br /><br />Dementia evaluation should include shared goals, history and examination, validated cognitive testing, assessment of daily function and contributing factors, and appropriate laboratory and imaging studies. Lecanemab and donanemab are approved for eligible patients with mild cognitive impairment or mild Alzheimer’s dementia and confirmed amyloid. They slow cognitive decline but do not restore lost abilities; amyloid-related imaging abnormalities require MRI monitoring. A slower donanemab dosing regimen appears to reduce these risks. Brexpiprazole is approved for agitation associated with Alzheimer’s dementia.<br /><br />The talk highlights potentially modifiable dementia risks. Blood-pressure control, physical activity, hearing and vision care, smoking avoidance, and healthy sleep may help reduce risk. Studies also associate lower dementia rates with moderate caffeinated coffee or tea, statin use, some diabetes treatments, and zoster vaccination; many of these findings are observational.<br /><br />Stroke prevention emphasizes the AHA’s Life’s Essential Eight, including blood-pressure, cholesterol, and blood-sugar management, exercise, healthy eating, sleep, and tobacco avoidance. After minor stroke or TIA, short-term aspirin plus clopidogrel can reduce early recurrence, but prolonged dual therapy increases bleeding risk. For stroke with atrial fibrillation, evidence supports starting anticoagulation early in many patients, while long-term rhythm monitoring is important after unexplained stroke. Optimal medical therapy is central to secondary prevention and may reduce the added benefit of carotid procedures in some patients.

Keywords

dementia

stroke prevention

mild cognitive impairment

Alzheimer's dementia

amyloid PET

lecanemab

donanemab

brexpiprazole

modifiable risk factors

blood pressure control

dual antiplatelet therapy

atrial fibrillation

Life's Essential Eight

secondary prevention