ABSTRACT
Dementia affects nearly 50 million people worldwide, translating into one new case every 3 seconds. Dementia syndrome is one of the leading causes of disability among older adults, yet it remains vastly underdiagnosed. A timely diagnosis of dementia is essential to ensuring optimal care and support of individuals and their loved ones. Although there is no single test for dementia, health care providers can use a structured approach to the workup and management of new cognitive symptoms. Comprehensive MEDLINE and PubMed searches were performed to develop an unbiased, practical diagnostic approach to these symptoms. This review guides primary care providers in the workup, diagnosis, delivery, and initial management of patients presenting with new cognitive symptoms.
Subject(s)
Cognitive Dysfunction/diagnosis , Dementia/diagnosis , Primary Health Care/methods , Aged , Cognitive Dysfunction/physiopathology , Dementia/physiopathology , Humans , Mass Screening/methods , Mental Status and Dementia TestsABSTRACT
The expansion of medical and recreational marijuana legalization facilitates patient access to cannabis, and many patients with epilepsy pursue marijuana as a treatment for seizures. We administered a nine-item survey on marijuana use to patients seen in an epilepsy clinic over a 9â¯month period at a tertiary care center in Oregon where recreational use was legalized in 2015. The majority of respondents (nâ¯=â¯39) reported cannabis use for the purpose of treating epilepsy (87.2%, nâ¯=â¯34), and strongly agreed (53.8%, nâ¯=â¯21) or agreed (28.2%, nâ¯=â¯11) that cannabis use improved seizure control. The most commonly selected cannabis strains were high cannabidiol (CBD) (30.8%, nâ¯=â¯12) or multiple types (30.8%, nâ¯=â¯12), with administration methods of smoking (66.7%, nâ¯=â¯26), edibles (48.7%, nâ¯=â¯19), and concentrates (43.6%, nâ¯=â¯17). More participants reported using marijuana with primarily CBD than primarily tetrahydrocannabinol (THC) or equal CBD:THC content, and very few women reported using marijuana with primarily THC compared with men (10% of female versus 47% of male respondents). Only 2 of 39 participants were able to give an exact dosage used in milligrams. Medical and recreational dispensaries were the most common cannabis sources, followed by homegrown and friends/family members. Although pharmaceutical CBD extract is now Food and Drug Administration (FDA)-approved for certain epilepsy types, access remains limited. Further research is needed to understand recreational cannabis use among patients with epilepsy while clinical research for pharmaceutical cannabis products continues.
