**3. Brief comment about our chapters**

*In the second chapter of this project, we delivered our personal experience on the most common cognitive disorders and discuss the novel information available in the medical literature on some types of dementia. We described Alzheimer Disease as a progressive non-reversible neurodegenerative disorder, characterized by cognitive decline including learning capacity, emotional and behavioral alterations, motor skills impairment, including dysfunction of the autonomic nervous system and desynchronization of circadian rhythms.* It has been predicted that a novel therapeutic agent that delays disease onset and progression by just 1 year would result in 9 million fewer cases by 2050 [31].

Vascular dementia (VaD) can be caused by disturbance of the blood supply to the brain leading to deprivation of the necessary such as nutrients including glucose, amino acids and oxygen to the neurons and its supporting cells. This particular type of dementia is strongly related with multifocal strokes, hypertension and diabetes mellitus type II and it is characterized by mental slowness; impaired initiative, planning, and executive function impairment; personality changes; and gait disorders. Arteriosclerotic brain disease presents as multiple focal areas of hypoperfusion randomly distributed in the cortex, also compromising subcortical structures. This particular pattern is never been observed in A.D. A familial form of VaD is cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), which is associated with vascular migraine headache and a subcortical ischemic lesion. CADASIL is caused by a mutation in the NOTCH3 gene on chromosome 19 being the most common genetic form of VaD. The disease is autosomal dominant. Dementia with Lewis Body is a type of dementia associated with abnormal protein deposits (α-synuclein) called Lewy bodies in the central nervous system (CNS), and these abnormal depositions affect the normal activities of the brain leading to clinical features of fluctuating consciousness, behavioral disorders, visual hallucinations, and parkinsonism. The metabolic defects described in this disease are very close to those found in AD, but there is also hypoperfusion in the occipital lobes. Parkinson dementia is characterized by bradykinesia, tremor at rest, gait disturbance, postural problems, rigidity, dysarthria, dysfunction of the judgment, reasoning, memory, depression, anxiety, insomnia, and cognitive decline due to loss of midbrain dopaminergic neurons in the pars compacta of the substantia nigra and consequent loss of dopamine input to the caudate nucleus and putamen (striatum), and is more prevalent in men. Idiopathic Parkinson disease with dementia can show hypoperfusion patterns similar to those observed in AD, but basal ganglia hypoperfusion is far more frequent, as is frontal precentral hypoperfusion [32].

The term dementia with Lewis Body and the clinical criteria were first introduced and proposed by Mc Keith and colleagues in 1996 during the First International Workshop of the

In the twenty-first century, many types of dementia have been identified being AD and VaD, the commonest one. Fortunately, from the last century, cognitive disorders such as idiopathic normal pressure hydrocephalus have specific treatment, and patients can reach a complete

Currently, apart for the advance role on the therapeutic field in almost all types of dementias, we highlighted the tremendous progress got in the field of diagnosis mainly in the field of pathological examination and metabolic activity in nuclear medical imaging tests such as single photon emission computed tomography and Positron Emission Tomography scans of

*In the second chapter of this project, we delivered our personal experience on the most common cognitive disorders and discuss the novel information available in the medical literature on some types of dementia. We described Alzheimer Disease as a progressive non-reversible neurodegenerative disorder, characterized by cognitive decline including learning capacity, emotional and behavioral alterations, motor skills impairment, including dysfunction of the autonomic nervous system and desynchronization of circadian rhythms.* It has been predicted that a novel therapeutic agent that delays disease onset and progression by just 1 year would result in 9 million fewer cases by 2050 [31]. Vascular dementia (VaD) can be caused by disturbance of the blood supply to the brain leading to deprivation of the necessary such as nutrients including glucose, amino acids and oxygen to the neurons and its supporting cells. This particular type of dementia is strongly related with multifocal strokes, hypertension and diabetes mellitus type II and it is characterized by mental slowness; impaired initiative, planning, and executive function impairment; personality changes; and gait disorders. Arteriosclerotic brain disease presents as multiple focal areas of hypoperfusion randomly distributed in the cortex, also compromising subcortical structures. This particular pattern is never been observed in A.D. A familial form of VaD is cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), which is associated with vascular migraine headache and a subcortical ischemic lesion. CADASIL is caused by a mutation in the NOTCH3 gene on chromosome 19 being the most common genetic form of VaD. The disease is autosomal dominant. Dementia with Lewis Body is a type of dementia associated with abnormal protein deposits (α-synuclein) called Lewy bodies in the central nervous system (CNS), and these abnormal depositions affect the normal activities of the brain leading to clinical features of fluctuating consciousness, behavioral disorders, visual hallucinations, and parkinsonism. The metabolic defects described in this disease are very close to those found in AD, but there is also hypoperfusion in the occipital lobes. Parkinson dementia is characterized by bradykinesia, tremor at rest, gait disturbance, postural problems, rigidity, dysarthria, dysfunction of the judgment,

Consortium on Dementia with Lewy Bodies [30].

**3. Brief comment about our chapters**

recovery.

8 Cognitive Disorders

the brain.

Dementia is also part of the clinical manifestation of some types of Parkinsonism such corticobasal degeneration in which bilateral and symmetrical hypoperfusion of the frontal, parietal lobe and basal ganglia are present. There is symmetrical severe basal ganglia hypoperfusion also affecting the mesial regions of the frontal lobes in supranuclear palsy. The hallmark finding in multiple system atrophy is cerebellar hypoperfusion, besides symmetric basal ganglia hypoperfusion [33].

Mixed Dementia: the association of AD and vascular dementia is the commonest cause of mixed dementia. Idiopathic normal pressure hydrocephalus is characterized by late onset, surgically treated progressive neurodegenerative disease caused by inadequate cerebrospinal fluid (CSF) dynamics and ventriculomegaly while other types including low pressure hydrocephalus are usually secondary to head injury, subarachnoid hemorrhage, infections, and other problems that cause an accumulation of the cerebrospinal fluids (CSF) in the ventricular system of the brain mainly associated to its impaired drainage. Wernicke encephalopathy and Korsakoff syndrome (Wernicke-Korsakoff syndrome) and Alcohol related dementia are preventable, life-threatening neuropsychiatric syndromes resulting from thiamine deficiency mainly in patients with chronic alcoholism, anorexia nervosa or patients that have undergone bariatric surgery for obesity, chronic hepatic disease, immunodeficiency syndromes, nutritional deficiencies of any cause, metastatic carcinomas, hyperthyroidism, prolonged parenteral nutrition, hyperemesis gravidarum, long-term dialysis and diuretic therapy among other causes and clinically, patients' complaints about short-term memory, confusional states, and neuropsychiatry manifestations, HIV-associated neurocognitive disorders (HAND). Many of the complications secondary to HIV-1 infection (including all opportunistic infections) have decreased dramatically excepting HAND which is quite common CNS disorder caused by HIV infection. Huntington disease: in our series of patients presenting Huntington's disease (HD), an important number of them do not have extrapyramidal signs of chorea. Frontotemporal dementia: patients with the different diseases in this group present severe bilateral hypoperfusion in the frontal lobes, predominantly in the mesial structures [34].

We comment about Creutzfeldt Jacob Disease as an extremely uncommon degenerative disorder due to a slow virus (prion) infection that affects the brain and it is also known as mad cow disease. The diagnosis of CJD is usually made when patient older than 60-year-old died and the spongiform changes in the brain post-mortem examination are confirmed. We also discussed about the available update information on the commonest cognitive screening test used to evaluate cognition, and finally we documented our conclusion from previous investigations done.

In the chapter titled "Identification of cognitive impairment markers (Neurospecific proteins, Magnetic Resonance Image) in patients with Diabetes Mellitus type 1," the authors studied the effects of metabolic disorders on the development of cognitive disorders in patients presenting the abovementioned disorder. They concluded that chronic hyperglycemia and glucose variability are risk factors for the development of cognitive dysfunction, which confirm the need for more severe compensation of the disease. They also highlighted: "For type 1 diabetic patients with unsatisfactory compensation of carbohydrate metabolism the neurophysiological tests looking for cognitive decline should be done."

Department of Neurology, Laboratory of Neuropathology and Electron Microscopy in Greece afforded this topic (The hypothalamus) and the AD and made a Golgi and electron micro-

Introductory Chapter: Cognitive Disorders and Its Historical Background

http://dx.doi.org/10.5772/intechopen.77084

11

They found that the pathological alterations of hypothalamic nuclei in AD would induce the autonomic instability, which would be particularly prominent at the advanced stages of the disease, aggravating the clinical condition of the patients exceedingly, a fact which is also observed in experimental models of AD as well as in the behavioral variant of frontotemporal

Finally, they concluded that a serious autonomic dysfunction in advanced stages of AD compose the tragic epilogue of the disorder which is related with the involvement of the hypo-

Other authors from New Zealand made a study about "Effective Restoration Home Support for Older Peoples Living with Dementia and their Caregivers." One of the most relevant aspects of this investigation was the identification of 10 key factors supporting the adequate restorative home support services for those patients. Its grouped in three primary headings that are congruent with the information published in the medical literature, and they have international implications which include policy and practice that keep the needs and wellbeing of the dementia diagnosed person and their caregiver central to all decision-making and keeping track of their progression. They also agreed that local solution will influence future decision-making, and this is one of the most important aspects that this chapter highlighted.

\* and Lourdes de Fátima Ibañez Valdés<sup>2</sup>

1 Department of Neurology, Faculty of Health Sciences, Nelson Mandela Academic

2 Epilepsy and Neurocysticercosis Clinic, Mthatha, Eastern Cape Province, South Africa

[1] Kinsella K, Velkoff VA. The demographics of aging. Aging Clinical and Experimental

[2] Alzheimer's Disease International. The Global Impact of Dementia. An Analysis of Prevalence, Incidence, Cost and Trends. London: Alzheimer's Disease International (ADI); 2015 [3] Lucca U, Tettamanti M, Tiraboschi P, et al. Prevalence of dementia in the oldest old: The Monzino 80-plus population based study. Alzheimers Dement. 2015;**11**:258-270

thalamus during the continuous pathological process of the disease.

\*Address all correspondence to: humbertofoyacasibat@gmail.com

Hospital, Walter Sisulu University, Mthatha, South Africa

Research. 2002;**14**(3):159-169

scopic study.

dementia.

**Author details**

**References**

Humberto Foyaca Sibat<sup>1</sup>

In the chapter: Dementia Friendly Assistive Brotherhood Communities, authors from Bournemouth University in United Kingdom highlighted the usability of an assistive software application developed for 8 patients living with dementia (PWLD) and 40 volunteers at 5 different cities of Pakistan.

Overall, the PWLD showed great interest in all the functionalities of the assistive brotherhood community application and were keen to adopt it permanently in their daily life activities. The PWLD specifically appreciated the increased socialization opportunities through the use of assistive brotherhood community application. The implementation of assistive brotherhood community application in the lives of the PWD will increase their confidence, selfesteem, and independence.

Another important chapter on Re-framing and Re-thinking Dementia in the Correctional Setting is written by two authors from University of Adelaide and University of South Australia. They raise the concern about the aging population in the Australian correctional setting. They highlighted the increasingly complex healthcare needs in the prisoner population who present with poorer physical, social, and mental health than the general population, and they also concluded that healthcare services within the correctional environment needs to match that in the general community and this requires the development of policies to support staff to put processes in place that will improve health outcomes for prisoners.

One chapter written by two Korean colleagues from Korea Institute of Science and Technology cover the most relevant aspects of Tau in Tauopathies that leads to Cognitive Disorders and in Cancer. They refer Tau as a copious microtubule-associated protein mainly expressed in neurons; it is also expressed in non-neuronal cell. Tauopathies are neurodegenerative diseases occurring mostly within the neuronal and glial cells of the central nervous system with a conspicuous tau pathology. Tau might have significant functions in non-neuronal cells. In this chapter, authors describe the associations between tauopathies and cancer.

Nowadays, some drugs used for the treatment of cancer are also used for the treatment of different neurological disorders like Parkinson's disease and AD. They said that Nilotinib is an FDA-approved protein tyrosine kinase inhibitor (TKI)—used for the treatment of chronic myeloid leukemia but it also targets AD and produces neuroinflammation and misfolded proteins that ultimately reduce cognitive damage. In Parkinson's disease, nilotinib triggers autophagy to remove hyperphosphorylated tau from the brain before they accumulate as plaques.

The hypothalamus plays a central role in autonomic functions, including the generation and control of the circadian rhythms, the thermoregulation, the homeostasis of proteins, the maintenance of energy supply and the feeding behavior. Five authors from Aristotelian University, Department of Neurology, Laboratory of Neuropathology and Electron Microscopy in Greece afforded this topic (The hypothalamus) and the AD and made a Golgi and electron microscopic study.

They found that the pathological alterations of hypothalamic nuclei in AD would induce the autonomic instability, which would be particularly prominent at the advanced stages of the disease, aggravating the clinical condition of the patients exceedingly, a fact which is also observed in experimental models of AD as well as in the behavioral variant of frontotemporal dementia.

Finally, they concluded that a serious autonomic dysfunction in advanced stages of AD compose the tragic epilogue of the disorder which is related with the involvement of the hypothalamus during the continuous pathological process of the disease.

Other authors from New Zealand made a study about "Effective Restoration Home Support for Older Peoples Living with Dementia and their Caregivers." One of the most relevant aspects of this investigation was the identification of 10 key factors supporting the adequate restorative home support services for those patients. Its grouped in three primary headings that are congruent with the information published in the medical literature, and they have international implications which include policy and practice that keep the needs and wellbeing of the dementia diagnosed person and their caregiver central to all decision-making and keeping track of their progression. They also agreed that local solution will influence future decision-making, and this is one of the most important aspects that this chapter highlighted.
