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    Dementia in Amyotrophic Lateral Sclerosis (ALS)

    Exams and Tests for ALS and Dementia continued...

    Lab tests for dementia

    There is no lab test that will diagnose dementia. Blood may be tested for other conditions that can cause dementia symptoms.

    Imaging studies for dementia

    Brain scans are the best way to see changes in brain structure that can be associated with some forms of dementia. Here are the types used to look at the brain:

    • A CT scan uses finely focused X-rays to show greater detail than a simple X-ray. It may show frontal lobe shrinkage (atrophy) in ALS with dementia.
    • MRI scans use magnets to show even greater detail of brain structures.
    • Single-photon emission computed tomography (SPECT) images are also sometimes used to show problems in brain functioning. SPECT is available at only a few large medical centers.

    Other tests for dementia

    • Electroencephalography (EEG) measures electrical activity in the brain. It is sometimes helpful in distinguishing various causes of dementia symptoms.
    • Electromyography (EMG) measures electrical activity in muscles. It can be used to distinguish ALS from other conditions that cause similar symptoms, such as muscle weakness, but are not motor neuron diseases.

    Treatment for Dementia in ALS

    Treatment of dementia in ALS and other motor neuron diseases focuses on relieving symptoms.

    Drugs for Dementia and ALS

    No specific drug treatment is available for frontal lobe dementia in motor neuron diseases like ALS.

    • The few available treatments for motor neuron diseases have had little effect on the dementia. Riluzole (Rilutek) is currently the only approved medication for motor neuron diseases. No strong evidence shows that this drug improves dementia due to motor neuron disease.
    • Gabapentin (Neuronton) is a drug sometimes used to treat muscle spasms, cramps or twitches in people with motor neuron diseases such as ALS, and has shown possible value for treating agitation in some forms of dementia (such as vascular dementia, or Alzheimer's disease), but has not been shown to affect dementia symptoms in patients related to motor neuron disease.
    • Drugs called cholinesterase inhibitors used in Alzheimer's disease (another type of dementia) may worsen irritability in people with frontal lobe dementia. These include donepezil (Aricept), rivastigmine (Exelon), and galantamine/galanthamine (Reminyl).

    Behavior disturbances may improve with medications that include:

    • Antidepressants that alter brain chemistry in certain ways can improve mood and/or calm agitation. These include the selective serotonin re-uptake inhibitors (SSRIs), such as fluoxetine(Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).
    • Antipsychotic medications such as dopamine blockers, which are also used to treat psychosis; these include olanzapine(Zyprexa). However, antipsychotics may increase the risk for death in people with dementia-related psychosis.

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