Lancet neurology
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Low-grade gliomas (LGG) are not benign neoplasms. Patients with LGG eventually die as a consequence of this disease. ⋯ Breakthroughs in molecular biology have improved our understanding of tumours and have led to the development of novel treatments and better prognoses. Ongoing clinical trials will help to elucidate the optimum management of patients with LGG.
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The traditional view of dementia is that the features most important to accurate diagnosis and management are cognitive decline and functional disability. Behavioural and psychological symptoms have generally been thought to be of secondary importance, but new evidence suggests that these are important determinants of patients' distress, carer burden, and outcome in dementia; they can also be valuable diagnostic pointers to the underlying pathological cause and disease diagnosis. ⋯ Although pharmacological management is a commonly used option, it is often limited in its effects and can be associated with a substantial risk of side-effects. Progress in understanding the pathophysiological mechanisms underpinning behavioural and psychological symptoms in dementia will assist in developing more effective treatment approaches.
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Dementia is one of the major causes of dependency after stroke. The prevalence of poststroke dementia (PSD)-defined as any dementia occurring after stroke-is likely to increase in the future. In community-based studies, the prevalence of PSD in stroke survivors is about 30% and the incidence of new onset dementia after stroke increases from 7% after 1 year 48% after 25 years. ⋯ In developed countries, the proportion of patients with presumed Alzheimer's disease among those with PSD is between 19% and 61%. Patients with PSD have high mortality rates and are likely to be functionally impaired. These patients should be treated according to the current guidelines for stroke prevention.
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Frontotemporal dementia (FTD) is a focal clinical syndrome characterised by profound changes in personality and social conduct and associated with circumscribed degeneration of the prefrontal and anterior temporal cortex. Onset is typically in the middle years of life and survival is about 8 years. ⋯ However, more than half of all patients with FTD, including some with a strong family history, show no apparent abnormality in the tau gene or protein, indicating pathological and aetiological heterogeneity. FTD provides a challenge both for clinical management and for theoretical understanding of its neurobiological substrate.