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ALZHEIMER'S DISEASE AND DEMENTIA
Dementia is a clinical syndrome characterized by impairment of multiple higher cortical functions that include memory, orientation, thinking, comprehension, calculation, capacity for learning, language, judgment,  executive function and visuo-spatial function. It is usually accompanied or preceded by deterioration in emotional control, social behavior or motivation.
Alzheimer's disease is the most common cause of dementia. Sporadic cases usually present after >60 year while familial types are rare and present in <60 year of age (early-onset dementia).
Short-term memory loss is the most common early symptom. Other spheres of cognitive impairment manifest after several years.

Patient Education

Patient and Caregiver

  • Good communication needs to be established between clinician, patient and family
  • If intensive long-term education and support services are provided to the caregivers, it may delay time to nursing home placement
  • Educate the patient and caregivers about the illness and available treatments
    • Address concerns about behavioral symptoms which may be associated with loss of social status, dignity and the need for increased caregiver support
    • Reassure that these are part of the illness and due to direct damage to the brain and are usually controllable with treatment
  • Teach the patient, family and other caregivers to recognize symptoms and to anticipate future manifestations
  • May be helpful to educate the caregivers concerning the basic principles of care
    • Keep requests relatively simple; avoid giving the patient complex tasks which may lead to frustration
    • Avoid confrontation and defer requests if patient becomes angered
    • Remain calm, firm and supportive
    • Be consistent and avoid unnecessary change
    • Provide frequent reminders, explanations and orientation clues
    • Recognize decline in capacity and adjust expectations
    • Seek professional attention during sudden decline in function or emergence of new symptoms

Healthcare Workers

  • Education of the nursing home staff may reduce the use of physical restraints and unnecessary antipsychotics

Caregiver Support

Reduces risk of substandard care, neglect or abuse

  • Refer caregivers to support group networks, if available
  • Respite care (eg visiting nurses, day care programs, brief nursing home stays, etc), if available, should be utilized to provide periods of rest for the caregivers from responsibilities
    • Allows caregivers to continue to work or fulfill other responsibilities
    • Helps the caregivers to relieve stress and mood disturbance associated with long-term care
  • Psychoeducational workshops may be useful for caregivers to help cope with frustration or mood disturbance

Assist with Financial and Legal Issues

  • Patients with dementia often lose their ability to make medical, legal and financial decisions as the disorder progresses
    • If arrangements are made while patient is still able to participate, caregivers can seek the patient’s guidance regarding long-term plans
  • Patients may wish to pass authority for legal and financial decision-making to a trusted family member/friend
    • This will help avoid difficulty and expense of petitioning the court for guardianship or conservatorship later
  • Discuss preference about medical treatment (eg nursing home placement, artificial life support, etc) during early part of illness so that patient may make known their wishes
  • Educate the patient/caregivers about the importance of financial planning for future treatment and nursing care
  • Advise patients to complete or update their wills, establish appropriate trusts and transfer of assets during early part of illness when mental competence for decision making is still maintained
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