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Dementia: Update for the Primary Care Physician

The study of Alzheimer’s disease and other dementias was a wasteland for serious investigative efforts when I was in medical school. Now it is one of the most exciting areas in biomedical research. The NEJM addressed the complexity of Alzheimer’s disease in an editorial on March 3, 2005, noting that it is a result not just of genetics but of a complex mixture of environmental and genetic factors. Nevertheless, the study of the genetics of Alzheimer’s has provided us with our most powerful insights into the pathogenesis of the disorder. This has come particularly from the study of kin with autosomally inherited Alzheimer’s disease. Drs. Lan Xiong, Claudia Gaspar, and G.A. Rouleau update us on this exciting topic in their article, “Genetics of Alzheimer’s Disease and Research Frontiers in Dementia.” The hope is that such research will eventually result in more specific treatments that can halt the progressive neuronal loss observed in Alzheimer’s disease. For now, however, we must be satisfied with symptomatic treatment. Dr. Ann Schmidt Luggen provides a “Review of the Pharmacological Management of Cognition and Behavioural Problems in Older Adults with Advanced Dementia.”

Drugs with proven efficacy against severe dementia have only recently become available in Canada. Dr. Dorothy Forbes, Shelley Peacock, and Dr. Debra Morgan have provided us with an important article, “Nonpharmacological Management of Agitated Behaviours Associated with Dementia.” Dr. Christine Fruhauf continues this theme with her article, “Dementia Care: Suggestions for Managing Behavioural Disturbances.” Drs. Dale Lund, Scott Wright, and Michael Caserta highlight the benefits of respite care in their article, “Respite Services: Enhancing the Quality of Daily Life for Caregivers and Persons with Dementia.” Drs. Jayna Holroyd-Leduc and Cara Tannenbaum address a completely different aspect of dementia management in their article, “Incontinence in the Long-Term Care Residents with Dementia.”

Our non-dementia articles this issue include a review of “New Antibiotics for the Older Adult” by Drs. Joseph Blondeau and Glenn Tillotson. Dr. Wilbert Aronow discusses “Therapy for Older Patients with Hypertension,” while Drs. C. Giede and A.M. Oza discuss “Metastatic Cervical Cancer in Older Patients.” Finally, we complete the issue with a book review by Dr. Jackie Gardner-Nix, entitled “Living with Chronic Pain.”

Enjoy this issue,
Barry J. Goldlist