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Beyond Rasouli: What has the Supreme Court said about Late-Stage Dementia and Continued Life-maintaining Treatment?

Beyond Rasouli: What has the Supreme Court said about Late-Stage Dementia and Continued Life-maintaining Treatment?

Teaser: 

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
With the rapidly increasing numbers of elders in North American Society, the prevalence of those living with dementia is clearly on the increase. According to the most recent document provided by the Alzheimer Society of Canada, The Rising Tide the growth in the numbers of those living with dementia will increase from 480,600 in 2008 (1.5% of Canada's population) to in the year 2038—1,125,200 people with dementia (2.8% of Canada's population).1 All the challenges that Canadian society faces with this growing population merely mirror the enormous complexities that those living with dementia, their families and health care professional providers must increasingly contend with. Government policy makers must find ways to address this increasing population in which Dementia plays a prominent role. The result of the Supreme Court ruling on the Rasouli case has major potential implication for those facing the later stages of dementia and those under whose care members of this population will be entrusted.
Key Words: dementia, aging population, substitute decision makers.

Identification of Potential or Preclinical Cognitive Impairment and the Implications of Sophisticated Screening with Biomarkers and Cognitive Testing

Identification of Potential or Preclinical Cognitive Impairment and the Implications of Sophisticated Screening with Biomarkers and Cognitive Testing

Teaser: 

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The last decade has seen an enormous growth in the interest in the recognition of and intervention in those diagnosed and living with the whole range of cognitive impairment and frank dementia. In the western world, the recognition of the impact on patients, families, health care systems, and societies that dementia poses has led to great efforts to help define the indicators for current and future dementia with the intention to treat those already afflicted even with the primarily symptomatic medications that exist and to recognize those at future risk with the hope of providing counselling to forestall its future development. The idea of "early diagnosis" appears at first glance to be attractive for the purposes of future planning and research studies, but it is not clear what the benefits and risks might be if screening processes define people at risk when beneficial interventions might not yet be determined. The ethical as well as financial implications must be explored and defined before implementation of such screening becomes a normal standard of practice.practice.
Key Words: cognitive impairment, dementia, screening, biomarkers, cognitive testing.

The Cost of Dementia in the United States

The Cost of Dementia in the United States

Teaser: 

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The prevalence of dementia appears to be increasing in most western countries. That when coupled with the increased average age of the older population has leads to an expectation that projections of financial costs to individuals, families and to society will grow over the next few decades. The current study, out of the United States, based on a number of robust data bases coupled with in-depth interviews has resulted in projections of the current true costs of caring for elderly people living with dementia. It also allowed for the projection of future costs over the next three decades. The results are quite mind-boggling: "We found that dementia leads to total annual societal costs of $41,000 to $56,000 per case, with a total cost of $159 billion to $215 billion nationwide in 2010. Our calculations suggest that the aging of the U.S. population will result in an increase of nearly 80% in total societal costs per adult by 2040."

Photography: Many Windows into Memories

Photography: Many Windows into Memories

Teaser: 

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

It was magical: the images coming to life at the bottom of the plastic tray filled with Kodak developer. First the blacks came and then the grays, as they coalesced into the picture I witnessed the excitement anticipated from scanning the negative and then the contact sheet that had all 24 pictures from the roll of film on it.

What's New from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4)

What's New from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4)

Teaser: 

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

In the winter and spring of 2012 I was privileged to be part of the executive working group that organized the fourth Canadian Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) which took place in May 2012. The process as described in both of the initial publications that came out in the fall of 2012 included many participants from all of those physician groups involved in caring for those at risk of dementia, as well as those not-for-profit organizations involved in educating the public.

You Can Manage a Dementia without Cure: Frontotemporal Degeneration

You Can Manage a Dementia without Cure: Frontotemporal Degeneration

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2
Teaser: 

Tiffany W. Chow, MD, MSc, Baycrest Health Sciences Rotman Research Institute, and Ross Memory Clinic; University of Toronto Depts. of Medicine (Neurology Division) and Psychiatry (Geriatric Psychiatry Division).

Abstract
Much of the published clinical research in dementia has focused on diagnostic biomarkers and neuroimaging analyses that are not yet validated for routine clinical practice or on unsuccessful clinical drug trials. Primary care providers can nonetheless make a significant difference in the management of patients with dementia and their families, based on appropriate referrals of non-Alzheimer's dementia cases to specialists and supporting informal caregivers.
Frontotemporal degeneration, a non-Alzheimer's dementia that strikes in the 6th decade of life, provides many opportunities for the entire healthcare team to educate and back families up through a harrowing neurodegenerative illness. This paper is intended to highlight for primary care physicians what can be done and how to accomplish it through a team approach. Some concepts, such as a switch from medicalized views of "behavioural and psychiatric symptoms of dementia" to "Responsive Behaviours" can be generalized across dementia etiologies, but the age at onset and marked social disability and dysfunction caused by frontotemporal degeneration warrant some additional guidelines to assure the safety and highest quality of life possible for the patient and those around him. In particular, refitting a day program to accommodate clients with frontotemporal degeneration and attending to the needs of children who find themselves in informal caregiver roles are addressed.
Keywords: caregiver, dementia, frontotemporal dementia, primary progressive aphasia.

Mild Cognitive Impairment

Mild Cognitive Impairment

It is always amazing when one is working in the field of medicine to discover new additions that are useful and something that will change one's approach. That is one of the wonderful things about medicine; that there is so much room for creativity while maintaining the essence of good science and coupling it with humanity and care.

Advances in Alzheimer's Disease Management

Advances in Alzheimer's Disease Management

Teaser: 

CHAPTER 7: Ethical and clinically humane end-of-life care for those living with dementia
by Michael Gordon

 

Editors:
Serge Gauthier, McGill University, Montreal, Quebec, Canada
Pedro Rosa-Neto, McGill University, Montreal, Quebec, Canada
Publisher: Future Medicine
Reviewed by: Michael Gordon, MD, MSc, FRCPC, FACP, FRCPEdin

It is always a pleasure to be able to discuss a new book to a receptive audience when I believe the book has something special to offer. When it comes to reviewing books outside the realm of medicine or the medical sciences, reviews often are reflective of the personal and aesthetic views of the reviewer. There are many books written for professional readers on the fringe of medical science that deal with non-clinical aspects of medicine and many that have translated important medical concepts to the lay audience and others in the form of memoirs and novels of the personal and historical type that add a great deal to the general wealth and richness of medicine and the associated medical sciences.

To undertake an academic text book is always a daunting task. Generally if experts and specialists in the field cannot write such a book without the help of others and currently the idea of editors securing experts to write the relevant chapters is a well-accepted methodology for achieving that goal. That being said it becomes the responsibility of the editors to make sure that those that they recruit to write the relevant chapters have the academically sound and clinically and research-based capability of doing so and on top of that have the writing skills to achieve their goal. Moreover, for the chapters to hang together in one strives to have some degree of congruence in the writing approaches and styles, while at the same time promoting the particular capabilities of the writers of each chapter. At the end it is hoped that the chapters hang together into a whole that attracts the reader and provides a perspective on the subject and each of its varied components that would be hard to achieve if the reader decided to explore each of the subject chapters separately without the benefit of them being collated, edited and reference into one easily accessible book.

I am therefore pleased and honoured to not only present the book to subscribers of HealthPlexus.net, Advances in Alzheimer’s Disease Management edited by Serge Gauthier and Pedro Rosa-Neto but to have been one of the contributors. At a time when the knowledge surrounding Alzheimer’s disease and other dementias is on the one hand expanding rapidly from the scientific perspective, for the practicing physician and patient living with dementia and their families, the challenges seems to be overwhelming. There seems to be a huge disconnect between the understanding and scientific progress of the causes in many domains of enquiry and the actual clinical impact that all this new knowledge currently has that physicians in the front lines of care can utilize clinically.

In medicine however, one never knows what key will be the one that opens the door we are all looking to enter. At any given time all we can do is to try and figure out using the best clues and evidence available to know what secrets lay behind that door. The readily accessible E-book format in which Advances in Alzheimer’s disease management is produced allows for a relatively low cost alternative to the usual costs of hard copy texts. The content of the book covers all the main challenging concepts and recommended or best-practices as they exists currently. Obviously in time, perhaps a very short time, some of these will change but for those in the field we all know that many of the concepts and practices have not changed in many years.

The table of contents includes the following subjects by the authors listed next to the chapter titles, with mine at the end. I have been given permission to reproduce my chapter, Ethical and clinically humane end-of-life care for those living with dementia on the HealthPlexus.net website so that subscribers can get a taste of the e-book itself.

1) Genetics of Alzheimer’s disease by Jayashree Viswanathan, Hilkka Soininen & Mikko Hiltunen;
2) Diagnosis of Alzheimer’s disease by Pedro Rosa-Neto, Jared Rowley, Antoine Leuzy, Sara Mohades, Monica Shin, Marina T Dauar and Serge Gauthier
3) Available symptomatic antidementia drugs by Marie-Pierre Thibodeau and Fadi Massoud
4) New drugs under development for Alzheimer’s disease by Lezanne Ooi, Kirubakaran Shanmugam, Mili Patel, Rachel Debono and Gerald Münch
5) Management of agitation and aggression: controversies and possible solutions by Clive Ballard and Anne Corbett
6) Guidelines for the diagnosis and treatment of Alzheimer’s disease by Serge Gauthier and Christopher JS Patterson
7) Ethical and clinically humane end-of-life care for those living with dementia by Michael Gordon

For those interested in ordering the book, this can be done through the following links:
The direct URL for the book is:
http://www.futuremedicine.com/doi/book/10.2217/9781780840840

For those who are interested in finding more information about the book/our e-book series, the email address is:
info@futuremedicine.com
For those who wish to place an order, the email is:
sales@futuremedicine.com

From Science to Smartphones: Boosting Memory Function One Press at a Time

From Science to Smartphones: Boosting Memory Function One Press at a Time

Teaser: 

Eva Svoboda, PhD,1,2 Gillian Rowe, PhD,1,2 Kelly Murphy, PhD,1,2
1Neuropsychology and Cognitive Health Program, Baycrest Centre, Toronto, ON.
2Department of Psychology, University of Toronto, Toronto, ON.

Abstract
Memory problems can be devastating as they limit independent functioning and disrupt social, family, and occupational roles. One form of remembering, prospective memory - remembering to attend to a task or event in the future—is particularly vulnerable to disruption. Fortunately memory is not a singular ability and patients can learn to compensate for memory difficulties by using preserved memory systems. Combining smartphone technology with appropriate training techniques has been shown to be effective in supporting prospective memory function even in individuals with amnesia. We have evidence that such technology may be used in a similar fashion to promote memory in mild cognitive impairment with the aim of delaying or preventing dementia onset. Even in dementia, memory training or support in forming new habits and routines which tap into preserved memory systems can be effectively used to help patients learn new names, reduce repetitive questions and remain oriented to the present. The best prevention is early intervention. Older adults presenting with memory complaints, no matter how mild, should be directed to maintain, reestablish, or institute habits of organization and written reminders, both to support current memory functioning and to preserve functional independence into the future should their concerns turn out to be the early manifestations of a neurodegenerative condition.
Keywords: amnesia, technology, dementia, mild cognitive impairment, memory intervention.

Plants are Good for the Soul Including for those Living with Dementia

Author(s): 
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Often in a geriatric medicine practice one of the salient complaints by families is how often their loved one tells them the same thing over and over again.
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Teaser: 

To tend to a plant, watch it grow and produce its leaves, flowers or vegetables affirms for many that there is a meaning to life, and anything that gives life meaning is a worthwhile endeavor.

Dr. Michael Gordon is currently medical program director of Palliative Care at Baycrest, co-director of their ethics program and a professor of Medicine at the University of Toronto. He is a prolific writer with his latest book Late-Stage Dementia: Promoting Comfort, Compassion, and Care and previous two books being Moments that Matter: Cases in Ethical Eldercare followed shortly on his memoir: Brooklyn Beginnings-A Geriatrician’s Odyssey. For more information log on to www.drmichaelgordon.com

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