Dementia: Stressful Assessments and Thorny Problems

Those of you who read my column on a regular basis know that dementia is one of my particular interests, and that I am fortunate to be able to work in the Toronto Western Hospital Memory Clinic on a regular basis. Recently, I had the very stressful task of assessing an esteemed senior colleague for possible dementia. This was a reminder to me of how stressful it must be for those family members who come to our clinic wondering whether their loved one has dementia. I suspect the stress and anxiety I felt assessing a colleague were nothing compared to what the average spouse feels when a beloved partner is being assessed. It is very satisfying for me to state that our journal regularly includes articles on caregiver stress, and how the physician can help.

Even the most minor stress is exacerbated by lack of sleep. However, among people with dementia the risks involved in taking medications increase, and treating insomnia is very difficult. This important topic is addressed by Dr. Jason Strauss in his article “Insomnia in Older Adults with Dementia.” Another very distressing problem, “Hallucinations in Dementia” is addressed by a renowned expert, Dr. Jiska Cohen-Mansfield. In our car-based society, one of the difficult issues in dementia management is that of fitness to drive. The article “Practical Experience-Based Approaches to Assessing Fitness to Drive in Dementia” by Drs. Frank Molnar, Anna Byszewski, Mark Rapoport, and William Dalziel addresses this thorny problem. We all know the difficulty in managing a patient with dementia in hospital who becomes delirious, and this is an issue in long-term care as well. This major issue is addressed in the article “Preventing Delirium among Older Adults with Dementia,” by Dr. Donna Fick and Dr. Ann Kolanowski.

Our Cardiovascular column, “Diagnosis and Management of Heart Failure with Preserved Ejection Fraction in Older Adults” by Dr. George Heckman and Dr. Robert McKelvie, addresses a clinical syndrome that is most prevalent among older adults. We all rely to a great extent on our vision to make sense of the world surrounding us, but visual impairment is distressingly common among older people, so the article “Current Options in Low Vision Rehabilitation” by Dr. Samuel Markowitz is very relevant. Health safety experts often maintain that a well-educated patient is a major bulwark against medical error. Practical advice in this regard is given in the article “Educating the Older Adult in Over-the-Counter Medication Use” by Dr. Judith Glaser and Dr. Lydia Rolita.

Enjoy this month’s issue.
Barry Goldlist