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dementia

Alzheimer and Related Dementias: The Prevention of Disease, Morbidity and Suffering

Alzheimer and Related Dementias: The Prevention of Disease, Morbidity and Suffering

Teaser: 


Kunin-Lunenfeld Applied Research Unit 2nd Annual Conference at Baycrest Centre for Geriatric Care, October 18, 2002

Joanna Goldberg, MSc, Associate Editor, Geriatrics & Aging.

Speakers

  1. The Role of Anti-inflammatories and the Inflammatory Hypothesis in the Prevention of Alzheimer Disease
    Presented by Patrick McGeer, MD, Vancouver, BC.
  2. Decreasing Dementia Risk and Minimizing Cognitive Decline with Participation in Engaging Activities and Memory Rehabilitation
    Presented by Angela Troyer, PhD, CPsych, Baycrest Centre for Geriatric Care, Toronto, ON.
  3. Pharmacological Strategies for Prevention of Alzheimer Disease
    Presented by Serge Gauthier, MD, FRCPC, McGill Centre for Studies in Aging, Montreal, QC.

The goal of research at the Baycrest Centre for Geriatric Care is to provide a scientifically based understanding of diseases and disorders of the elderly. Through various educational methods, staff are trained to implement new practices in assessment, management and rehabilitation. The ultimate goal is to find preventative measures to delay or eliminate the onset of disease. Three of the eight lectures at this conference that touched on how future research, clinicians and care providers may help to achieve these goals in patients with dementia are presented in this report.

I.

Dementia and Wandering Behaviour in Long-term Care Facilities

Dementia and Wandering Behaviour in Long-term Care Facilities

Teaser: 

Nina M. Silverstein, PhD, Associate Professor, Gerontology, University of Massachusetts Boston, College of Public & Community Service, Boston, MA.
Gerald Flaherty, Director of Special Projects & Safe Return Alzheimer's Association, Massachusetts Chapter, Boston, MA.

Nearly half of all residents in long-term care settings suffer from some type of dementing illness, with Alzheimer disease by far the most common type. People with dementia should be presumed at high risk for wandering due to their cognitive deficits and unpredictable behaviour. Recommendations are shared to minimize attempts to wander and actual wandering episodes by promoting a more therapeutic environment both through the physical structure and through staff training. In addition, effective strategies to follow in situations when a resident is, in fact, missing are presented.
Key words: dementia, wandering, long-term care, environment.

Review of “Management of Dementia”

Review of “Management of Dementia”

Teaser: 

by Simon Lovestone and Serge Gauthier, Martin Dunitz, 2001.

Reviewed by Chris MacKnight, MD, MSc, FRCPC, Assistant Professor, Dalhousie University.

When I was asked to review this book I thought, Not another guide to dementia! I was right--this isn't yet another guide to dementia. It is an excellent, helpful and practical book, and one that I greatly enjoyed.

The authors, Drs. Serge Gauthier and Simon Lovestone, are experienced and respected experts in dementia, and they have distilled that experience into 150 easily read and understood pages. Being from both sides of the Atlantic, they bring a nice trans-continental perspective to the book, and their respect for their patients is evident on every page.

The authors don't get bogged down in the minutiae of pathophysiology and pharmacology, but rather present what a practitioner needs to know to get the job done. They begin with a chapter on the newly diagnosed patient, and follow with chapters on common behavioural problems (including one on sleep), treatment of the cognitive symptoms, the possibility of disease modification and, finally, a chapter on long-term care, including the design of the facility.

There are a number of excellent features in this book. The end section contains many instruments commonly used in assessing and following patients with dementia, complete with guides for their use. I particularly enjoyed the cases, scattered throughout the text, that aptly illustrated the management issues and were very real-life. The references at the end of each chapter are both comprehensive and current.

I highly recommend this book to trainees and clinicians (both physicians and non-physicians) who see patients with dementia. Most nursing homes, if not every nursing home ward, should have a copy on hand. Even a specialist is likely to learn something from these pages. Unlike so many books I see, I believe I'll actually use this one.

Dementia: A Developmental Approach (On Personhood and Spirituality)

Dementia: A Developmental Approach (On Personhood and Spirituality)

Teaser: 

D'Arcy Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Fellow in Care of the Elderly at Baycrest Centre, Toronto, ON.

Introduction
I was recently given the difficult task of creating a paper on the application of developmental theory to the human condition of dementia. Given the complexity of that endeavor, this article will address both content and process issues involved. I will start with a consideration of the relevant developmental stage as conceptualized by Erikson, and then demonstrate that the biomedical model of dementia is actually insufficient to allow a discussion of dementia in a developmental context. This will be followed by an introduction to a paradigm shift from the biomedical model to the social-environmental model whereby developmental issues in dementia can be more fully explored. The prominence of spirituality as a means to resolve Erikson's final crisis of integrity versus despair will be discussed with reference to both personal reflection as well as recent arguments by clinical ethicists and psychologists working in this field and a prominent patient with dementia. Finally, connections to a different developmental model will serve to confirm the views put forth here.

Erikson's Life Cycle: Application to Dementia
According to Erikson, the dominant antithesis in old age is "integrity versus despair".

The Neurological Examination in Aging, Dementia and Cerebrovascular Disease Part 3: Coordination, Balance and Gait

The Neurological Examination in Aging, Dementia and Cerebrovascular Disease Part 3: Coordination, Balance and Gait

Teaser: 


Part 3: Coordination, Balance and Gait

David J. Gladstone, BSc, MD, Fellow, Cognitive Neurology and Stroke Research Unit, Sunnybrook and Women's College Health Sciences Centre, Division of Neurology, University of Toronto, Toronto, ON.
Sandra E. Black, MD, FRCPC, Professor of Medicine (Neurology), University of Toronto; Head, Division of Neurology and Director, Cognitive Neurology Unit, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON.

Abstract
This four-part series of articles provides an overview of the neurological examination of the elderly patient, particularly as it applies to patients with cognitive impairment, dementia or cerebrovascular disease. The focus is on the method and interpretation of the bedside physical examination; the mental state and cognitive examinations are not covered in this review. Part 1 (featured in the September issue of Geriatrics & Aging) began with an approach to the neurological examination in normal aging and in disease, and reviewed components of the general physical, head and neck, neurovascular and cranial nerve examinations relevant to aging and dementia. Part 2 (featured in the October issue) covered the motor examination with an emphasis on upper motor neuron signs and movement disorders.

The Neurological Examination in Aging, Dementia and Cerebrovascular Disease Part 2: Motor Examination

The Neurological Examination in Aging, Dementia and Cerebrovascular Disease Part 2: Motor Examination

Teaser: 

Part 2: Motor Examination

David J. Gladstone, BSc, MD, Fellow, Cognitive Neurology and Stroke Research Unit, Sunnybrook and Women's College Health Sciences Centre, Division of Neurology, University of Toronto, Toronto, ON.

Sandra E. Black, MD, FRCPC, Professor of Medicine (Neurology), University of Toronto; Head, Division of Neurology and Director, Cognitive Neurology Unit, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON.

Abstract
This four-part series of articles provides an overview of the neurological examination of the elderly patient, particularly as it applies to patients with cognitive impairment, dementia or cerebrovascular disease. The focus is on the method and interpretation of the bedside physical examination; the mental state and cognitive examinations are not covered in this review. Part 1 (featured in the September issue of Geriatrics & Aging) began with an approach to the neurological examination in normal aging and in disease, and reviewed components of the general physical, head and neck, neurovascular and cranial nerve examinations relevant to aging and dementia. Part 2, featured here, covers the motor examination with an emphasis on upper motor neuron signs and movement disorders.

Sleep Disturbances and Dementia: Another Perspective

Sleep Disturbances and Dementia: Another Perspective

Teaser: 

Daniel Foley, MS, National Institute on Aging, National Institutes of Health, Bethesda, MD.

Introduction
It is well known that sleep disturbances can occur secondary to the onset and progression of Alzheimer disease (AD) and related dementias in many patients.1 In the community setting, sleep disturbances in AD patients can disrupt the sleep of caregivers and other family members and increase the risk of institutionalization.2 In the institutional setting, sleep disturbances and other behavioural features known generally as "the sundown syndrome" present management problems for nurses and other attending staff in the late evening and at night.3

In contrast, few studies have reported on the possible neuropsychological deficits that may arise from disrupted sleep. However, because sleep complaints are common among elderly persons, clinical and epidemiological studies are now beginning to address the association between sleep disorders and cognitive function.4 Prevalence data show that a majority of older adults without dementia have one or more complaints, including difficulty initiating sleep, early morning awakening, daytime sleepiness and feeling unrested in the morning. These complaints may be attributable to underlying medical conditions that are common in old age such as hypertension, diabetes, depression and arthritis, or they may stem directly from the effects of common primary sleep disorders such as sleep-disordered breathing and restless leg syndrome.

Neuronuclear Imaging in the Evaluation of Early Dementia

Neuronuclear Imaging in the Evaluation of Early Dementia

Teaser: 

Daniel HS Silverman, MD, PhD, Ahmanson Biological Imaging Center, Division Nuclear Medicine, Department of Molecular and Medical Pharmacology, School of Medicine, University of California, Los Angeles, CA.

Introduction
Early-stage dementia is often unrecognized or misdiagnosed.1 This can be particularly problematic for dementias due to neurodegenerative disease, like Alzheimer's, where the most can be gained from effective therapies that intervene as early as possible in the course of progressive, irreversible damage to brain tissue. Conventional methods for evaluation are often inaccurate for making a diagnosis or prognosis in the early stages of dementia. However, over the past several years it has become increasingly evident that certain neuroimaging methods--making use of low levels of radioactive compounds to noninvasively elucidate brain function--can be used to sensitively identify such disease at the time of a patient's first presentation of symptoms.

Neuronuclear Imaging in Dementia Assessment
Over the last two decades, clinicians and researchers have gained substantial experience in using the three-dimensional imaging capabilities of positron emission tomography (PET) and single photon emission computed tomography (SPECT) for the identification and differential diagnosis of dementia.

The Neurological Examination in Aging, Dementia and Cerebrovascular Disease

The Neurological Examination in Aging, Dementia and Cerebrovascular Disease

Teaser: 


Part 1: Introduction, Head and Neck, and Cranial Nerves

David J. Gladstone, BSc, MD, Fellow, Cognitive Neurology and Stroke Research Unit, Sunnybrook and Women's College Health Sciences Centre and Division of Neurology, University of Toronto, Toronto, ON.

Sandra E. Black, MD, FRCPC, Professor of Medicine (Neurology), University of Toronto; Head, Division of Neurology and Director, Cognitive Neurology Unit, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON.

Abstract
This four-part series of articles provides an overview of the neurological examination of the elderly patient, particularly as it applies to patients with cognitive impairment, dementia or cerebrovascular disease. The focus is on the method and interpretation of the bedside physical examination; the mental state and cognitive examinations are not covered in this review. Part 1 begins with an approach to the neurological examination in normal aging and in disease, and reviews components of the general physical, head and neck, neurovascular and cranial nerve examinations relevant to aging and dementia. Part 2 covers the motor examination with an emphasis on upper motor neuron signs and movement disorders. Part 3 reviews the assessment of coordination, balance and gait. Part 4 discusses the muscle stretch reflexes, pathological and primitive reflexes, sensory examination and concluding remarks.

The Management of Lewy Body Disease

The Management of Lewy Body Disease

Teaser: 

Chris MacKnight, MD, MSc, FRCPC, Assistant Professor, Division of Geriatric Medicine, Dalhousie University, Halifax, NS.

Introduction
Lewy body disease is one of the many conditions causing dementia. As it is relatively common, and has an effective management distinct from that of Alzheimer disease,1 all physicians who see older adults should have some familiarity with Lewy body disease.

Diagnosis
Lewy body disease is underdiagnosed.2 It should be suspected in an older adult who presents with cognitive impairment (even if quite mild) in addition to hallucinations or parkinsonism. Clinical criteria are presented in Table 1.3,4 The criteria of fluctuation have proven difficult to apply at the bedside, but clinical tools are now available.5 The parkinsonism is often mild and subtle, and is more often rigidity than tremor. An important feature is neuroleptic sensitivity. Up to 80% of these patients can, even with low doses, develop reactions to neuroleptics or atypical agents, which are often severe.6 Extrapyramidal symptoms and cognitive decline are the most common manifestations. The decline can be permanent, and neuroleptic malignant syndrome can occur. This likelihood of reaction to neuroleptics is one of the chief reasons to be familiar with the disorder and to have a low threshold to at least suspect its presence.

It can sometimes be difficult to distinguish Lewy body disease from Alzheimer disease, Parkinson's disease or delirium.