André Tanguay, MD, Chief Physician, Pavillon Hubert-Maisonneuve, CHSLD Drapeau-Deschambault, Rosemère, QC.
A common theme in dementia is misunderstanding--patients with dementia are confused in their thoughts, about the people around them, and by their environment. Furthermore, the patient's family should not be astounded by the seemingly different viewpoints of professionals. In dementia, understanding is of the utmost importance between professionals and family caregivers, and delivering the facts in a clear manner is essential. Striving for this goal, the training tool presented in this article allows the factual understanding of the natural progression of Alzheimer disease. Clinical data and 13 grades are charted within a single table to allow optimal understanding of this disease.
Key words: Alzheimer disease, caregivers, GDS-FAST, training table, MMSE.
Functional Tests Help Assess Treatment Efficacy in Dementia
Karl Farcnik, MD, FRCP(C)
Michelle Persyko, PhD
Functional assessments have been a very important component in the development of treatments for dementia, especially Alzheimer's disease (AD). This is due on the one hand to the complexity of the disease process, and on the other to the limited efficacy of current treatments. AD, for example, is associated with symptomatology occurring in three different domains: cognition, activities of daily living (ADL) and behaviour. Cognitive deterioration is of greatest significance in the earlier stages of the disease process. ADL are affected throughout the disease process but are of greatest signifi-cance during the mild to moderate stages of the disease. Behavioural problems, by contrast, tend to be much more significant as the severity of the disease increases. The challenge has been to develop instruments which measure the effectiveness of treatment in all three domains. Initially, the testing focused only on cognition and global functioning based on regulatory requirements. However, as treatment efficacy with drugs such as acetylcholinesterase inhibitors was noted, it became apparent that treatment had an impact on other domains. In fact, many of these instruments have been developed in the past few years.
Thomas Tsirakis, BA
Alzheimer Disease (AD) is the leading cause of dementia in Canada, affecting 8% of the general population over 60 years of age, and more than 35% of those over 80 years of age. The current number of Canadians affected with the disease is estimated to be 160,000 with approximately 10,000 dying of AD and related dementias every year.
The normal progression of AD typically follows a gradual 7- to 10-year decline in cognitive abilities. All brain functions are eventually affected, but disturbances in judgment, memory, and language appear early on in the disease, with motor function, and bowel and bladder control being maintained during this time period. The progressive and slow decline of an individual's cognitive abilities in AD has been compared to observing the process of normal human development in a reverse order.
Since there is currently no definitive clinical test available for establishing the presence of AD, it is imperative that the clinician utilize standardized diagnostic criteria and formal testing in order to rule out the possibility of any reversible forms of dementia. Individuals presenting with cognitive deficits of a rapid onset should be suspected of having some underlying etiology other than AD.
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