Those who read my brief introductions to Geriatrics & Aging each month know that I am very interested in dementia. Every geriatrician is involved in managing patients with dementia, but that is very different from being “interested.” I think for many of us “Johnny Come Lately” types (I include myself in that group), the topic became popular when the first of the cholinesterase inhibitors became available for clinical use. Although they are hardly miracle drugs, they do make a difference and, even more importantly, they inspire hope in patients, families, and doctors. The enhanced monitoring of these patients sparked by these medications means better general medical care and hence better outcomes than can be ascribed to the medications alone. As a result, in the original drug trials, patients treated with placebo did better than historical controls with Alzheimer disease. Another improvement in care has resulted from multidisciplinary memory clinics. The skills and knowledge of occupational therapists, social workers, nurses, and others are now often available to patients with dementia, further improving their outcomes and relieving some of the incredible stress that families and caregivers experience.
Nevertheless, it is still frustrating that we do not have more efficacious pharmacological treatments for dementia such as are available for another common degenerative neurological disorder, namely, Parkinson’s disease. However, research is ongoing, and there is now more light shining at the end of the tunnel. The theme of this edition of Geriatrics & Aging is, therefore, new drug treatments for the management of dementia.
We start off with our CME article focused on “The Latest in Drug Therapy for Dementia: Gleanings from the Third Canadian Consensus Conference on Diagnosis and Treatment of Dementia” by Dr. David Hogan, former president of the Canadian Geriatrics Society (CGS). A general overview of what we are likely to see in the coming years as far as drug therapy is concerned is covered in the article “Emerging Drug Therapies in Alzheimer’s Disease” by my colleague Dr. David Tang-Wai. However, recognizing that cholinesterase inhibitors are still the mainstay of pharmacological management we also have an article on “Switching Cholinesterase Inhibitors: When and How” by Dr. Chris MacKnight, a former president of the CGS. Although as doctors we tend to focus on the cognitive issues in dementia, for families the behaviour of individuals with dementia is often the “make or break” problem that leads to institutionalization. This topic is addressed in the article “Pharmacologic Treatment of Agitation and Apathy in Dementia” by Drs. Shailaja Shah, Gautam Rohatgi, and Daniela Ganescu.
We have an assortment of other articles on issues of importance to older patients. The Cardiovascular Disease column is “Treatment of High-Risk Older Adults with Lipid-Lowering Drug Therapy” by Dr. Wilbert Aronow, a frequent contributor to this journal and also one of the world’s best-known specialists in geriatric cardiology. Not surprisingly, our Dementia column “Dementia: Recognition of Psychotic Symptoms among Older Adult”’ by Dr. Abi Rayner and our Caregiving column “Everyday Functioning across the Spectrum of Cognitive Impairment” by Dr. Holly Tuokko are also related to this month’s focus theme. Our Men’s Health column is entitled “Why Men Die Younger than Women” by Dr. Bridget Gorman & Dr. Jen’nan Ghazal Read. Dr. Timothy O. Lipman thoroughly reviews “The Role of Herbs and Probiotics in GI Wellness for Older Adults” for our Nutrition column. Our final article is a case study on a topic that I have found to be absolutely fascinating, having reviewed the literature at one point after seeing a couple of affected patients in my clinic. It is entitled “Visual Hallucinations among Older Adults: The Charles Bonnet Syndrome” by Dr. Nages Nagaratnam, with peer commentary by Dr. François Sirois.
Enjoy this issue,
Barry Goldlist
