Many people have come to view cardiopulmonary resuscitation (CPR) as a routine intervention following cardiac arrest, and they insist on CPR for their loved ones even when the physician explains its likely futility. Physicians who refuse a family member’s request to perform unwarranted CPR risk becoming the center of media, legal, and disciplinary scrutiny. Although CPR is largely perceived as a benign life-saving intervention, it inflicts indignity and possibly pain on a dying patient and should not be used when it is unlikely to succeed or to benefit the patient if successful. The growing acceptance of do-not-resuscitate orders for patients with advanced cancer has not spread to families of patients suffering from the late stages of other degenerative or terminal illnesses. Having blunt discussions about the true consequences and risks of CPR might foster greater willingness to abstain from administering CPR to patients unlikely to benefit.

This article was originally published by HMP Communications LLC (Annals of Long-Term Care: Clinical Care and Aging), 05/16/2011.

Guylaine Ferland, PhD,Département de Nutrition, Université de Montréal; Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC.
Carol E. Greenwood, PhD,Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, and Kunin-Lunenfeld Applied Research Unit, Baycrest, Toronto, ON.
Bryna Shatenstein, PhD, PDt, Département de Nutrition, Université de Montréal; Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC.

Abstract
While prospective epidemiologic studies have provided strong evidence linking higher intakes of many nutrients with slower rates of cognitive decline and reduced dementia risk, randomized controlled trials on supplementation with individual nutrients have largely been disappointing. In contrast, recent research points to substantial benefits for brain aging and cognition from consumption of a varied diet centred on plant-source foods, whole grains and fish, and avoidance of foods rich in saturated and trans fats. An unhealthy dietary pattern, in conjunction with obesity, low physical activity, and smoking, could contribute to a pro-inflammatory state and oxidative stress which could exacerbate risk for development of cognitive decline the metabolic syndrome, diabetes, and cardiovascular disease.
Keywords: nutrition, dementia, Alzheimer's disease, nutrients, dietary patterns.

Mary A. Corcoran, OTR, PhD, Professor of Clinical Research and Leadership, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.

There is an average delay of 20 months between the first recognition of symptoms of Alzheimer’s disease or a related disorder (ADRD) and the seeking of physician help. One reason for this delay is tendency for families to miss early symptoms until the onset of behavioural disturbances. Families may provide more timely accounts with prompted questions. It is important to diagnose cognitive impairment early since there are potential benefits to early treatment. The purpose of this article is to help guide caregivers in identifying a list of symptoms that reflect first indicators of ADRD, based on a study of 68 spouse caregivers of patients with ADRD.
Key words: Alzheimer’s disease, dementia, caregivers, diagnosis, primary care.

Ellen Costello, PT, PhD, Assistant Professor of Physical Therapy, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.
Mary A. Corcoran, OTR, PhD, Professor of Clinical Research and Leadership, The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.

Bathing individuals with dementia has been reported as one of the most difficult activities of daily living and often results in unwanted behaviours. A review of the literature on bathing practices for those with dementia resulted in few empirically tested bathing techniques. Based on this review and the authors’ clinical experience, the following guidelines are presented: (1) consider a towel/bed bath in lieu of a shower/tub bath—be flexible; (2) educate the caregiver (improved outcomes are noted)—communication is key; and (3) optimize the environment to meet the needs of the individual and to maintain safety.
Key words: dementia, Alzheimer’s disease, bathing, caregiver, hygiene.

David B. Hogan, MD, FRCPC, Professor and Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, AB.

Cholinesterase inhibitors are a treatment option for most people with Alzheimer’s disease of mild to moderate severity. This article offers an approach to their use, based on the recommendations of the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. Treatment decisions must be individualized. Monitoring includes evaluating both safety and effectiveness, which entails more than just assessing cognition. Treatment is clinically beneficial when there is evidence of improvement, stabilization, or a slowing of the rate of decline seen prior to the start of treatment without unacceptable side effects.
Key words: dementia, Alzheimer’s disease, cholinesterase inhibitors, safety, effectiveness.

Hsu-Ko Kuo, MD, MPH, Department of Geriatrics and Gerontology, National Taiwan University; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yau-Hua Yu, DDS, DMSc, Department of Medical Research, Veterans General Hospital, Taipei, Taiwan.
Shin-Yu Lien, BS, School of Nursing, Chang Gung University, Taoyuan, Taiwan.
Yi-Der Jiang, MD, PhD, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

There has been a substantial increase in total cases of diabetes mellitus in industrialized countries among older adults. Diabetes mellitus has been increasingly recognized as a risk factor for cognitive impairment and dementia. This article discusses the epidemiological evidence for diabetes to predict Alzheimer’s disease, vascular dementia, and decline in various domains of cognition. We also address the features of diabetes-related executive dysfunction and its importance in the clinical care of diabetic older adults.
Key words: diabetes mellitus, cognition, Alzheimer’s disease, vascular dementia, frontal executive dysfunction.