Abstract
Once diagnosed with Alzheimer’s disease or related disorders, patients and caregivers must integrate treatment and management plans. While there are no cures for these disorders, there are opportunities to optimize function and quality of life. There are pharmacological treatments available for dementia as well as for the behavioral and psychiatric symptoms that often accompany these diagnoses. Persistence can insure that drug treatments provide optimal benefit. Also nonpharmacological interventions including environmental modifications can be helpful, particularly for the behavioral problems. Supervision to insure adequate medical care, maximize independence and social interaction, and preserve patient dignity will require ongoing review of the patient’s changing condition. A comprehensive approach to management will also consider legal and financial needs, support for the caregiver, and the possibility of research participation. Clinicians can introduce the possibility of research for the hope it offers to their patients and to the generations to come.
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References
Burgener SC, Berger B. Measuring perceived stigma in persons with progressive neurological disease: Alzheimer’s dementia and Parkinson’s disease. Dementia. 2008;7:31–53.
Kraemer HC, Tinklenberg J, Yesavage JA. ‘How far’ vs ‘how fast’ in Alzheimer disease: the question revisited. Arch Neurol. 1994;51:275–9.
Behuniak SM. The living dead? The construction of people with Alzheimer’s disease as zombies. Ageing Soc. 2011;31:70–92.
Kaye ED, Petrovic-Poljak A, Verhoeff NPLG, Freedman M. Frontotemporal dementia and pharmacologic interventions. J Neuropsychiatry Clin Neurosci. 2010;22:19–29.
Tariot PN, Farlow MR, Grossberg GT, Graham SM, McDonald S, Gergel I, Memantine Study Group. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA. 2004;291(3):317–24.
Riordan KC, Hoffman Snyder CR, Wellik KE, Caselli RJ, Wingerchuk DM, Demaerschalk BM. Effectiveness of adding memantine to an Alzheimer dementia treatment regimen which already includes stable donepezil therapy: a critically appraised topic. Neurologist. 2011;17:121–3.
Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundman M, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer’s disease. The Alzheimer’s Disease Cooperative Study. N Engl J Med. 1997;336:1216–22.
Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005;352:2379–88.
Aisen PS, Schneider LS, Sano M, Diaz-Arrastia R, van Dyck CH, Weiner MF, et al. High-dose B vitamin supplementation and cognitive decline in Alzheimer disease: a randomized controlled trial. J Am Med Assoc. 2008;300:1774–83.
Quinn JF, Raman R, Thomas RG, Yurko-Mauro K, Nelson EB, Van Dyck C, et al. Docosahexaenoic acid supplementation and cognitive decline in Alzheimer disease: a randomized trial. J Am Med Assoc. 2010;304:1903–11.
Henderson ST, Vogel JL, Barr LJ, Garvin F, Jones JJ, Costantini LC. Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer’s disease: a randomized, double-blind, placebo-controlled, multicenter trial. Nutr Metab (Lond). 2009;10:31.
Roman MW. Axona (Accera, Inc): a new medical food therapy for persons with Alzheimer’s disease. Issues Ment Health Nurs. 2010;31:435–6.
Scheltens P, Kamphuis PJ, Verhey FR, Olde Rikkert MG, Wurtman RJ, Wilkinson D, et al. Efficacy of a medical food in mild Alzheimer’s disease: a randomized, controlled trial. Alzheimers Dement. 2010;6:1–10.
Hulme C, Wright J, Crocker T, Oluboyede Y, House A. Non-pharmacological approaches for dementia that informal carers might try or access: a systematic review. Int J Geriatr Psychiatry. 2009;25:756–63.
Desai AK, Grossberg GT. Diagnosis and treatment of Alzheimer’s disease. Neurologic disorders update: current thinking and practices. Neurology. 2005;64:34–9.
Swanson KA, Carnahan RM. Dementia and comorbidities: an overview of diagnosis and management. J Pharm Pract. 2007;20(4):296–317.
Martin BK, Frangakis CE, Rosenberg PB, Mintzer JE, Katz IR, Porsteinsson AP, et al. Design of depression in Alzheimer’s disease study-2. Am J Geriatr Psychiatry. 2006;14:920–30.
Lyketsos CG, Steele C, Galik E, Rosenblatt A, Steinberg M, Warren A, et al. Physical aggression in dementia patients and its relationship to depression. Am J Psychiatry. 1999;156:66–71.
Teri L. Behavior and caregiver burden: behavioral problems in patients with Alzheimer disease and its association with caregiver distress. Alzheimer Dis Assoc Disord. 1997;11:35–8.
Olin JT, Katz IS, Meyer BS, Schneider LS, Lebowitz BD. Provisional diagnostic criteria for depression of Alzheimer’s disease: rationale and background. Am J Geriatr Psychiatry. 2002;10:129–41.
Breitbart W, Marotta R, Platt MM, Weisman H, Derevenco M, Grau C, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry. 1996;153:234–7.
Herrmann N. Use of SSRIs in the elderly: obvious benefits but unappreciated risks. Can J Clin Pharmacol. 2000;7:91–5.
Teri L, Gallagher-Thompson D. Cognitive-behavioral interventions for treatment of depression in Alzheimer’s patients. Gerontologist. 1991;31:413–6.
Teri L, Gibbons LE, McCurry SM, Logsdon RG, Buchner DM, Barlow WE, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. J Am Med Assoc. 2003;290:2015–22.
Zec RF, Burkett NR. Non-pharmacological and pharmacological treatment of the cognitive and behavioral symptoms of Alzheimer disease. NeuroRehabilitation. 2008;23:425–38.
Teri L, Logsdon RG. Identifying pleasant activities for Alzheimer’s disease patients: the pleasant events schedule-AD. Gerontologist. 1991;31:124–7.
Weiner MF, Teri L. Psychological and behavioral management. In: Weiner MF, Lipton AM, editors. The dementias: diagnosis, treatment and research. Washington, D.C.: American Psychiatric Publishing, Inc; 2003. p. 181–218.
Chemerinski E, Petracca G, Manes F, Leiguarda R, Starkstein SE. Prevalence and correlates of anxiety in Alzheimer’s disease. Depress Anxiety. 1998;7:166–70.
Luxenberg JS. Clinical issues in the behavioural and psychological symptoms of dementia. Int J Geriatr Psychiatry. 2000;15:5–8.
Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and cognitive impairment: results from the Cardiovascular Health Study. J Am Med Assoc. 2002;288:1475–83.
Madhusoodanan S, Bogunovic OJ. Safety of benzodiazepines in the geriatric population. Expert Opin Drug Saf. 2004;3:485–93.
Ballard C, Creese B, Corbett A, Aarsland D. Atypical antipsychotics for the treatment of behavioral and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opin Drug Saf. 2011;10:35–43.
Cummings JL. Cholinesterase inhibitors: a new class of psychotropic compounds. Am J Psychiatry. 2000;157:4–15.
Gleason OC. Delirium. Am Fam Physician. 2003;67:1027–34.
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean R, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a U.S. panel of experts. Arch Intern Med. 2003;163:2716–24.
Gilley DW, Wilson RS, Beckett LA, Evans DA. Psychotic symptoms and physically aggressive behavior in Alzheimer’s disease. J Am Geriatr Soc. 1997;45:1074–9.
Tariot PN, Blazina L. The psychopathology of dementia. In: Morris JC, editor. Handbook of dementing illnesses, neurological disease and therapy. New York: Marcel Dekker, Inc; 1994. p. 461–76.
Whitehouse PJ, Patterson MB, Strauss ME, Geldmacher DS, Mack JL, Gilmore GC, et al. Hallucinations. Int Psychogeriatr. 1996;8:387–92.
Schneider LS, Pierre N, Tariot PN, Dagerman KS, Davis SM, Hsiao JK, et al. Effectiveness of atypical antipsychotics in patients with Alzheimer’s disease. N Engl J Med. 2006;355:1525–38.
Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia. J Am Med Assoc. 2005;293:596–608.
Nagaratnam N, Lewis-Jones M, Scott D, Palazzi L. Behavioral and psychiatric manifestations in dementia patients in a community: caregiver burden and outcome. Alzheimer Dis Assoc Disord. 1998;12:330–4.
Cohen-Mansfield J, Mintzer JE. Time for change: the role of nonpharmacological interventions in treating behavior problems in nursing home residents with dementia. Alzheimer Dis Assoc Disord. 2005;19:37–40.
Mann AH, Graham N, Ashby D. Psychiatric illness in residential homes for the elderly: a survey in one London borough. Age Aging. 1984;13(5):257–65.
Buchanan JA, Christenson AM, Ostrom C, Hofman N. Non-pharmacological interventions for aggression in persons with dementia: a review of the literature. Behav Analyst Today. 2007;8:413–25.
Inouye SK. Delirium and other mental status problems in the older patient (Chapter 26). In: Goldman L, Ausiello D, editors. Cecil medicine. 23rd ed. Philadelphia, PA: Saunders Elsevier; 2007.
Francis J. Delusions, delirium, and cognitive impairment: the challenge of clinical heterogeneity. Journal of the American Geriatric Society. 1992;40:844–9.
Fick DM, Agostini JV, Inouye SK. Delirium superimposed on dementia: A systematic review. Journal of the American Geriatric Society. 2002;50:1723–32.
Flaherty JH. The evaluation and management of delirium among older persons. Med Clin North Am. 2011;95:555–77.
Sultzer DL, Levin HS, Mahler ME, High WM, Cummings JL. A comparison of psychiatric symptoms in vascular dementia and Alzheimer’s disease. Am J Psychiatry. 1993;156:1806–12.
Aharon-Peretz J, Masiah A, Pillar T, Epstein R, Tzischinsky OP, Lavie P. Sleep-wake cycles in multi-infarct dementia and dementia of the Alzheimer’s type. Neurology. 1991;41:1616–9.
Ala TA, Yang KH, Sung JH, Frey II WH. Hallucinations and signs of parkinsonism help distinguish patients with dementia and cortical Lewy bodies from patients with Alzheimer’s disease at presentation a clinicopathological study. J Neurol Neurosurg Psychiatry. 1997;62:16–21.
Boeve BF, Silber MH, Ferman TJ, Kokmen E, Smith GE, Ivnik RJ, et al. REM sleep behavior disorder and degenerative dementia—an association likely reflecting Lewy body disease. Neurology. 1998;51:363–70.
McKeith I, Fairbairn A, Perry R, Thompson P, Perry E. Neuroleptic sensitivity in patients with senile dementia of Lewy body type. Br Med J. 1992;305:673–8.
Lindau M, Almkvist O, Johansson SE, Wahlund LO. Cognitive and behavioral differentiation of frontal lobe degeneration of the non-Alzheimer’s type and Alzheimer’s disease. Dement Geriatr Cogn Disord. 1997;9:205–13.
Mendez MF, Perryman KM, Miller BL, Cummings JL. Behavioral differences between frontotemporal dementia and Alzheimer’s disease: a comparison on the BEHAVE-AD rating scale. Int Psychogeriatr. 1998;10:155–62.
Whitehouse P, Frisoni G, Post S. Breaking the diagnosis of dementia. Lancet Neurol. 2004;3:124–8.
Gauthier S. Advances in the pharmacotherapy of Alzheimer’s disease. Can Med Assoc J. 2002;166:616–23.
Logsdon RG, Pike KC, McCurry SM, Hunter P, Maher J, Snyder L, et al. Early-stage memory loss support groups: outcomes from a randomized controlled clinical trial. J Gerontol B Psychol Sci Soc Sci. 2010;65:691–7.
Goldsilver PM, Gruneir MRB. Early stage dementia group: an innovative model of support for individuals in the early stages of dementia. Am J Alzheimers Dis Other Demen. 2001;16:109–14.
Logsdon RG, McCurry SM, Teri L. Timelimited support groups for individuals with early stage dementia and their care partners: preliminary outcomes from a controlled clinical trial. Clin Gerontol. 2006;30:5–19.
Zarit SH, Femia EE, Watson J, Rice-Oeschger L, Kakos B. Memory club: a group intervention for people with early-stage dementia and their care partners. Gerontologist. 2004;44:262–9.
Gräßel E, Trilling A, Donath C, Luttenberger K. Support groups for dementia caregivers—predictors for utilisation and expected quality from a family caregiver’s point of view: a questionnaire survey PART I. BMC Health Serv Res. 2010;10:219–26.
Kurz A, Hallauer J, Jansen S, Diehl J. Efficacy of caregiver support groups for dementia. Der Nervenarzt. 2005;76:261–9.
Thompson C, Spilsbury K. WITHDRAWN: Support for carers of people with Alzheimer’s type dementia. Cochrane Database Syst Rev. 2007:CD000454.
Mittelman MS, Ferris SH, Shulman E, Steinberg G, Levin B. A family intervention to delay nursing home placement of patients with Alzheimer disease: a randomized controlled trial. J Am Med Assoc. 1996;276:1725–31.
Weiner MW, Aisen PS, Jack Jr CR, Jagust WJ, Trojanowski JQ, Shaw L, et al. The Alzheimer’s disease neuroimaging initiative: progress report and future plans. Alzheimers Dement. 2010;6:202–11.
Aisen PS, Petersen RC, Donohue MC, Gamst A, Raman R, Thomas RG, et al. Clinical core of the Alzheimer’s disease neuroimaging initiative: progress and plans. Alzheimers Dementia. 2010;6:239–46.
Jack Jr CR, Albert MS, Knopman DS, McKhann GM, Sperling RA, Carrillo MC, et al. Introduction to the recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dementia. 2011;7:257–62.
Pul R, Dodel R, Stangel M. Antibody-based therapy in Alzheimer’s disease. Expert Opin Biol Ther. 2011;11:343–57.
National Institutes of Health. Studies find possible new genetic risk factors for Alzheimer’s disease [Press Release]. http://www.nia.nih.gov/newsroom/2011/04/studies-find-possible-new-genetic-risk-factors-alzheimers-disease (2011).
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This work was supported in part by the Alzheimer Disease Research Center at Mount Sinai funded by the following NIA grant: AG 005138
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Hoover, S., Sano, M. (2013). After the Diagnosis of Dementia: Considerations in Disease Management. In: Ravdin, L., Katzen, H. (eds) Handbook on the Neuropsychology of Aging and Dementia. Clinical Handbooks in Neuropsychology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3106-0_5
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