Management of Patients with Dementia: The Role of the Physician

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Preface Contents About the Authors 1: Management of Patients with Dementia: An Introduction About This Book Overview of the Dementia Landscape What Is Dementia? Epidemiology of Dementia Causes of Dementia Dementia Disorders A Generic Disease Model of Neurodegenerative Dementia Disorders Alzheimer’s Disease Frontotemporal Dementia Lewy Body Dementia and Parkinson’s Disease Dementia Vascular Dementia Other Causes of Dementia Conclusion References 2: Diagnosis and Support of Patients with Dementia: A Patient Perspective on Current Goals and Practice Introduction Timely Diagnosis Key Issues Practice and Perspectives Disclosure of the Diagnosis Key Issues Practices and Perspectives Disclosure and Quality Reactions to Diagnosis Sharing the Diagnosis with Others and Perceptions of Their Community Care and Support Key Issues Practices and Perspectives Information Received Care and Support Conclusions References 3: Diagnostic Evaluation of Dementia Introduction Biomarker-Based Diagnosis of Alzheimer’s Disease (AD) Timely Diagnosis of Dementia History Taking Introduction General Aspects of History Taking for Dementia Diagnosis With Whom? Medical History Social History and Life Style Habits Disease Course Family History Cognitive Symptoms Memory Concentration and Attention Orientation Language Executive Disorders Behavioural and Psychological Signs and Symptoms of Dementia (BPSD) Mood Disorders and Anxiety Sleep and Diurnal Rhythm Disturbances Hallucinations and Delusions Agitation and Aggressiveness Personality Motor Symptoms Physical Examination Blood Sampling, ECG, EEG Neuropsychological Examination Introduction Cognitive Screening Tests A Dementia Diagnosis Requires a Full Neuropsychological Examination Differential Diagnosis: Role of the Neuropsychological Examination Structural Imaging: Magnetic Resonance Imaging (MRI) From Exclusion of Other Causes to Automated Volumetry Limited Sensitivity and Specificity of Structural Imaging Biomarkers PET Imaging Introduction FDG-PET Amyloid PET CSF Biomarkers Introduction Lumbar Puncture (LP) Core AD CSF Biomarkers Core AD CSF Biomarkers for Early Diagnosis Core AD CSF Biomarker for Differential Dementia Diagnosis Conclusions References 4: Disclosure of Diagnosis in MCI and Dementia Introduction Mild Cognitive Impairment: Dealing with an Uncertain Label Is It Safe to Disclose a Diagnosis of MCI and Mild Dementia? Physician’s Practices and Attitudes Regarding Diagnostic Disclosure in MCI and Mild Dementia The Process of Diagnostic Disclosure Setting the Stage: The Initial Visit at the Doctor’s Office Pre-Biomarker Sampling Counselling Disclosing the Diagnosis Conclusion References 5: Anti-dementia Medication Introduction History of Pharmacological Treatment of Dementia Pharmacodynamics and Pharmacokinetics: Relevant Information for Clinicians Acetylcholinesterase Inhibitors Memantine Pharmacogenetics: Towards a Personalised Treatment Translation of Clinical Trial Outcomes to Relevant Benefits in Clinical Practice Donepezil Galantamine Rivastigmine Memantine Comparative Evidence of Efficacy Safety and Tolerability Possible Beneficial Effects of AChEIs on Comorbidities in AD Patients Treatment Efficacy Beyond the AD Health-Economic Issues State-of-the-Art Management: Key Issues in Clinical Practice When to Start? Who Should Prescribe the Treatment? When to Switch or Combine? When to End Treatment? Regulatory Recommendations Future Treatments and How Close Are They? Instead of Summary Supplemental Cases Case Comments Case 1 Case 2 Case 3 Case 4 References 6: Review of Medication in Patients with Dementia Introduction Lack of Follow-Up Prescribing Cascade Polypharmacy Potentially Inappropriate Medications De-prescribing Review of Drugs in Patients with Advanced Dementia Kidney Function Potentially Inappropriate Prescribing AGS Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older adults STOPP/START PRISCUS List Possible Cognitive Side Effects of Major Drug Classes Individual Assessment A04 Antiemetics A10 Diabetes agents G04 Urological Agents M01A NSAID N01 Anaesthetics N02 Analgesics N03 Antiepileptics N04 Anti-Parkinson Drugs N05A Neuroleptics N05C Hypnotics and Sedatives N06A Antidepressants Other Medicines and Electroconvulsive Therapy Other Issues Conclusion References 7: Management Approaches for Behavioural and Psychological Symptoms of Dementia Introduction Assessment Addressing Causative Problems of BPSD Medical Problems Medication Caregiver Approach Environment Non-pharmacological Treatment of BPSD Specific Psychotherapeutic Interventions Daily Routine and Activities Exercise Therapy Sensory-Based Interventions Aromatherapy Massage Therapy Multisensory Stimulation, Snoezelen and Virtual Reality Arts-Based Interventions Humour Therapy and Elder Clowns Music Therapy Art Therapy Bright Light Therapy Pharmacological Treatment of BPSD Cognitive Enhancers Antidepressants Antipsychotics Mood Stabilisers Benzodiazepines Other Drugs Neuromodulation Conclusion References 8: Management of Vascular Risk Factors in Dementia Introduction Clinical Case A: Why Should Doctors Focus on Vascular Factors? The Importance of Vascular Risk Factors in Cognitive Decline and Incident Dementia Hypertension, Hypercholesterolemia, and Obesity Diabetes Stroke Alcohol Consumption and Smoking Associations Between Risk Factors Dementia and Control of Vascular Risk Factors Clinical Case B: Reperfusion Therapies in Dementia Concluding Remarks References 9: Assessment and Management of Pain in Patients with Dementia Introduction Pain in the Elderly Epidemiology of Pain in Dementia Alzheimer’s Disease Other Types of Dementia Pathophysiology of Pain in Dementia Supraspinal Mechanism of Pain Pathological Changes in Alzheimer’s and Pain Processing Pathological Changes in Other Types of Dementia Evidence from Experimental Pain Studies Observation and Assessment of Pain in Dementia General Assessment of Pain in the Elderly Mild to Moderate Dementia Severe Dementia Pain Assessment Scales Treatment of Pain in Dementia General Principles of Pain Treatment Paracetamol Non-steroidal Anti-inflammatory Drugs Opioider Use of Analgesics in Elderly with Dementia Dilemmas in Treating Pain in Dementia Conclusion Case 1 Case 2 References 10: Management of Motor Symptoms in Dementia Disorders Introduction Management of Motor Symptoms in Alzheimer’s Disease Pharmacological Treatment of Parkinsonism in AD Non-pharmacological Treatment of Parkinsonism in AD Treatment of Falls Treatment of Myoclonus Treatment of Paratonia in AD Treatment of Motor Symptoms in Parkinson’s Disease Dementia and Dementia with Lewy Bodies Pharmacological Treatment of Parkinsonism in DLB and PDD Non-pharmacological Treatment of Parkinsonism in DLB and PDD Treatment of Falls in DLB and PDD Treatment of Myoclonus in DLB and PDD Treatment of Motor Symptoms in Vascular Dementia Pharmacological Treatment of Vascular Parkinsonism Management of Motor Symptoms in Frontotemporal Dementia Management of Motor Symptoms in Corticobasal Degeneration Management of Motor Symptoms in Progressive Supranuclear Palsy Management of Motor Symptoms in Huntington’s Disease Treatment of Motor Symptoms in Multisystem Atrophy Case Presentation References 11: Management of Sleep Disorders in Patients with Dementia Introduction Regulation of Sleep and Wakefulness Sleep Changes and Sleep Disorders in the Elderly Changes in Sleep Physiology Common Sleep Disorders in the Elderly Pathophysiology of Sleep Disturbances Sleep in Patients with Dementia Sleep Disturbance and Comorbidities in Different Types of Dementia Alzheimer’s Disease (AD) Sleep in Patients with Vascular Dementia Sleep in Patients with Frontotemporal Dementia Sleep in Patients with Lewy Body Dementia Assessment of Sleep Disorders in Patients with Dementia Subjective Measures of Sleep and Wakefulness Objective Measures of Sleep and Wakefulness as Assessed by Polysomnography Treatment Non-pharmacological Treatment (Table 11.4) Pharmacological Treatment Conclusion References 12: Seizures and Epilepsy in Dementia: Diagnosis and Management Pathophysiology of Epilepsy in Dementia Seizures and Dementia Share Common Risk Factors and Pathological Features A Bidirectional Relationship: Dementia Increases Risk of Seizures and Seizures Worsen Cognitive Function Animal Models of Network Disruption and Epilepsy in Alzheimer’s Disease The Role of Interictal Epileptiform Discharges Epilepsy in Other Forms of Dementia Opportunities for Translational Research Clinical Seizure Semiology and Differential Diagnosis Seizure Semiology Obtaining a Good Seizure History in Dementia Patients: Common Challenges Differential Diagnosis Status Epilepticus in Patients with Dementia Making a Diagnosis Recommended Investigations Acute Setting Outpatient Setting Imaging Electroencephalography Diagnosing Non-convulsive Status Epilepticus Management Approaches General Principles of Epilepsy Management in Dementia General Aspects of Drug Treatment Antiepileptic Drugs Used in Patients with Dementia Newer Antiepileptic Drugs Levetiracetam Lamotrigine Gabapentin Oxcarbazepine and Eslicarbazepine Lacosamide Topiramate, Perampanel, and Brivaracetam (BRV) Older Antiepileptic Drugs Carbamazepine Phenytoin Phenobarbital Valproic Acid Benzodiazepines: Chronic Use Aspects Requiring Special Consideration Bone Health Acute Seizure Treatment with Benzodiazepines Valproate Encephalopathy Case Scenarios and Summary Teaching Points Case 1 Case 2 Case 3 References 13: Physical and Cognitive Exercise for Patients with Dementia Introduction Methodological Considerations Physical Exercise Exercise and the Brain: Effects and Underlying Mechanisms Effects of Exercise in MCI and Dementia Planning and Adapting Exercise to Patients with Cognitive Impairment and Dementia Conclusion Cognitive Stimulation and Training Cognitive Stimulation Cognitive Training Conclusion References 14: Promoting Functional Independence in Dementia Introduction Functional Independence in Patients with Dementia Loss of Independence Over the Disease Course Other Factors Affecting Loss of Independence in Dementia Assessment of Functional Independence in Dementia Proxy-Report Scales Performance-Based Assessment Safety Other Approaches Interventions for Promoting Functional Independence Supporting Independent Living Summary Maintaining Activities of Daily Living Summary Promoting Social Function Summary Maximising Physical Function Summary Supporting Sensory Function and Communication Other Essential Considerations for Delivery of Interventions Setting Mode of Delivery Role of Multidisciplinary Teams Conclusions References 15: Patients with Dementia in Hospital Introduction Person-Centred Care Benefits How Can We Deliver Person-Centred Care for People in Hospital? Dementia Champions Volunteers Liaison Psychiatry/Mental Health Teams Hospital Environment Built Environment Internal Design Medical Mental Health Units Comprehensive Geriatric Assessment What Is Comprehensive Geriatric Assessment? Sensory Impairment Eating and Drinking Including Oral Health Undiagnosed or Unrecognised Dementia Common Medical Issues in People with Dementia Multimorbidity and Frailty Frailty Polypharmacy, Anticholinergic Burden and Deprescribing Delirium Diagnosis Interventions to Prevent or Reduce Delirium Treating Delirium Case: Jill’s Story Summary References 16: Long-Term Care for Patients with Dementia Introduction Admission to Long-Term Care Common Clinical Issues in People with Dementia Delirium Urinary Incontinence Weight Loss, Decreased Appetite, and Feeding Lower Respiratory Tract Infections Pressure Ulcers Vaccinations Antibiotics Telemedicine in People with Dementia Death and Dying in Long-Term Care Course of Care and Mortality in LTC Advance Care Planning Managing Transfers Palliative Care Covid-19 and Long-Term Care Case Study Commentary Summary References 17: End-of-Life Care in Patients with Advanced Dementia Introduction Domains of Good End-of-Life Care in Dementia The Use of Measurement Instruments in End-of-Life Dementia Care Conclusion References 18: Systematic Medical Follow-Up of Patients with Dementia Introduction Why Is Follow-Up in Patients with Dementia Important Contents of Follow-Up Role of Caregivers Monitoring Disease Progression and Emergence of New Symptoms Co-morbidities Review of Pharmacological Treatment Alcohol and Other Substance Abuse Assessment of Competency, Driving, and Other Legal Issues Ensuring Adequate Support, Information, and Counseling Organization of Medical Follow-Up in Patients with Dementia Conclusion References Index