Friday, December 5, 2008

Diagnosis and Treatment of Alzheimer's and Dementia


These guidelines were developed for physicians and teachers. However, if you look through the list you will see that these guidelines are useful for caregivers. This is especially true for caregivers that are new and overwhelmed by the diagnosis.

If you know a caregiver you should consider forwarding this list of guidelines. I find that I need to refer to my own lists often. As a caregiver we tend to focus on the right now and today. However, unless all contingencies are considered enormous problems could present themselves down the road.
People with mild to moderate dementia (and Alzheimer's) are usually cared for by the family personal care physician and the patient's family. The personal care physician is often very busy and is not a specialist in the area. The family is often ill equipped to take on this task due to lack of formal training, education, and experience. Family caregivers and the primary caregiver usually take a learn as you go approach. A team of physicians, teachers, and researchers have created a set of guidelines for personal care physicians on how to manage dementia once a diagnosis is made. This article should be read by physicians but I found it very helpful as a caregiver. From the caregiver perspective it will help you understand the services you need and help you interact with your family physician to assure that appropriate actions are being taken and treatments rendered.

Guidelines for the diagnosis and treatment of dementia (PDF)
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Canadian Medical Association Journal Press Release

People with mild to moderate dementia are cared for largely by family physicians as well as the patient’s own family, and management of care can be complex and challenging. A team of clinicians, teachers and researchers from the University of Calgary, Dalhousie University, McGill University, Sunnybrook Health Sciences and the University of Toronto, University of Ottawa, University of Western Ontario, Universite de Montreal, University of Saskatchewan and affiliated institutions have created comprehensive guidelines for family physicians on how to manage dementia once a diagnosis has been made. This approach focuses on supporting both the patient and the primary caregiver.

From Diagnosis and treatment of dementia: Approach
to management of mild to moderate dementia


Recommended actions to assist patients with a mild to moderate
dementia and their families after a diagnosis has been made

• Inform the patient and his or her family (if present and appropriate) of the
diagnosis (this would include general counselling and responding to specific
questions)

• Identify the presence of a family caregiver, what support this person can
offer, his or her status (i.e., evidence of strain) and his or her needs (this
would include trying to deal with any identified needs) — ongoing activity

• Decide on the need for referrals for further diagnostic and management
assistance (e.g., referral to genetic clinic for suspected familial cases) —
ongoing activity

• Assess for safety risks (e.g., driving, financial management, medication
management, home safety risks that could arise from cooking or smoking,
potentially dangerous behaviours such as wandering) — ongoing activity

• Determine presence of any advance planning documents (e.g., will, enduring
power of attorney, personal directive). If there are no such documents, advise
that they be drafted. Note that this may include assessing the patientís capacity
to either draft these documents or whether they should be put into effect.

• Assess the patient’s decision-making capacity — ongoing activity

• Refer the patient and family to Alzheimer's Association or Society near them. If none is available have them contact the national association.

• Provide information and advice about nonpharmacologic and pharmacologic
treatment options and availability of research studies*

• Develop and implement a treatment plan with defined goals; continually
update plan

• Monitor response to any initiated therapy

• Monitor and manage functional problems (e.g., urinary incontinence) as they
arise

• Assess and manage behavioural and psychological symptoms of dementia as
they arise

• Monitor nutritional status and intervene as needed

• Deal with medical conditions and provide ongoing medical care

• Mobilize community-based and facility-based resources as needed (this
includes being knowledgeable about supportive housing and long-term care
options and the appropriate timing, and process, for facility placement)

David B. Hogan MD, Peter Bailey MD, Sandra Black MD, Anne Carswell MSc PhD, Howard Chertkow MD,Barry Clarke MD, Carole Cohen BA MD, John D. Fisk PhD, Dorothy Forbes RN PhD,Malcolm Man-Son-Hing MSc MD, Krista Lanctôt PhD, Debra Morgan RN PhD, Lilian Thorpe MD PhD

Contact: Dr. Hogan, University of Calgary, 403-220-4578, dhogan@ucalgary.ca

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