Useful guide on dementia

The AMA's "Diagnosis, Management and Treatment of Dementia -- A Practical Guide for Primary Care Physicians" provides a timely and valuable resource for physicians.

Editorial. June 19, 2000.

Former President Ronald Reagan's widely publicized Alzheimer's condition has focused media and public attention on the disease and on other problems that confront the nation's rapidly increasing elderly population. As a result, growing numbers of aging Americans and their families are consulting their physicians for counsel.

An American Medical Association publication, "Diagnosis, Management and Treatment of Dementia -- A Practical Guide for Primary Care Physicians," provides a timely and valuable resource for physicians in many areas of practice.

How to get the guide

Although a major portion of the 48-page booklet is devoted to diagnosis and treatment of dementia, it also provides incisive information to help address not only the medical needs of the patient but also the problems that confront families and loved ones.

There is growing recognition of the public health implications of dementia, which now affects millions of patients and their families. After age 65, the prevalence of dementia rises exponentially and doubles every 10 years; between 35% and 45% of those older than 85 are estimated to have a dementing disorder. The course of dementia may run from two to 20 years. Although institutionalization is frequent, most patients are cared for in the community by family members -- a great expenditure of both psychological and financial resources.

Much dementia care is sought from primary care physicians, whose ongoing support is essential as the condition progresses. As a result, the AMA, with a grant from the AMA Foundation, developed the guide to assist the primary care physician in the initial diagnosis of the disorder, management and treatment, and supportive intervention for family caregivers. Included are sections on diagnosis, co-morbidity, managing and treating cognitive problems, treating behavioral symptoms, office concerns, family caregiving, safety -- including automobile driving -- and elder abuse. A wide list of community resources is identified, a tool that will assist physicians as well as patients' families.

Finally, there is a valuable section on end-of-life issues in dementia. Although many physicians routinely think of cancer, congestive heart failure and chronic obstructive pulmonary disease as conditions for which palliative care and hospital referral may be appropriate, many do not view dementia in the same way.

As the guide points out, although infections or complications from immobility may be the final events that are the proximate cause of death, Alzheimer's disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Looking at dementia as a terminal illness from which people are dying over a many-year period instead of over a few months allows the physician to focus explicitly and aggressively on a palliative care plan.

The section on end-of-life issues covers key topics, including advanced care planning (with such directives as living wills and durable powers of attorney); aggressive symptom control; altered benefits and burdens in making decisions about treatment; feeding issues; formal hospice referral; family support; and ethical issues involved in artificial feeding and hydration.

It is a certainty that the number of patients with Alzheimer's and other forms of dementia will increase in the coming years. There is no immediate prospect of a cure. It therefore is incumbent on physicians -- particularly those in primary care fields -- to be prepared to meet the needs of these patients and, perhaps of equal importance, their families. The AMA's new guide provides a considerable amount of clinical and practical advice toward that end.

ADDITIONAL INFORMATION:

How to get the guide

Copies of "Diagnosis, Management and Treatment of Dementia" may be ordered from the AMA Program on Aging and Community Health, (312) 464-5563. The price is $3 for AMA members (to cover costs) and $5 for nonmembers. It has been designated for up to three hours of Category I continuing medical education credit.