Skip to main content

Dementia

  • Chapter
Geriatric Medicine

Summary

A comprehensive approach based on evidence from the scientific literature promises to reduce the disability of dementia substantially in the near future. However, the use of medications and modifications in staff or family’s approach to the patient still requires ingenuity and perseverance. Even modest individual benefits, when spread over the large numbers of older Americans who will become demented, means sizable reductions in projected costs of care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 299.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 379.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Small GW, Rabins PV, Barry PP, et al. Diagnosis and treatment of Alzheimer disease and related disorders. JAMA. 1997;278:1363–1371.

    Article  PubMed  CAS  Google Scholar 

  2. Ernst RL, Hay JW. The US economic and social costs of Alzheimer’s disease revisited. Am J Public Health. 1994;84: 1261–1264.

    PubMed  CAS  Google Scholar 

  3. Ross GW, Abbot RD, Petrovich H, et al. Frequency and characteristics of silent dementia among elderly Japanese-American men: the Honolulu-Asia Aging Study. JAMA. 1997:277:80–85.

    Article  Google Scholar 

  4. Brookmeyer R, Gray S, Kawas C. Projections of Alzheime’s disease in the United States and the public health impact of delaying disease onset. Am J Public Health. 1998;88:1337–1342.

    PubMed  CAS  Google Scholar 

  5. Ritchie K, Kildea D. Is senile dementia “age-related” or “ageing related”?—evidence from meta-analysis of dementia prevalence in the oldest old. Lancet. 1995;346:931–934.

    Article  PubMed  CAS  Google Scholar 

  6. Mohs RC, Breitner JCS, Silverman JM, Davis KL. Alzheime’s disease; morbid risk among first-degree relatives approximates 50% by 90 years of age. Arch Gen Psychiatry. 1987;44:405–408.

    PubMed  CAS  Google Scholar 

  7. Kennedy G, Hofer M, Cohen D, Schindledecker R, Fisher J. Significance of depression and cognitive impairment in patients undergoing programmed electrical stimulation of cardiac arrhythmias. Psychosom Med. 1987;49:410–421.

    PubMed  CAS  Google Scholar 

  8. Katzman R. Alzheimer’s disease. N Engl J Med. 1986;314: 964–973.

    Article  PubMed  CAS  Google Scholar 

  9. Inouye SK, Bogardus ST, Charpentier PA, et al. A clinical trial of a multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999,340:669–676.

    Article  PubMed  CAS  Google Scholar 

  10. Reifler BV. Mixed cognitive-affective disturbances in the elderly: a new classification. J Clin Psychiatry. 1986;47:354–356.

    PubMed  CAS  Google Scholar 

  11. Jost BC, Grossberg GT. Evolution of psychiatric symptoms in Alzheimer’s disease: a natural history study. J Am Geriatr Soc. 1996;44:1078–1081.

    PubMed  CAS  Google Scholar 

  12. Richards M, Touchon J, Ledesert B, Richie K. Cognitive decline in ageing: are AAMI and AACD distinct entities? Int J Geriatr Psychiatry. 1999;14:534–540.

    Article  PubMed  CAS  Google Scholar 

  13. Peterson R, Smith G, Waring S, et al. Mild cognitive impairment; clinical characterization and outcome. Arch Neurol. 1999;56:303–308.

    Article  Google Scholar 

  14. Huber SJ, Paulson GW. The concept of subcortical dementia. Am J Psychiatry. 1985;142:1313–1317.

    Google Scholar 

  15. McKieth LG, Galasko D, Kosaka K, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology. 1996; 47:1113–1124.

    Google Scholar 

  16. Luis CA, Barker WW, Gajaraj K, et al. Sensitivity and specificity of three clinical criteria for dementia with Lewy bodies in an autopsy-verified sample. Int J Geriatr Psychiatry. 1999;14:526–533.

    Article  PubMed  CAS  Google Scholar 

  17. Mahendra B. Depression and dementia: the multi-faceted relationship. Psychol Med. 1985;15:227–236.

    Article  PubMed  CAS  Google Scholar 

  18. Heston LL, White JA, Mastri AR. Pick’s disease; clinical genetics and natural history. Arch Gen Psychiatry. 1987;44: 409–411.

    PubMed  CAS  Google Scholar 

  19. Folstein SE, Folstein ME, Psychiatric features of Huntington’s disease. Psychiatr Dev. 1983;2:193–206.

    Google Scholar 

  20. Koenig S, Gendelman HE, Orenstein JM, et al. Detection of AIDS virus in macrophages in brain tissues from AIDS patients with encephalopathy. Science. 1986;233:1089–1093.

    PubMed  CAS  Google Scholar 

  21. Harrington MG, Merril CR, Asher DM, Gajdusek DC. Abnormal proteins in the cerebrospinal fluid of patients with Creutzfeldt-Jakob disease. N Engl J Med. 1986;315: 279–283.

    Article  PubMed  CAS  Google Scholar 

  22. Cutler NR, Haxby JV, Duara R, et al. Brain metabolism as measured with serial assessment in a patient with familial Alzheimer’s disease. Neurology. 1985;35:184.

    Google Scholar 

  23. Grober E, Lipton RB, Hall C, et al. Memory impairment on free and cued selective reminding predicts dementia. Neurology. 2000;54:827–832.

    PubMed  CAS  Google Scholar 

  24. Folstein M, Anthony JC, Parhad I, Duffy B, Gruenberg EM. The meaning of cognitive impairment in the elderly. J Am Geriatr Soc. 1985;33:228–235.

    PubMed  CAS  Google Scholar 

  25. Sherwin BB. Mild cognitive impairment: potential pharmacological treatment options. J Am Geriatr Soc. 2000;48:431–441.

    PubMed  CAS  Google Scholar 

  26. Molloy DW, Standish TIM. A guide to the standardized Mini-Mental State Examination. Int Psychcogeriatr. 1997;9: 87–94.

    Article  Google Scholar 

  27. Kelman HR, Thomas C, Kennedy GJ, Chen J. Cognitive impairment and mortality among older community residents. J Am Public Health. 1994;84:1255–1260.

    CAS  Google Scholar 

  28. Devanand DP, Jacobs DM, Tang M-X, et al. The course of psychopathology in mild to moderate Alzheimer’s disease. Arch Gen Psychiatry. 1997;66:205–210.

    Google Scholar 

  29. Stahelin HB, Monsch AU, Spiegel R. Early diagnosis of dementia via a two-step screening and diagnostic procedure. Int Psychogeriatr. 1997;9:123–130.

    Article  PubMed  Google Scholar 

  30. Kasper JD. Cognitive impairment among functionally limited elderly people in the community: future considerations for long-term care policy. Milbank Q. 1990;68: 81–109.

    PubMed  CAS  Google Scholar 

  31. Auer S, Reisberg B. The GDS/FAST system. Int Psychogeriatr. 1997;9:167–171.

    Article  PubMed  Google Scholar 

  32. Reifler BV, Larson E. Excess disability in demented elderly outpatients: the rule of halves. J Am Geriatr Soc. 1988;36: 82–83.

    PubMed  CAS  Google Scholar 

  33. Nyenhuis DL, Gorelick PB. Vascular dementia: a contemporary review of epidemiology, diagnosis, prevention, and treatment. J Am Geriatr Soc. 1998;46:1437–1448.

    PubMed  CAS  Google Scholar 

  34. Mittelman MS, Ferris SH, Shulman E, Steinberg G. The effects of a multicomponent program on spouse-caregivers of Alzheimer’s disease patients: results of a treatment/control study. In: Heston LL, ed. Progress in Alzheimer’s Disease and Similar Conditions. Washington, DC: American Psychiatric Association Press; 1995:259–270.

    Google Scholar 

  35. Butler RN. Sounding board; on behalf of older women. N Engl J Med. 1996;334:794–796.

    Article  PubMed  CAS  Google Scholar 

  36. Boss P, Caron W, Horbal J, Mortimer J. Predictors of depression in caregivers of dementia patients: boundary ambiguity and mastery. Fam Process. 1990;29:245–254.

    Article  PubMed  CAS  Google Scholar 

  37. Cohen D, Eisdorfer C. Depression in family members caring for a relative with Alzheimer’s disease. J Am Geriatr Soc. 1988;36:885–889.

    PubMed  CAS  Google Scholar 

  38. Gallagher D, Rose J, Rivera P, et al. Prevalence of depression in family caregivers. Gerontologist. 1989;29:449–456.

    PubMed  CAS  Google Scholar 

  39. Coleridge PT, George LK. Predictors of institutionalization among caregivers of patients with Alzheimer’s disease. J Am Geriatr Soc. 1986;34:493–498.

    Google Scholar 

  40. Gwyther LP. Care of Alzheimer’s Patients: A Manual for Nursing Home Staff. Washington, DC: American Health Care Association and the Alzheimer’s and Related Disorders Association; 1988.

    Google Scholar 

  41. Breitner JCS. The end of Alzheimer’s disease? Int J Geriatr Psychiatry. 1999;14:577–586.

    Article  PubMed  CAS  Google Scholar 

  42. Rosenberg RN. The molecular and genetic basis of AD: the end of the beginning. The 2000 Wartenberg lecture. Neurology. 2000;54:2045–2054.

    PubMed  CAS  Google Scholar 

  43. Cummings JL. Cholinesterase inhibitors: a new class of psychotropic compounds. Am J Psychiatry. 2000;157:4–15.

    PubMed  CAS  Google Scholar 

  44. Rogers SE, Friedhof LT, Apter JT, et al. The efficacy and safety of donepezil in patients with Alzheimer’s disease: results of a US multi-center, randomized, double-blind, placebo controlled trial. Dementia. 1996;7:293–303.

    PubMed  CAS  Google Scholar 

  45. Kaufer DI, Cummings JL, Christine D. Effect of tacrine on behavioral symptoms in Alzheimer’s disease: an open label study. J Geriatr Psychiatry Neurol. 1996;9:1–6.

    PubMed  CAS  Google Scholar 

  46. Becker RE, Colliver JA, Markwell SJ, et al. Effects of metrifonate on cognitive decline in Alzheimer’s disease: a double-blind, placebo-controlled, 6-month study. Alzheimer Dis Relat Disord. 1998;12:54–67.

    Article  CAS  Google Scholar 

  47. Knopman D, Schneider LS, Davis K, et al. Long term tacrine (Cognex) treatment effects on nursing home placement and mortality: the Tacrine Study Group. Neurology. 1996:47:166–177.

    PubMed  CAS  Google Scholar 

  48. Livingston G, Katona C. How useful are cholinesterase inhibitors in the treatment of Alzheimer’s disease? A number needed to treat analysis. Int J Geriatr Psychiatry. 2000:15:203–207.

    Article  PubMed  CAS  Google Scholar 

  49. Cameron I, Curran S, Newton P, et al. Use of donepesil for the treatment of mild-moderate Alzheimer’s disease: an audit of the assessment and treatment of patients in routine clinical practice. Int J Geriatr Psychiatry. 2000;15:887–891.

    Article  PubMed  CAS  Google Scholar 

  50. Vellas B, Inglis F, Potkin S, et al. Interim results from an international clinical trial with rivastigmine evaluating a 2-week titration rate in mild to severe Alzheimer’s disease patients. Int J Geriatr Psychopharm. 1998;1:140–144.

    CAS  Google Scholar 

  51. Röseler M, Anand R, Cicin-Sain A, et al. Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: international randomized controlled trial. Br Med J. 1999;318: 633–638.

    Google Scholar 

  52. Maelicke A. Allosterric modulation of nicotinic acetylcholine receptors as a treatment strategy for Alzheimer’s disease. Dement Geriatr Cogn Disord. 2000;11(suppl 1):11–18.

    Article  PubMed  CAS  Google Scholar 

  53. Krall WJ, Srmek JJ, Cutler NR. Cholinesterase inhibitors: a therapeutic strategy for Alzheimer’s disease. Ann Pharmacother. 1999;33:441–450.

    Article  PubMed  CAS  Google Scholar 

  54. Sano M, Ernesto C, Thomas RG, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer’s disease. N Engl J Med. 1997;336:1216–1222.

    Article  PubMed  CAS  Google Scholar 

  55. Marden K, Sano M. Estrogen to treat Alzheimer’s disease: too little, too late? So what’s a woman to do? Neurology. 2000;54:2035–2036.

    Google Scholar 

  56. Lyketsos CG, Steinberg M, Tschanz JT, et al. Mental and behavioral disturbances in dementia: findings for the Cache County Study on Memory and Aging. Am J Psychiatry. 2000;157:708–714.

    Article  PubMed  CAS  Google Scholar 

  57. Teri L, Rabins P, Whitehouse P, et al. Management of behavior disturbance in Alzheimer disease: current knowledge and future directions. Alzheimer Dis Assoc Disord. 1992;6:77–88.

    PubMed  CAS  Google Scholar 

  58. Roca RP. Managing the behavioral complications of dementia. In: Cobbs EL, Duthie EH, Murphy JB, eds. Geriatric Review Syllabus: A Core Curriculum in Geriatric Medicine, 4th Ed., Iowa: Kendall/Hunt; 1999:183–186.

    Google Scholar 

  59. Lyketsos CG. Remarks before the FDA Psychopharmaco-logical Drugs Advisory Committee, March 18, 2000.

    Google Scholar 

  60. Greenwald BS, Kramer-Ginsberg E, Mann DB, et al. Dementia with coexistent major depression. Am J Psychiatry. 1989;146:1472–1478.

    PubMed  CAS  Google Scholar 

  61. Wragg RE, Jeste VD. Overview of depression and psychosis in Alzheimer’s disease. Am J Psychiatry. 1989;146:577–587.

    PubMed  CAS  Google Scholar 

  62. Teri L, Logsdon R, Uomoto J, et al. Behavioral treatment of depression in dementia: a controlled trial. J Gerontol. 1997;32B:P159–P166.

    Google Scholar 

  63. Cohen-Mansfield J, Werner P. Management of verbally disruptive behaviors in nursing home residents. J Gerontol Med Sci. 1996;52:M369–M377.

    Google Scholar 

  64. Swauger KC, Tomlin C. Moving toward restraint-free patient care. J Nurs Admin. 2000;30:325–329.

    Article  CAS  Google Scholar 

  65. Moody HR. From informed consent to negotiated consent. Gerontologist. 1988;28:64–70.

    PubMed  Google Scholar 

  66. Houlihan DJ, Mulsant BH, Sweet RA, et al. A naturalistic study of trazodone in the treatment of behavioral complications of dementia. Am J Geriatr Psychiatry. 1994;2:78–85.

    Google Scholar 

  67. Katz IR, Jeste VD, Mintzer JE, et al. Comparison of resperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, doubleblind trial. J Clin Psychiatry. 1999;60:107–115.

    PubMed  CAS  Google Scholar 

  68. Street JS, Clark WS, Gannon KS, et al. Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer’s disease in nursing care facilities: a doubleblind randomized, placebo-controlled trial. The HGEU Study Group. Arch Gen Psychiatry. 2000;57:968–976.

    Article  PubMed  CAS  Google Scholar 

  69. McManus DQ, Arvantis LA, Kowalcyk BB. Quetiapine, a novel antipsychotic: experience in elderly patients with psychotic disorders. Seroquel Trial 48 Study Group. J Clin Psychiatry. 1999;60(5):292–298.

    PubMed  CAS  Google Scholar 

  70. Maletta GJ. Treatment of behavioral symptomatology of Alzheimer’s disease, with emphasis on aggression: current clinical approaches. Int Psychogeriatr. 1992;4:117–130.

    PubMed  Google Scholar 

  71. Magai C, Cohen C, Kennedy GJ, Gomberg D. A controlled clinical trial of sertraline in the treatment of depression in nursing home residents. Am J Geriatr Psychiatry. 2000;8:66–75.

    Article  PubMed  CAS  Google Scholar 

  72. Salzman C. Practical considerations for the treatment of depression in elderly and very elderly long-term care patients. J Clin Psychiatry. 1999;60(suppl 20):30–33.

    PubMed  Google Scholar 

  73. Clerc GE, Ruimy P, Verdeau-Palles J. A double blind comparison of venlafaxiine and fluoxitine in patients hospitalized for major depression and melancholia. Int Clin Psychopharmacol. 1994;9:139–143.

    PubMed  CAS  Google Scholar 

  74. Burrows G, Kremer C. Mirtazapine: clinical advantages in the treatment of depression. Psychopharmacology. 1997; 17(suppl 1):34S–39S.

    CAS  Google Scholar 

  75. Overman W, Stoudemire A. Guidelines for legal and financial counseling of Alzheimer’s disease patients and their families. Am J Psychiatry. 1988;145:1495–1500.

    PubMed  Google Scholar 

  76. Gillick MR. Rethinking the role of tube feeding in patients with advanced dementia. N Engl J Med. 2000;342:206–210.

    Article  PubMed  CAS  Google Scholar 

  77. Karlawish JH, Quill T, Meier DE. A consensus-based approach to providing palliative care to patients who lack decision-making capacity. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 1999;130:835–840.

    PubMed  CAS  Google Scholar 

Download references

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer-Verlag New York, Inc.

About this chapter

Cite this chapter

Kennedy, G.J. (2003). Dementia. In: Geriatric Medicine. Springer, New York, NY. https://doi.org/10.1007/0-387-22621-4_75

Download citation

  • DOI: https://doi.org/10.1007/0-387-22621-4_75

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-95514-8

  • Online ISBN: 978-0-387-22621-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics