دانلود کتاب 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