Article excerpt


* Banner Sun Health Research Institute

Phoenix, Arizona

* Columbia University/New York-Presbyterian Hospital

New York, New York

* Johns Hopkins Hospital

Baltimore, Maryland

* Massachusetts General Hospital

Boston, Massachusetts

* Montef iore Medical Center

New York, New York

* Mount Sinai Medical Center

New York, New York

* Rush University Medical Center

Chicago, Illinois

* Ronald Reagan UCLA Medical Center

Los Angeles, California

* University of California, San Diego, Medical Center

San Diego, California

* University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania

* University of Washington Medical Center

Seattle, Washington

* University of Wisconsin Hospitals and Clinics

Madison, Wisconsin

* Wake Forest University Baptist Medical Center

Winston-Salem, North Carolina

* Washington University Medical Center

St Louis, Missouri

Dementia affects about 4 million to 5 million people in the United States. It affects about one percent of people aged 60 to 64 years and as many as 30 percent to 50 percent of those aged more than 85 years. Demenria is a cause of significant morbidity and mortality and is a cause of institutionalization. It places a substantial bui'den on patients and their caregivers.

Patients with dementia present a significant diagnostic and treatment challenge to primary care physicians. The leading types of irreversible dementia:

* Alzheimer's disease (about 50 percent of cases),

* Vascular dementia (about 40 percent of cases), and

* Lewy body dementia.

Treatment and caregiver decisions often are based on whether mild, moderate, or severe dementia has been diagnosed in a patient. Primary care physicians may decide in consultation with the patient or patient's caregiver to refer the patient to a center specializing in dementia.

This month's Clinical Center of Excellence series features facilities offering comprehensive diagnostic modalities and state-of-the-art treatment modalities including investigational protocols for dementia. The centers also use behavioral interventions and support care.

The dementia centers were chosen based on a survey of neurologists. Each center was asked to provide patient statistics, research protocol information, and other pertinent dementia management feaUires. We do not rank the centers relative to each other but highlight what makes each one unique. We could not profile them all but have included a list of the other Clinical Centers of Excellence identified by our survey (see the accompanying list).

Medical Economics' editors also have gathered management and referral tips from the experts associated with the featured centers. These tips may be useful when managing patients with seizure disorders in the primary care setting.

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Management and referral of dementia

The patient with dementia presents a complex clinical picture for the primary care physician. The differential diagnosis includes looking for cause of both irreversible and reversible causes of dementia Potentially reversible causes of dementia include drugs, delirium, and depression. Underlying medical conditions such as Alzheimer's disease are responsible for irreversible dementia Diagnosis often is made by history and physical examination.

Experts from this issue's Clinical Centers of Excellence offer diagnosis and treatment guidelines for dementia


"Older people who have memory complaints should be evaluated," says Karen Bell, MD, director of the Alzheimer's Clinical Trials Group at Columbia University/New YorkPresbyterian Hospital. "I think that's the most important thing because Alzheimer's disease is under-diagnosed and under-treated. …