The Clinical Management of Early Alzheimer's Disease: A Handbook

The Clinical Management of Early Alzheimer's Disease: A Handbook

The Clinical Management of Early Alzheimer's Disease: A Handbook

The Clinical Management of Early Alzheimer's Disease: A Handbook

Synopsis

The enormous human and economic toll of Alzheimer's Disease in societies in which more and more people are living into old age is well-recognized. Scientists and practitioners alike have been working to limit it. Their major focus has been patients in the later stages of the disease, when dementia is fully established. Yet patients in the early stages of cognitive decline, far more numerous, often still living independently with family members, present a bewildering variety of challenges. Bringing together leading authors with diverse expertise, this Handbook offers the first comprehensive overview of approaches to the management of early-stage issues. The authors summarize the important implications of the latest research in their own fields for: the recognition and formal diagnosis of cognitive problems; the assessment of specific difficulties in daily functioning; the formulation of a management plan integrating pharmacological, neuropsychological, behavioral, and cognitive strategies; and the facilitation and support of caregivers' efforts. All professionals involved in any way with the care of early Alzheimer's patients and their families will find this book an indispensable reference.

Excerpt

This book is divided into two parts. The first part deals with clinical and cognitive aspects of Alzheimer's Disease (AD) crucial for the diagnosis of early dementia and related disorders, reviewing recent research findings in this area. The second raises the important issue of appropriate and optimal management in the early stages of the disease.

The complex question of how to evaluate the costs of chronic diseases, such as AD, for a society is addressed in Chapter 1; in particular the impact of medical treatment and care strategies in the very early stages of AD are discussed. Important points raised in this chapter are the unclear relationship between type and amount of expenditure on care and the patient's and caregiver's welfare. Many methodological issues related to the cost analysis of dementia still remain unresolved and further studies are needed to help health professionals in their choice of treatment and care utilization.

Guidelines for screening and the clinical evaluation of dementia in primary health care are proposed in Chapter 2. Clinical features and diagnostic criteria of the most frequent dementias are described and suggestions are made about which patients should be referred to specialists for further investigations. A basic laboratory workup is recommended and indications for neuroimaging proposed. The impact of methods developed for cognitive psychologists on neuropsychological assessment is discussed in Chapter 3. In contrast to traditional neuropsychological formulations, new approaches showed that AD can selectively impair specific cognitive systems or processes while sparing others, that factors allowing an optimization of cognitive performance may be identified, and that there is an important heterogeneity in both the nature and the progression of deficits. These findings have greatly influenced the practice of assessment and rehabilitation in AD. Moreover, it was also demonstrated that—beyond the observed heterogeneity—certain types of deficits, such as deficits in exec-

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