Practical Management of Dementia: A Multi-Professional Approach

As the general population (and by inference, each of us) anticipates an increasingly longer lifespan, the problem of dementia also looms larger and may reach epidemic proportions at its present rate of growth. Thus, we anxiously await dividends from an expanding body of work in the fields of genetics, molecular biology, and neuroimaging that may reveal the cause(s) and effective treatment(s) for this condition. In the meantime, a cohesive strategy is required to care for those suffering from serious cognitive decline.

In this context, Curran and Wattis have prevailed upon a multidisciplinary group of experts to outline a very readable and comprehensive approach to caring for those with Alzheimer’s dementia and related disorders. Their stated goal is to bridge the gap between the existing knowledge base derived from research in this area and the ability of clinicians to apply this information in a strategy that optimizes patient care. Their stated agenda is to contribute meaningfully to the process of training practitioners to identify dementia as early as possible, respect patient autonomy, and employ treatment approaches that emphasize the spiritual needs of the individual. The discussion from several perspectives results in some repetition, but, overall, the book is a sound review of our present knowledge about the dementias and their management.

The editors have divided the text loosely into three parts. The first reviews the history, definition, epidemiology, diagnosis, classification, and strategies for early identification. They note that age is the single most important risk factor. Family history, certain genetic variations (e.g., APOE, E4 homozygotes), and depression are also important predisposing factors that may increase the risk substantially. Conversely, there is preliminary evidence indicating that such disparate factors as regular physical activity; the use of wine, coffee, statins, nonsteroidal antiinflammatory drugs, certain vitamins (e.g., C and E); and higher educational attainment (as well as length of training) may reduce the risk of dementia.

The chapter authors underscore that dementia is a syndrome with multiple causes, such as vitamin deficiencies, infections, and endocrine dysfunction—conditions that may be correctible, or at least substantially improved. They highlight the three most common irreversible types (i.e., Alzheimer’s disease, vascular dementia, and Lewy body dementia), noting that accurate and early diagnosis can have a favorable impact on both treatment and prognosis. In this light, they review a number of simple early screening assessments, but they also note that there is no pathognomonic test for Alzheimer’s disease.

The second part uses case examples to clarify the role of different professionals (i.e., consultants, psychologists, physicians, nurses, and occupational therapists) in the assessment, diagnosis, and management of dementia. One chapter is devoted to each profession’s unique perspective, emphasizing the need to shift from a medical model orientation to a positive person-centered approach to care.

The third part examines the delivery care system for the dementias, focusing on the memory clinic, legal aspects, and the spiritual needs of the individual.

The strength of this book is the inclusion of multiple perspectives, but the weakness is substantial redundancy. Despite the latter, I believe that this is an important consolidation of our present knowledge and a good primer for those involved in the care of the dementias.