Older adults with diabetes have a high risk of undiagnosed cognitive dysfunction, depression, and functional disabilities. Cognitive dysfunction in this population is associated with poor diabetes control.

Normal aging is associated with weight loss; however, a new study suggests that weight loss may accelerate before the onset of clinical signs of Alzheimer's disease.

Three genes with autosomal dominant mutations have been identified that may lead to Alzheimer symptoms in carriers before they reach age 60. The article presents a variety of questions nurses may be asked, as well as possible answers.

Alzheimer’s disease (AD) is the leading cause of dementia in elderly people, affecting one in ten persons over age 65 and nearly half of those 85 or older. PCPs initially assess and treat individuals with cognitive impairment. Understanding the basic and clinical features of AD leads to early diagnosis and treatment.

When it comes to dementia medications, there is no convincing evidence that 1 drug is better than another; therefore, clinicians' treatment choice should be based on a drug's adverse effect profile, ease of use, and cost.

As people age, it is normal to experience occasional problems with memory and other mental skills. Dementia is not a normal part of aging. It is a disorder that gets progressively worse with time and affects personality, judgment, thinking, memory, and behavior. Dementia can be caused by Alzheimer's disease or other diseases that damage the brain. The damage is progressive, which means the symptoms get worse over time and cannot be reversed.

Conference participants agreed on a set of 7 basic principles to guide caregiver assessment policy and practices. Recommendations are based primarily on a comprehensive review of published reports, or when data were not conclusive, on the consensus opinion of the group.

Excellence in care requires using best practice assessment (including screening and ongoing assessments over time), using standardized instruments, and measuring the outcomes of care. The care of older adults with delirium, dementia and depression is often complex due to the number of chronic illnesses (numerous medications, coping with reduced function), and any acute illness that the client may have superimposed on these conditions. Practice settings would benefit from the participation and expertise of advanced practice nurses for full implementation.

The purpose of the Dementia Clinical Practice Guideline is to offer care providers and practitioners in long-term care facilities a systematic approach to recognizing, assessing, treating, and monitoring patients with dementia, including impaired cognition and problematic behavior. The guideline is intended to help practitioners to provide dementia patients with a systematic assessment and care plan, leading to appropriate management that maximizes functioning and quality of life and minimizes the likelihood of complications and functional decline.

This guideline makes specific recommendations on Alzheimer’s disease, dementia with Lewy bodies (DLB), frontotemporal dementia, vascular dementia and mixed dementias, as well as recommendations that apply to all types of dementia.

Recommendations for screening and assessment, pharmacologic management, management of behavioral and psychological symptoms, social and caregiver management of dementia, and community resources are covered.

The appropriateness criteria are reviewed annually and updated by the panels as needed, depending on introduction of new and highly significant scientific evidence.

This clinical algorithm is to be used together with the Clinical Practice Guideline: Dementia. < < link internally to entry on this page > > The guideline was developed by an interdisciplinary workgroup, using a process that combined evidence- and consensus-based approaches. Because scientific research in the long-term care population is limited, many recommendations were based on the expert opinion of practitioners in the field.

There were insufficient data to make any recommendations regarding cognitive screening of asymptomatic individuals. Persons with memory impairment who were not demented were characterized in the literature as having mild cognitive impairment. These subjects were at increased risk for developing dementia or AD when compared with similarly aged individuals in the general population. Recommendations: There were sufficient data to recommend the evaluation and clinical monitoring of persons with mild cognitive impairment due to their increased risk for developing dementia (Guideline). Screening instruments, eg, Mini-Mental State Examination, were found to be useful to the clinician for assessing the degree of cognitive impairment (Guideline), as were neuropsychologic batteries (Guideline), brief focused cognitive instruments (Option), and certain structured informant interviews (Option). Increasing attention is being paid to persons with mild cognitive impairment for whom treatment options are being evaluated that may alter the rate of progression to dementia.

Based on evidence in the literature, the following recommendations are made. 1) The DSM-III-R definition of dementia is reliable and should be used (Guideline). 2) The National Institute of Neurologic, Communicative Disorders and Stroke–AD and Related Disorders Association (NINCDS-ADRDA) or the Diagnostic and Statistical Manual, 3rd edition, revised (DSM-IIIR) diagnostic criteria for AD and clinical criteria for Creutzfeldt–Jakob disease (CJD) have sufficient reliability and validity and should be used (Guideline). Diagnostic criteria for vascular dementia, dementia with Lewy bodies, and frontotemporal dementia may be of use in clinical practice (Option) but have imperfect reliability and validity. 3) Structural neuroimaging with either a noncontrast CT or MR scan in the initial evaluation of patients with dementia is appropriate. Because of insufficient data on validity, no other imaging procedure is recommended (Guideline). There are currently no genetic markers recommended for routine diagnostic purposes (Guideline). The CSF 14-3-3 protein is useful for confirming or rejecting the diagnosis of CJD (Guideline). 4) Screening for depression, B12 deficiency, and hypothyroidism should be performed (Guideline). Screening for syphilis in patients with dementia is not justified unless clinical suspicion for neurosyphilis is present (Guideline).

These guidelines evaluate the best evidence for screening methods, diagnosis, and management of dementia, based on computerized literature searches. Articles were abstracted to determine whether there were sufficient data to recommend a method for early detection, diagnosis or management of dementia.

This clinical practice guideline represents core care recommendations for AD management that are clear, measurable, practical and based on scientific evidence, as available. The California Workgroup has provided its expert opinion when research evidence has been unavailable or when research results were inconsistent. The intended audience of this guideline is primary care practitioners, including physicians, nurse practitioners, physician assistants, social workers, and other professionals providing primary care to AD patients and their families.

As part of comprehensive management, the family physician may be responsible for coordinating assessments of patient function, cognition, comorbid medical conditions, disorders of mood and emotion, and caregiver status. Suggestions for easily administered and scored assessment tools are provided, and practical tips are given for supporting primary caregivers, thereby increasing efficiency and quality of care for patients with Alzheimer's disease.

Once the clinical diagnosis of Alzheimer's disease has been made, a treatment plan must be developed. This plan should include cholinesterase inhibitor therapy to temporarily improve cognition or slow the rate of cognitive decline, management of comorbid conditions, treatment of behavioral symptoms and mood disorders, provision of support and resources for patient and caregiver, and compliance with state-mandated reporting requirements for driving impairment and elder abuse. The primary caregiver can be a valuable ally in communication, management of care, and implementation of the care plan.

Cholinesterase inhibitors benefit patients with AD (Standard), although the average benefit appears small; vitamin E likely delays the time to clinical worsening (Guideline); selegiline, other antioxidants, anti-inflammatories, and estrogen require further study. Antipsychotics are effective for agitation or psychosis in patients with dementia where environmental manipulation fails (Standard), and antidepressants are effective in depressed patients with dementia (Guideline). Educational programs should be offered to family caregivers to improve caregiver satisfaction and to delay the time to nursing home placement (Guideline). Staff of long-term care facilities should also be educated about AD to minimize the unnecessary use of antipsychotic medications (Guideline). Behavior modification, scheduled toileting, and prompted voiding reduce urinary incontinence (Standard). Functional independence can be increased by graded assistance, skills practice, and positive reinforcement (Guideline).

Alzheimer’s disease does more than rob people of their memories; people with Alzheimer’s experience other kinds of symptoms. Cognitive symptoms disrupt memory, language, and thinking. Another category is behavioral and psychiatric symptoms. These symptoms occur in many — but not all — individuals with Alzheimer’s. In early stages of the disease, people may experience irritability, anxiety or depression. In later stages, a range of other symptoms may occur including sleep disturbances, physical or verbal outbursts, emotional distress, restlessness, pacing, shredding paper or tissues, and yelling, delusions (firmly held belief in things that are not real), and hHallucinations (seeing, hearing, or feeling things that are not there).