Dealing with Dementia A Guide to Alzheimer's

This work examines dementia with a special focus on Alzheimer's disease. A down-to-earth, comprehensive, and compassionate resource, this guide provides guidance for anyone struggling to come to terms with a diagnosis of dementia for themselves or a loved one. Filled with practical advice on drug treatments, complementary therapies, and residential or respite care, this guide is an invaluable tool for anyone worried about the effects of aging on the mind.

Dr. Brian Draper is the assistant director of the academic department for old age psychiatry at Prince of Wales Hospital in Sydney, Australia.

List of illustrations

x

List of tables

xi

Preface

xiii

CHAPTER 1 WHAT IS DEMENTIA?

1

(11)

Defining dementia

1

(1)

How does dementia differ from normal ageing?

2

(4)

What are the main types of dementia?

6

(1)

How common is dementia?

7

(1)

Is dementia becoming more common?

8

(1)

What is the impact of dementia upon society?

9

(2)

Summary

11

(1)

CHAPTER 2 PREVENTION OF DEMENTIA I

12

(14)

Disease prevention

12

(3)

Public health model of prevention

15

(1)

Universal dementia prevention strategies

16

(1)

Age and the role of antioxidants

16

(2)

Education, intelligence and brain reserve

18

(4)

Cerebral blood flow

22

(1)

Nutrition

22

(2)

Summary

24

(2)

CHAPTER 3 PREVENTION OF DEMENTIA II

26

(19)

Selective dementia prevention strategies

26

(1)

Genetic factors

26

(3)

Vascular risk factors

29

(3)

Nutrition

32

(2)

Gender: The role of hormone replacement therapy

34

(1)

Inflammation: The role of anti-inflammatory medication

35

(1)

Occupational exposures: Electromagnetic radiation, fumigants/defoliants

36

(1)

Delirium (acute confusional state)

37

(1)

Indicated dementia prevention strategies

38

(1)

Cognitive impairment

38

(1)

Depression in old age

39

(1)

Some unproven factors

39

(2)

Summary

41

(4)

CHAPTER 4 THE SYMPTOMS AND COURSE OF DEMENTIA

45

(26)

Pre-dementia: Mild cognitive impairment

45

(1)

Early or mild dementia

46

(6)

Moderate or middle stage dementia

52

(11)

Severe or late stage dementia

63

(6)

Advanced dementia

69

(1)

Summary

70

(1)

CHAPTER 5 TYPES OF DEMENTIA

71

(17)

Alzheimer's disease

74

(4)

Vascular dementia

78

(2)

Dementia with Lewy bodies

80

(2)

Frontotemporal dementia

82

(2)

Other neurodegenerative causes of dementia

84

(1)

Other dementias

85

(2)

Summary

87

(1)

CHAPTER 6 DEMENTIA ASSESSMENT

88

(18)

What is dementia assessment?

89

(1)

Who should perform the assessment?

89

(8)

What else may be causing memory changes? The differential diagnosis of dementia

97

(5)

Making the diagnosis

102

(2)

Initial management

104

(1)

Summary

105

(1)

CHAPTER 7 DRUG TREATMENTS

106

(17)

Some general principles

106

(1)

Memory and cognition: The cognitive (memory) enhancing drugs

107

(6)

Cognitive (memory) enhancing drugs not yet available in Australia

113

(1)

Some unproven cognitive (memory) enhancing drugs

114

(1)

Drugs for the behavioural and psychological symptoms of dementia

115

(7)

Medical problems that impact on dementia

122

(1)

Summary

122

(1)

CHAPTER 8 PSYCHOSOCIAL TREATMENTS

123

(15)

Some general rules of communication

123

(1)

Early dementia

124

(2)

Emotional support and lifestyle advice

124

(1)

Memory training

125

(1)

Making memories

126

(1)

Moderate-severe dementia

126

(11)

Validation therapy

127

(2)

Reminiscence therapy

129

(1)

Reality orientation

130

(1)

Music therapy

131

(1)

Physical exercise and activity programs

131

(1)

Aromatherapy and touch therapy

132

(1)

Audiotapes and videotapes

133

(1)

Behaviour therapy

134

(1)

Pet therapy

135

(1)

Light therapy

135

(1)

Multisensory stimulation: Snoezelen rooms

135

(1)

Physical restraints

136

(1)

Summary

137

(1)

CHAPTER 9 FAMILIES AND OTHER CARERS

138

(16)

The impact of early dementia

138

(5)

The impact of moderate dementia

143

(3)

The impact of severe dementia

146

(2)

Gender differences

148

(1)

Family education and support

149

(2)

Alzheimer's Association

151

(1)

Positive aspects of caregiving

152

(1)

Summary

153

(1)

CHAPTER 10 COMMUNITY CARE SERVICES

154

(16)

History of community care in Australia

154

(2)

Aged Care Assessment Program

156

(4)

Home and Community Care (HACC) Program

160

(1)

Carer services

161

(3)

Community Aged Care Packages (CACPs)

164

(2)

Aged Care Psychiatry (Psychogeriatric or Mental Health for Older People) Services

166

(1)

Innovative community services

166

(2)

The future of community care in Australia

168

(1)

Summary

168

(2)

CHAPTER 11 RESIDENTIAL CARE

170

(18)

Why does placement into residential care occur?

170

(1)

Preparation required for entering residential care

171

(3)

Requirements of good residential care

174

(4)

Types of residential care for dementia

178

(3)

The residential care system in Australia

181

(1)

Resident fees and charges

182

(3)

Quality in aged care facilities

185

(2)

Future concerns

187

(1)

Summary

187

(1)

CHAPTER 12 ETHICAL AND LEGAL ISSUES

188

(16)

Ethical principles

188

(1)

Mental competency: Decision-making capacity

189

(1)

How is decision-making capacity determined?

189

(2)

Substitute decision makers

191

(1)

Advance health care directives

192

(1)

Power of attorney and enduring power of attorney

193

(1)

Enduring guardianship

193

(1)

Guardianship

194

(1)

Driving

195

(3)

Research on subjects with dementia

198

(1)

Electronic tagging

199

(1)

Placement into residential care

200

(1)

End-of-life decisions

201

(2)

Summary

203

(1)

CHAPTER 13 THE FUTURE

204

(16)

Detection of pre-symptomatic individuals and early diagnosis

204

(6)

Prevention

210

(1)

Treatment

211

(3)

How will effective prevention and treatment of dementia affect society?

214

(5)

Summary

219

(1)

Appendix 1 Australian telephone helplines

220

(2)

Appendix 2 Websites

222

(8)

Appendix 3 Books for careers

230

(2)

Glossary

232

(6)

Notes

238

(14)

Index

252

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Dealing with Dementia A Guide to Alzheimer's Disease and Other Dementias

Summary

Author Biography

Table of Contents

Supplemental Materials