Managing the patient

Management of the patient with dementia is discussed in greater detail in ,CñapteL4JJ...4. Management starts with the assessment and diagnosis, and perhaps the difficult dilemma is how much of the diagnosis and prognosis to discuss with the patient.(73) Most practitioners do not discuss the diagnosis with the patient themselves, although especially in the early stages a frank consultation can be beneficial. For most patients, however, cognitive impairment renders an appreciation of the diagnosis and prognosis difficult.

A large part of managing the patient is directed towards managing mood and behavioural disturbance. Accurate assessment of the disturbance is critical, and includes determining the antecedents and responses to the behaviour as well as a full description of the behaviour and any associated abnormalities in the mental state. Treatments of behavioural disturbance in AD are most often behavioural and sometimes restricted to giving information to careers. However, pharmacological interventions are an important part of the management of behavioural disturbance, even though caution regarding the use of psychotropic medications in those with dementia is necessary.

Specific treatments for AD have been developed, concentrating in clinical trials on ameliorating the core symptom of cognitive impairment. The cholinomimetic approaches are the most advanced, but other therapies are receiving extensive evaluation. Although designed for the large part as strategies to enhance cognition, these compounds also favourably appear to affect function and may reduce behavioural disturbance. Further evaluation is being conducted to determine whether there are disease-modifying effects. Drug treatments for AD are described in Chapter6.2.7.

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