Approaches to Dementia Care

We are very thankful to the talented group of authors who have contributed to this month’s Practical Neurology on cognitive impairment and dementia. Until we have better treatment options for these degenerative dementia disorders, we need to be agile at providing the most appropriate assistance to the patient and caregiver at each stage of the disease. Our goal was to present practical information that the practicing neurologist can effectively use when they encounter their patients with cognitive impairments. Instead of a series of articles describing different diagnostic entities, the articles are written to provide tips for how to approach the clinical assessment, cognitive testing, behavioral symptoms, treatment management, and caregiver issues that arise during the course of the disease. We review key aspects of the diagnosis including symptom evaluation, diagnostic testing approaches, and management advice. We describe the importance of neuropsychologic testing. The approaches to abnormal and unwanted behaviors are outlined. Both current and novel cognitive treatment approaches are summarized. The importance of caring for the caregiver and ways to support them are discussed. Finally we explore how the role of genetics may impact the patient and their family. Come take the journey with us.

In Clinical Approach to Dementia, Drs. Bouchachi and Kataki outline the clinical evaluation and approach to persons with cognitive impairments, including typical clinical features and common diagnoses, history taking, examination features, cognitive/behavioral/functional assessments, diagnostic testing, and current treatment options. Next, in Neuropsychologic Approaches to Dementia, Dr. Nguyen, Ms. Prieto, and Dr. Dawson emphasize the circumstances when referral for neuropsychologic testing is most beneficial. They review the assessment and interpretation of test batteries and describe the role of the neuropsychologist in assisting with diagnoses, education, and maximizing patient function and outcomes. My article, Behavioral Approaches in Dementia Care, follows, where very practical information for both nonpharmacologic approaches and rational pharmacotherapy for abnormal behaviors are outlined. In his excellent review, Novel Treatments for Alzheimer Disease Disorders, Dr. Cummings describes the up and coming therapeutic interventions and their specified targets currently being investigated for Alzheimer disease. The recent FDA announcement regarding the approval of aducanumab, the monoclonal antibody designed to remove amyloid from the brain of people with Alzheimer disease is discussed. Dr. Hodgson, in her contribution, Dementia Caregiver Needs, describes the needs of the caregiver and how to support them along their journey in caring for an individual with dementia, giving practical advice regarding resources and education. Finally, we are delighted to share the scientific research and insights of Dr. Tanzi regarding the Genetics of Dementia. He describes key facts a clinical neurologist should be aware of regarding the genetics of neurodegenerative conditions including common mutations and when to consider genetic testing of patients or families.

As the numbers of dementia patients continue to rise, so does the hope of new treatments and improved diagnostic and management techniques. The critical role of the neurologist is to stay abreast of these new discoveries and to incorporate them into the day-to-day reality of caring for the patient and their caregivers so that both can achieve the best quality of life possible. We hope that the insights of our authors will help you all more easily navigate these waters.