The Clinical Management of Early Alzheimer's Disease: A Handbook

363 Pages·2003·1.3 MB·English

by  Reinhild Mulligan

The Clinical Management
of Early Alzheimer’s Disease
A Handbook

The Clinical Management
of Early Alzheimer’s Disease
A Handbook
Edited by
Reinhild Mulligan
University Hospitals of Geneva
Martial Van der Linden
University of Geneva
Anne-Claude Juillerat
University Hospitals of Geneva
LAWRENCE ERLBAUM ASSOCIATES, PUBLISHERS
2003 Mahwah, New Jersey London
This edition published in the Taylor & Francis e-Library,2008.
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Copyright © 2003 by Lawrence Erlbaum Associates, Inc.
Allrightsreserved.Nopartofthisbookmaybereproducedinany
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without prior written permission of the publisher.
Lawrence Erlbaum Associates, Inc., Publishers
10 Industrial Avenue
Mahwah, NJ 07430
Cover design by KathrynHoughtalingLacey
Library of Congress Cataloging-in-Publication Data
TheclinicalmanagementofearlyAlzheimer’sdisease:ahandbook/
editedbyReinhildMulligan,MartialVanderLinden,Anne-Claude
Juillerat.
p. cm.
Includes bibliographical references and index.
ISBN 0-8058-3370-6 (alk. paper)
1.Alzheimer’sdisease. 2.Alzheimer’sdisease—Patients—Care.
I.Mulligan,Reinhild. II.VanderLinden,Martial. III.Juillerat,
Anne-Claude.
[DNLM:1.AlzheimerDisease—therapy. 2.AlzheimerDisease—
diagnosis. WT155 C6414 2003]
RC523 .C575 2003
616.8’3106—dc21 2002017867
CIP
ISBN 1-4106-0722-4 Master e-book ISBN
Contents
Foreword vii
Scott Henderson
Preface ix
List of Contributors xiii
1 Sociodemographicand Economic Aspects 1
Jean-Pierre Michel, Gabriel Gold,FrançoisHerrmann,DinaZekry,
ReinhildMulligan, andPanteleimonGiannakopoulos
2 Clinical Aspects 21
SergeGauthier
3 Cognitive-Neuropsychological Aspects 35
FabienneCollette, Martial Van der Linden, Anne-ClaudeJuillerat,
andThierryMeulemans
4 Assessment: TheMultidisciplinaryApproach 75
ReinhildMulligan
5 The Role of Memory Clinics in Diagnosis 101
and Management
Eli J.Jaldow, JulianaOnwumere, and Michael D.Kopelman
6 Pharmacological Treatment: Recent Developments 109
EzioGiacobini
v
vi CONTENTS
7 Psychiatric and Behavioral Problems: Pharmacological 129
Approaches
Philippe H. Robert
8 Psychiatric and Behavioral Problems: Psychosocial 143
Approaches
Michael Bird
9 Cognitive Intervention 169
Martial Van der Linden, Anne-ClaudeJuillerat, andStéphaneAdam
10 The Assessment of Functioning in Daily Life 235
Anne-ClaudeJuilleratand Martial Van der Linden
11 The Role ofCaregiversin Assessment and Intervention 281
FrancineFontaine,BrigitteGilbert, andKarineMorasse
12 Taking Care of theCaregivers 297
LouiseLévesqueand MarieGendron
Author Index 319
Subject Index 341
Foreword
Aftersometwomillionyearsofhumanevolution,anunprecedentedde-
mographic process has begun. Large numbers of people are remaining
alive until a late age. Since the Middle Pleistocene, this has never hap-
penedbefore.Theconsequenceisthatmillionsofhumanbrainsarenow
surviving to the stage when neurodegenerative events start to manifest
themselves.Andthesebrainsarethebiologicalbasisoftheirowners’men-
tallife,ownerswhonowconstituteasmuchasonefifthofsomepopula-
tions.Withinthisgroupofelderlypersons,asizeablefractionhavesome
degreeofcognitivedecline.Forsome,thisdeclineisprogressive.Theper-
sonalandsocialconsequencesareprofound.Theeconomicandhealthcare
consequencesnowthreatenthewealthiestofcountries.
Inthehealthcareoftheelderly,muchattentionhasrightlybeengivento
thecareofpersonswithfullyestablisheddementias.Notnearlysomuch
attentionhasbeendirectedatmilderandincipientstatesofcognitivede-
cline.Yetfromtheviewpointofpopulationhealth,thisgroupisjustasde-
serving.Theyarenumericallyfargreaterthanthenumbersofpeoplewith
dementia,theircognitivedeclineisassociatedwithnontrivialdisablement
indailylife,andtheirimpairmentisbelievedtobeatastagewheninter-
ventionsmayhavesomechanceofslowingdegenerationandprotecting
theperson’sfunctionalcapacity.
Here,then,isanareaofneedthatcallsforarangeofscientificeffortsto-
ward treatment and prevention: in neuropharmacology, neuropsycho-
logy,behavioraltreatments,andpsychosocialinterventions.Theadvances
achievedineachoftheseneedthentobeappliedthroughprofessionaland
communityresources.Drs.Mulligan,VanderLinden,andJuillerathavea
fullrecognitionofthis,buttheyalsorevealtheirawarenessoftheneedfor
thisdiversityofresourcestoworktogether.Indeed,thatisaprimarymo-
tiveintheirorganizingandeditingthishandbook.Itisallverywelltohave
an array of highly trained expertise within a community, but that is for
vii
viii FOREWORD
naughtiftheexpertsdonotworkinharmonywitheachother,withadmin-
istrators,and,aboveall,withtheirconsumers.Wherecomplementarityis
highlyvalued,theperformanceofsuchteamsflourishes.Theeditorswant
tohelpachievethat.
Between these two covers, there is assembled a body of information,
ideas,andperspectivesthatmakeTheClinicalManagementofEarlyAlzhei-
mer’s Disease an exceptionally rich resource for those who work for the
healthandwell-beingofolderpersons.Itisprofessionallyandscientifi-
callynonpartisanbecauseitcarriescontributionsfrommanydisciplines.
Anditbalancestheneedforevidence-basedtreatmentswiththeneedfor
compassion.Asacontributiontothehealthcareoftheelderly,itisabook
thatshoulditselfagewell!
—ScottHenderson
Preface
Thisbookisdividedintotwoparts.Thefirstpartdealswithclinicaland
cognitiveaspectsofAlzheimer’sDisease(AD)crucialforthediagnosisof
earlydementiaandrelateddisorders,reviewingrecentresearchfindings
inthisarea.Thesecondraisestheimportantissueofappropriateandopti-
malmanagementintheearlystagesofthedisease.
Thecomplexquestionofhowtoevaluatethecostsofchronicdiseases,
suchasAD,forasocietyisaddressedinChapter1; inparticulartheimpact
ofmedicaltreatmentandcarestrategiesintheveryearlystagesofADare
discussed.Importantpointsraisedinthischapteraretheunclearrelation-
ship between type and amount of expenditure on care and the patient’s
and caregiver’s welfare. Many methodological issues related to the cost
analysis of dementia still remain unresolved and further studies are
neededtohelphealthprofessionalsintheirchoiceoftreatmentandcare
utilization.
Guidelinesforscreeningandtheclinicalevaluationofdementiainpri-
maryhealthcareareproposedinChapter2.Clinicalfeaturesanddiagnos-
ticcriteriaofthemostfrequentdementiasaredescribedandsuggestions
aremadeaboutwhichpatientsshouldbereferredtospecialistsforfurther
investigations. Abasic laboratory workup is recommended and indica-
tionsforneuroimagingproposed.Theimpactofmethodsdevelopedfor
cognitivepsychologistsonneuropsychologicalassessmentisdiscussedin
Chapter3.Incontrasttotraditionalneuropsychologicalformulations,new
approachesshowedthatADcanselectivelyimpairspecificcognitivesys-
temsorprocesseswhilesparingothers,thatfactorsallowinganoptimiza-
tion of cognitive performance may be identified, and that there is an
importantheterogeneityinboththenatureandtheprogressionofdeficits.
Thesefindingshavegreatlyinfluencedthepracticeofassessmentandre-
habilitationinAD.Moreover,itwasalsodemonstratedthat—beyondthe
observedheterogeneity—certaintypesofdeficits,suchasdeficitsinexec-
ix