HOME HELP FEEDBACK SUBSCRIPTIONS ALL ISSUES SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lavretsky, H. Search for Related Content PubMed Articles by Lavretsky, H.

Practical Dementia Care

Helen Lavretsky, M.D.

Key Words: Book Reviews • Alzheimer's Disease

Practical Dementia Care is written for clinicians representing many disciplines, including physicians, psychologists, nurses, social workers, rehabilitation therapists, and others who treat patients with dementia, in various settings, as well as administrators and policymakers. The book was intended to provide a common language and frame of reference and to serve as a practical guide to the day-to-day care of patients with dementia. The major emphasis is on diagnosis, evaluation, and treatment. The theme throughout the book is respect for autonomy and the rights of patients and their families.

In general, the book is well written. The clearly presented material is enhanced by the use of graphs and tables. The authors demonstrate the "nuts-and-bolts" of evaluation and management in both typical and challenging clinical situations by sharing their clinical observations and skills with the readers. The book promotes multidisciplinary and multidimensional approaches to dementia care, directed toward improving functional outcomes and quality of life for both patients and their caregivers. The authors offer decision-making algorithms for such critical steps as care coordination and placement, and legal and financial issues.

In Chapters 8 and 9, the authors offer a structured, practical approach to evaluating mental, behavioral, and functional disturbances, an approach consisting of four "Ds": 1) Define and describe the phenomenology; 2) Decode or identify possible causes; 3) Devise a treatment plan; and 4) Determine whether the treatment works. This approach helps organize a frequently confusing process of clinical management into logical decision-making steps—which carries the potential to improve the interaction among all care-providers and managers of behavioral and functional disturbances in patients with dementia.

Chapter 10 describes the latest advances in pharmacological and other biological treatments of dementia. On page 209, it provides the indications and an algorithm for prescribing cholinesterase inhibitors with additional neuroprotective agents. The uses of other psychotropic agents are also discussed and compared; these include antipsychotics, antidepressants and other agents, and biological treatment approaches. The review and the recommendations offer evidence-based approaches.

Chapter 11 addresses the inadequately understood issue of terminal care in patients with dementia, and one on which consensus is lacking. The authors provide guidelines for care and for assessing the probability of mortality in the next 6 months (page 228). They justify the steps in making a decision that is very difficult for clinicians and caregivers—the timing of initiating hospice care in terminal dementia.

Chapter 12 provides additional important guidelines for managing situations complicated by ethical issues and other situations for which no easy solutions exist, such as "what to do if a person with a memory problem refuses cognitive evaluations;" "Should anyone with dementia be allowed to drive?" "Who should make health decisions for a person who is severely incapacitated?" "Should medications and restraints be used to control behavior?" and other questions. Many practitioners may find this chapter helpful.

Chapter 13 overviews the currently available genetic evidence related to neurodegenerative and vascular dementing illnesses, as well as recommendations for genetic testing and genetic counseling.

I have read this practical manual for dementia care with interest and found it easy-to-follow and clinically relevant. I hope that many care-providers and family members will find this book useful in their day-to-day care of persons with dementia.

ACKNOWLEDGMENTS

Dr. Lavretsky is Assistant Professor of Psychiatry, UCLA Department of Psychiatry and UCLA Neuropsychiatric Institute and Hospital.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lavretsky, H. Search for Related Content PubMed Articles by Lavretsky, H.