cover image European Journal of Neurology

European Journal of Neurology

1998 - Volume 5
Issue Supplement S4 | October 1998

Original Article

Abstract

Alzheimer's disease is a progressive, neurodegenerative disease that preferentially afflicts the elderly. Its clinical features include impairment of cognitive function and decline in activities of daily living, as well as emotional and personality changes. The effective management of Alzheimer's disease requires a partnership between physician and caregiver. Caregivers play a crucial role in the long‐term care of demented patients. The demonstration that home‐based care is a more economically viable solution than institutional care has led to the realization that community‐based care must be supported and preserved if society is to cope with the burgeoning number of patients with Alzheimer's disease. Physicians depend upon caregivers to impart information concerning a patient's cognitive, functional and behavioural symptoms, whether for diagnosis, to assess the efficacy of a particular treatment, or to ascertain the staging of the disease. Caregivers suffer an enormous physical, emotional, financial and psychological burden as a consequence of the demands of caring. They are frequently at risk of ill‐health and depression themselves, jeopardizing their ability to care. These problems can be alleviated through support, information, education, counselling, and various treatment programmes, which the physician can provide either directly to the caregivers, or can arrange for them. Where caregivers have a more realistic expectation of their caregiving role, and of the patient's capabilities, they are invariably better able to cope. They can be taught to manage effectively the troublesome behavioural symptoms of Alzheimer's disease, which are the most distressing features for the caregiver. The result of a strong and effective alliance between caregiver and physician is a carer who is more accepting and realistic about the caregiving role, and therefore better able to rise to the demands of caring. In turn, the physician is fully informed about the patient and in the best possible position to prescribe treatment, whether pharmacological or non‐pharmacological, for the patient and/or caregiver. The patient whose behavioural symptoms are better managed, thereby reducing anxiety and aggression, receives an optimal level of care, both from the Caregiver and physician.

Original Article

Abstract

Alzheimer's disease is characterized by deterioration in the domains of cognition, function and behaviour. Cognitive decline is manifest as short‐term memory, language and visuospatial deficits. These, along with deficits in perception and executive function affect the patient's ability to function, as indicated by loss of ability to perform activities of daily living (ADLs). Abnormal behaviours, including depression, delusions and aggression are frequently a feature of Alzheimer's disease, occurring at different stages of the disease. Although Alzheimer's disease is primarily associated with cognitive deficits, functional decline and aberrant behaviours are its most problematic aspects for both patients and their caregivers. Loss of ability to perform ADLs imposes the need for increased levels of care. Moreover, caregiver burden is closely associated with the type and severity of behavioural disturbances. Although cognition is correlated with ability to perform ADLs, the fact that behavioural symptoms also play a role in deteriorating function means that cognitive testing alone cannot accurately predict disease progression. Hence, an integrated approach, involving measurement of cognition, function and behaviour is required for accurate diagnosis, assessment of the stage and progression of dementia, the effects of intervention, and the amount and type of assistance that the Alzheimer's disease patient requires.

Original Article

Abstract

The loss of ability to function, as well as abnormal behavioural symptoms that accompany cognitive decline in Alzheimer's disease, place a steadily intensifying burden upon caregivers to provide for patients' needs. This burden frequently manifests among caregivers as ill‐health and depression. The rapidly growing numbers of demented patients in the population means that society, too, is faced with increasingly intractable issues concerning health resource allocation. As the greatest part of the cost of caring for an Alzheimer's disease patient is incurred by their institutionalization, the maintenance of demented patients in the community for as long as possible is a desirable goal from a health economic perspective. A vital part of this strategy is the development of effective symptomatic treatments. Such treatment may modulate the behavioural symptoms of Alzheimer's disease that are the major indicator of institutionalization, or may preserve a patient's function, enabling them to live independently, or cared for at home for longer periods before institutionalization is warranted. Several different pharmacological strategies for managing Alzheimer's disease are currently being investigated. While there is some evidence that non‐steroidal anti‐inflammatory drugs and oestrogen can act as protective agents against Alzheimer's disease, cholinergic therapy represents the best approach to the symptomatic treatment of the disease; cholinesterase inhibitors have been demonstrated to improve the symptoms of Alzheimer's disease in a number of large‐scale clinical trials. However, antioxidants such as vitamin E have also demonstrated efficacy in some studies. The findings of these key areas of therapeutic enquiry are described in this review.

List of Contributors

List of Contributors

Original Article

European Journal of Neurology