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Medical Management
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Developing an initial management strategy

Medical care of most patients with Alzheimer’s disease is managed by their primary care physicians. The chief goals of treatment are to maintain quality of life; maximize function in daily activities; enhance cognition, mood and behavior; and foster a safe environment.

Key elements of a strategy to achieve these goals include:

  • If Alzheimer’s disease is the primary health issue, schedule regular surveillance and health maintenance visits every three to six months. Co-existing conditions may dictate a more frequent surveillance schedule.

  • Form a therapeutic alliance with the patient’s primary caregivers. Monitor the caregivers’ health, stamina and stress levels.

    • Note: If the caregivers are blood relatives, they may be worried about getting Alzheimer’s disease. Be prepared to address their concerns.

      • Educate the patient and family about what to expect in terms of prognosis and disease progression. Involve the patient and family in treatment goals tailored to the patient’s current level of cognitive function.

      • Explain how Alzheimer’s disease may affect management of co-existing conditions.

      • Encourage the family to maintain the patient’s physical activity and social engagement to the greatest extent possible.

      • Raise awareness of safety issues that will need to be addressed as the disease progresses. These issues include driving; operating tools and kitchen appliances; and handling household poisons, firearms and other dangerous items.
        View Alzheimer's Association Statement on Driving

      • Explain that Alzheimer’s affects perception and balance, and falls become a major risk.

      • Inform the patient and family about the risk of wandering and about the availability of the MedicAlert® + Alzheimer’s Association Safe Return®  program.

      • Educate the patient and family about nonmedical issues that will need to be addressed. The national and local offices of the Alzheimer’s Association can help families find resources related to all of the following issues:

        • a general need for ongoing information and support
        • a living will
        • durable power of attorney for health care
        • review of finances
        • planning for changing care needs over the course of the disease
        • preferences for end-of-life care

Modifying the management strategy over time

Greg A. Sachs, M.D., Ph.D., of the University of Chicago, has discussed how medical decision-making in Alzheimer’s disease changes over time.

  • For a person with mild Alzheimer’s who has few other medical issues, most of the care plan would look like a similar plan for a patient without dementia.

  • For a person with advanced dementia who is bedbound and no longer recognizes family and friends, the strategy might resemble that of a hospice care plan. It should focus on comfort and palliation.

  • The most challenging part of managing treatment may come during the middle stages, when either families or clinicians may begin to feel that some interventions are no longer appropriate. Patients at this stage may have problems complying with the treatment plan or have difficulty understanding its purpose.

    • During this transitional time, it is especially important for physicians to work with patients and families to help them:

      • Prepare for further changes that can be expected as the disease progresses.

      • Understand how Alzheimer's progression may impact the comfort of treatments for both dementia and co-existing conditions.

      • Define the most important goals of treatment, such as maintaining quality of life, reducing caregiver burden, delaying nursing home placement and achieving a peaceful death.

      • Encourage family communication early on and discussion about signs or symptoms that would indicate it is time for transition to another care setting. Signs may include incontinence, wandering or chronic or high levels of caregiver stress.

      • Suggest to the caregivers that they comfort and reassure the person with Alzheimer's by offering to always provide the best possible care without promising how that care will be delivered (e.g., at home with family providing all care or in a long-term care setting).

      Learn more about the stages of Alzheimer’s disease

       


           

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          Alzheimer's Association

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          Formed in 1980, the Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's care, support and research.