Preface
Do not cast me off in old age; when my strength fails, do
not forsake me, Psalms 71:9
The diagnosis of dementia or even the possibility of such a
diagnosis is often greeted with fear and trepidation by those
affected, The ensuing fears of losing one’s mind and capabilities
and of being abandoned or ‘put away’ in an institution are
contemplated as fates worse than death. The disease stealthily encroaches in some individuals, robbing them of insight
into their illness before they can truly appreciate what has
happened. Others notice the changes building month to
month and year to year but resign themselves to the process.
Still others fight the changes or those around them who insist
that they cut back on the activities that once meant independence
and integrity but now carry the risk of disaster.
In its early stages, dementia is a disease that unifies
patients, caregivers, and clinicians in a necessary alliance as
patients try to cope with changes in cognition and function,
caregivers attempt to adapt to these changes, and clinicians
seek to provide both diagnosis and treatment for a disorder
that is often incurable. The pitfalls in this alliance are clear:
patients wrestle with fear and confusion that may sabotage
their cooperation, caregivers struggle to overcome significant
grief and exhaustion, and clinicians must remain engaged
despite a tendency to develop a fatalistic; complacency. Many
of these factors are amplified as dementia progresses into
moderate and severe stages, ultimately culminating in a
terminal state. Patients become robbed of those intellectual
and functional abilities that made them unique individuals,
while their Caregivers can be overwhelmed with the drain of
caregiving-a burden that, in turn, increases their own
likelihood of dying by nearly 50%. Clinicians must deal with
the myriad problems associated with dementia, including delirium, apathy, depression, agitation, and psychosis, while still
struggling to retain their ability to see and to respond to the
humanity of each patient.
Those clinicians who read and use this book will find sufficient
information teaching them about nearly every facet of
dementia—its forms, pathways, pitfalls, and treatments. The
book is designed to be a practical guide that can be brought
into the clinic when one is evaluating and treating patients.
l have endeavored to provide case vignettes and clinical tips
to help clinicians move beyond a simple hook knowledge of
dementia and to hone their practical skills in assessment and
treatment. I urge all clinicians, however, to integrate their own
clinical styles into whatever techniques I suggest. Furthermore,
they must understand that the rapid pace of research into
dementia and its treatments may affect some of the information
in this book, especially that relating to medication selection
and dosing in Alzheimer disease.
With this in mind, the core theme underlying this book is to
look for the human being behind the dementia. In practical
terms, a clinician who masters every facet of dementia may be
knowledgeable but not necessarily Wise or caring. Every individual
with dementia is more than a diseased brain; he or she is
also an ailing human who is surrounded by grieving caregivers
with good hearts but limited amount of time and patience.
A busy and harried clinician can easily lose sight of these factors
when he or she is Working with demented individuals who can
no longer express their own needs and wishes and who now are
engaging in troubling behavioral problems.
Despite the efforts I have expended on this text, my sincerest
hope is that the ongoing work of researchers and clinicians throughout the world will render this book obsolete by
discovering definitive methods for the early diagnosis and
treatment of Alzheimer disease. and other forms of dementia.
In fact, since the publication of the first edition of this book,
there have been major strides in this direction, including the
potential revolution of amyloid-targeted neuroimaging and
anti-amyloid therapies for Alzheimer disease. All of these
new developments are detailed in the text, along with
updates for other dementia types. The very title has even
been changed to focus on the pre-eminet role of Alzheimer
disease in both research and clinical work. I have also added
a chapter on Mild Cognitive Impairment given the growing
body of research on its relevance as 21 common prodromal
state of Alzheimer disease. I hope that this newly revised
work continues to serve as an invaluable guide and resource
for all clinicians caring for individuals with dementia.