II. Epidemiology

  1. Nursing Home placement results from Behavior problems
    1. Minimally related to Cognitive Impairment alone

III. Management: Specific Behavioral Conditions

  1. Agitation in Dementia (Occurs in 80% of Dementia)
  2. Sleep Problems in Dementia (Occurs in 70% of Dementia)
  3. Wandering Behavior in Dementia
  4. Psychiatric illness (may result in pseudodementia)
    1. Psychosis in Dementia
    2. Depression in Dementia

IV. Management: Family Counseling of Patients with Dementing illness

  1. Discuss Diagnosis and Prognosis (Ample time?)
  2. Recommend Alzheimer's Disease Resources
  3. Refer family to Attorney and Financial planner
    1. Living Wills
    2. Advanced Directives
    3. Power of attorney
  4. Discuss difficult decisions at an early stage
    1. Driving
      1. Risk of accidents no higher in first year
      2. Risk of accidents increases 5x by fourth year
    2. Nursing Home placement
    3. Tube feeds
  5. Watch for caregiver stress or Elder Abuse
  6. Emphasize 3 principles
    1. Need to provide structure and routine for patient
    2. Need to limit goals and expectations for patient
    3. Establish and maintain a low demand environment
      1. See No-fail Environment in Dementia

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