Mast / Yochim Alzheimer’s Disease and Dementia

2018
ISBN: 978-1-61334-503-0
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 76 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

An essential guide to assessing and treating people with dementia syndromes
As the number of older adults with dementia continues to skyrocket, every health care professional needs accurate, up-todate knowledge of these conditions, their prevention, and possible treatments. This compact, evidence-based book discusses essential aspects of the diagnosis, assessment, and interventions of Alzheimer’s disease and the syndromes of dementia and mild cognitive impairment. It reviews the diagnostic criteria from the
National Institute on Aging, Alzheimer’s Association, and the DSM-5 and provides a broad range of treatment options, including psychosocial, educational, and lifestyle interventions.

Practitioners will especially appreciate the current overview of caregiver interventions. Practitioners and students alike will find the clear information, the tools for assessment, and other resources provided in this volume extremely useful for helping patients and their families cope with dementia.

Zielgruppe

For psychotherapists, clinical psychologists, psychiatrists, general practitioners, counselors/social workers, students, and trainees

Autoren/Hrsg.

Mast, Benjamin T.

Yochim, Brian P.

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Geriatrie, Gerontologie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Alzheimer und Demenz

Leseproben

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Description
1.1 Terminology
Dementia refers to a syndrome of cognitive and behavioral declines that are severe enough to interfere with daily functioning. Dementia is a broad category of cognitive changes with a variety of causes (or types) including Alzheimer’s disease, cerebrovascular disease (vascular dementia), and/or Lewy bodies (Lewy body dementia). Dementia is distinct from normal age-related declines in cognitive functioning. Although there are reversible forms of dementia, this volume focuses on dementias that are irreversible. Alzheimer’s disease is the most common cause (or type) of dementia, with 60–80% of dementia cases caused by the neuropathology of Alzheimer’s disease. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) adopted the term major neurocognitive disorder for this condition (American Psychiatric Association [APA], 2013). Mild cognitive impairment (MCI) (also known as mild neurocognitive disorder) represent less severe forms of cognitive change that may or may not develop into dementia over time. MCI is not considered normal aging or dementia, but has often been conceptualized as a transitional condition between the two. There are multiple forms of MCI, including amnestic MCI (isolated memory impairment), nonamnestic MCI (impairment in isolated cognitive ability that is not memory), and multiple domain MCI, in which multiple areas of cognition are mildly impaired, but the person retains relative independence and does not meet the criteria for dementia. Mild neurocognitive disorder is the term used for MCI in the DSM-5. It does not differentiate between amnestic or nonamnestic subtypes, but involves specification of the possible or probable etiology. 1.2 Definition
1.2.1 Dementia The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; APA, 1994) defined dementia as impairment in memory and one other area of cognitive functioning, including aphasia, apraxia, agnosia, or executive functioning. These declines must be more severe than normal age-related declines to warrant a diagnosis of demen|2|tia more specifically, they must be severe enough to interfere with daily functioning, including occupational functioning or leisure activity. Clinicians often use instrumental activities of daily living (IADLs) as an index for this portion of the diagnostic criteria among older people who are no longer working (e.g., medication management, driving, shopping, housework, management of finances, and using the telephone or technology). The DSM-5 indicates that performance on neuropsychological testing is typically 2 or more standard deviations below the mean compared with people of similar background (i.e., of similar age, education, and ethnic/cultural background) in individuals with dementia (major neurocognitive disorder) and 1 to 2 standard deviations below the mean among people with MCI (mild neurocognitive disorder). DSM-5 also broadened the potential areas of cognitive impairment by including impairment in social cognition, complex attention, and/or perceptual-motor functioning. DSM-5 criteria no longer require impairment in memory, which was a key criterion in DSM-IV. DSM-5 diagnoses of major neurocognitive disorder or dementia rest upon quantifiable impairment (2 standard deviations below normative levels) in one or more abilities, whether in memory or other cognitive domains. Neurocognitive disorder (NCD) due to Alzheimer’s disease is the only NCD diagnosis that requires impairment in two or more domains (unless there is evidence of a relevant genetic mutation). This is an important advance because many clinicians believed that the requirement of memory impairment, previously described as the “Alzheimerization” of dementia (Royall, 2003), led to underdetection of types of dementia that are not characterized by prominent memory impairment in the earliest stages, such as frontotemporal dementia, vascular dementia, and Lewy body dementia. According to the DSM-5 criteria, the cognitive changes in the individual still need to be severe enough to interfere with daily living to be diagnosed as a major NCD (dementia), must be a decline from prior levels of functioning, must not be accounted for by another DSM condition (e.g., major depressive disorder), and must not be caused by another medical condition (such as delirium). The NIA/AA diagnostic guidelines for dementia due to Alzheimer’s disease (McKhann et al., 2011) are a revision of the McKhann et al. 1984 guidelines. Several scientific advances are reflected in the new criteria: (1) the pathology of Alzheimer’s disease occurs across a broad clinical spectrum, ranging from normal to MCI to dementia; (2) other neuropathologies (e.g., Lewy body disease) can also cause dementia; (3) the development and use of biomarkers in research on Alzheimer’s disease; (4) the observation that memory impairment is not always the predominant deficit in Alzheimer’s disease; (5) advances in the understanding of genetic risk factors and mutations in Alzheimer’s disease; and (6) the removal of age cutoffs for diagnosis of dementia – with the growing awareness that Alzheimer’s disease is the same disease whether it strikes someone in their 40s or 90s, there is no need for “pre-senile” and “senile” categories. These new guidelines for dementia (McKhann et al., 2011) require cognitive or behavioral symptoms that interfere with work or usual activities and represent a decline from a previous level of functioning. Occasionally patients retain the ability to perform IADLs such as paying bills or cooking, but they have become impaired in their work. Evidence of two areas of cognitive |3|impairment must be detected from a clinical interview and an objective cognitive assessment. Potential areas of impairment include acquiring and remembering new information, reasoning and handling of complex tasks or judgment, visuospatial abilities, language functions, or changes in behavior, personality, or comportment. Occasionally patients perform well on measures of executive functioning but still show poor judgment. Unlike those of the DSM-IV, these criteria include visuospatial abilities. The NIA/AA criteria also place an emphasis on changes in behavior or comportment. Thus, while the vast majority of patients with dementia due to Alzheimer’s disease show impairment in memory and one other domain, occasionally there are patients who perform well on testing but show poor judgment and changes in their comportment; these criteria appropriately focus clinical attention on these changes. 1.2.2 Mild Cognitive Impairment MCI is a decline in cognitive functioning that is not normal aging but is also not severe enough to impair daily living and warrant a diagnosis of dementia. People with MCI show evidence of cognitive impairment but have relatively independent functioning (albeit with some compensation needed). Although a variety of diagnostic criteria have been proposed, most include the following: Concern expressed by the patient, someone who knows the patient well, or a clinician, over cognitive change; Normal general intellectual functioning; Impairment in memory or another area of cognitive functioning; Relative independence (with compensation) in daily functioning; No dementia. DSM-IV did not include a specific diagnosis of MCI, but described mild neurocognitive disorder as falling under those conditions requiring further study (APA, 1994, Appendix B). Because DSM-IV criteria did not offer guidelines concerning the level of cognitive impairment needed to make a diagnosis of dementia, the resulting distinction between dementia and MCI rested on whether the person had impairment in daily living attributable to the cognitive changes. These diagnostic systems focus on identifying MCI and dementia as syndromes with subsequent differential diagnosis focused on the cause or type, as described in more detail in Section 1.7. However, ongoing evolution of diagnostic systems is moving the diagnosis of Alzheimer’s disease from one of exclusion to one of inclusion using biomarkers that indicate positive signs for Alzheimer’s disease pathology. A working group jointly sponsored by the National Institute on Aging and the Alzheimer’s Association (NIA/AA) proposed three new diagnoses: preclinical...