When working with patients with dementia and related disorders, it is important to gain an understanding of the support system surrounding the patient and the primary caregiver.
Before recommending therapy for dementia-related disorders, MTM providers should make sure to review the entire medication profile (including neutraceuticals and over-the-counter products) to assess for items that may be contributing to or causing cognitive impairment.
The MTM provider should remember to address other comorbid conditions that may manifest as a result of dementia (eg, depression, anxiety, insomnia).
The use of scales and inventories is valuable to objectively track cognitive status and functioning in activities of daily life.
Dementia causes significant cognitive decline over time, resulting in poor self-care and eventually death. There are different types of dementia (Table 19-1), however Alzheimer's disease is the most common. While most think of dementia as occurring in old age, some patients may develop early-onset dementia in their 40s or 50s.1 Dementia can be devastating not only to the patient, but also to their caregivers and families. Although medications may offer some relief and comfort, they basically delay the inevitable—death. The provision of medication therapy management (MTM) can play a vital role in making the journey and its transitions as painless and meaningful as possible.
Table 19-1.Common Types of Dementia in Late Life2,3 |Favorite Table|Download (.pdf) Table 19-1. Common Types of Dementia in Late Life2,3
Lewy body dementia
Other (Parkinson's disease, Frontotemporal dementia, Huntington's disease, Creutzfeldt–Jakob disease)
Potentially reversible causes of dementia (eg, normal-pressure hydrocephalus, thyroid dysfunction, vitamin B12 deficiency, depression, Wernicke–Korsakoff syndrome)
Before interviewing the patients and caregivers, MTM providers need to place themselves in their situation. For those who have never had a personal experience working with a patient with Alzheimer's disease, it may be a good idea to reflect.
Imagine you have been told you have an illness that will in time erase your memories. It will start with recent things: What you had for breakfast, what sitcom you watched last night, if you spoke with your son, daughter, brother or spouse. In time, you will lose your ability to work, the ability to care for your loved ones. Eventually you'll lose the ability to take care of yourself. You will be dependent on those around you which, sadly, is not always a comforting thought. You will begin to misplace things, perhaps blaming others for stealing them. With ...