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, Medication therapy management (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 because of dementia (eg, depression, anxiety, insomnia).
The use of scales and inventories is valuable to track cognitive status and functioning in activities of daily life.
Dementia causes significant cognitive decline that occurs over time, resulting in poor self-care and death. There are different types of dementia (Table 19-1); however, Alzheimer 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 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 19-1Common Types of Dementia in Late Life |Favorite Table|Download (.pdf) TABLE 19-1 Common Types of Dementia in Late Life
|Alzheimer disease |
|Vascular dementia |
|Dementia with Lewy bodies |
|Mixed dementia |
|Other (eg, Parkinson disease dementia, Frontotemporal dementia, Huntington disease, Creutzfeldt-Jakob disease) |
|Potentially reversible causes of cognitive dysfunction (eg, normal pressure hydrocephalus, thyroid dysfunction, vitamin B12 deficiency, delirium, depression, Wernicke–Korsakoff syndrome) |
Before interviewing the patient and/or caregiver, the MTM provider needs to place himself/herself in their situation. For those who have never had a personal experience working with a patient with Alzheimer disease, it may be a good idea to reflect.
Reflection: 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 will lose the ability to take care of yourself. You will be dependent on those around you, which, sadly, is not always a thing of comfort. You will begin to misplace things, perhaps blaming others for stealing them. With every hour and day that inevitably passes, you take a step closer to forgetting the names, ...