Nonpharmacologic Treatment

Treatment of AD involves both pharmacologic and nonpharmacologic methods. Upon the initial diagnosis, the patient and family should be counseled on the course of the illness, prognosis, available treatments, legal decisions, and quality-of-life issues. The life of a patient with AD must become progressively more simple and structured as the disease progresses, and the caregiver must learn to keep requests and demands on the patient simple. The family of the patient will need to be prepared to face changes in life that will occur as the disease becomes worse. Basic principles in the treatment of patients with AD are shown in Table 35-4.

Table 35-3 Stages of Cognitive Decline

Stage

Clinical Altribulp

Pathology and Clinical Picture-

Stage 1 Ifcicogmrtw impairment Staged Very niii decline

Stage 3 Mild cognitive (Jeclme

5w>e<i Moderate iognicivi

(Jecline (irtfct or early-slage ADf

Stage 5 Moderalety se^e «^Wliw dccline (morieraie AD)

St.K|<L(i Severe cognitive decline Imoderalefy severe AD}

Swoe? wefyieve«^ ocjgnitiv^ decline (seven; AD)

Ho memory fwchlmvi and no impairment it evident 10 a healrh cane piofenlonAl lapses ol memory ior getting familiar names or locations of personal objacts (ejg, keys of gla&e^ problems not evident to tin-ink. i.mv^-, coworkin, ck heallti uaie profesionalj Fiends, family and ■mwoila.'rs txjgm to notice (Jtrfkienck1! piobkjfre wuh mmis or words

Ijr.trjrru; Ir.riC; ptrfHTrtfirVC hiti«Uc<omi i^itlent; i(;ti.-nlKjn uf n\*Jing nHttflf (iisjiru.'!;

losing valuable ulijoiis: decline m planning .iryJ organizational abMies

Mrtdkii interview oet« ts i l«i cut tSef tie-Kies d«rejs«i kno^ietkje c-f (mi nt evi nrs: Impaired ablliiyHj perform difficult mathematical picbleflv; (ejg, ft); decreased ability to pc?i foim complo* taskt (managmy finances); dKiiusod recaHof peisonal b^toiy; individuals rvvy becomie wirwjviri ind mtOvej Major gaps in memory appear arvdasirstwoewnrhdAy-lo-day activities is necetsaiy; inability to retail JiiiiiK ^utli js current addir-si ind tdcfhUH number "my b-rt| "v dflHicufty wilh oiie-iatijn place and lime, less challan^ng maihematical problems may bft»me difftculr (ejgi set «I or can recall Iheir own name and those ol sp«jse and children {«gi'Hl ant pefsgngltyjnd bo)iav»als>im|iicj;ni may-errerijeidiluslwY, iirfmxiusnosvhiliviiiiiions, compulsions) and c-xtensr-iehe^jwith/^OlsbKHortHtnfflHssaiy (ejg.1cik;tingli loss of awareness efiitOH* ft^ftiinOH tM JultiUfkf nys rimytfil icjmI I Ml n_\. 11 Of t*fn.T | s Tjmwl hfctciyftdrciidiing.niV'd hr^j in i Milng dimiod piopeitydmupiloni oi ■Jtx'pi'^iifcii c>icle oofii; kdeaso in ui-rary and fecal inooriircrcc wawAiing and gotliny lost becomc- commcn final it^ge of illn«\- by; of ability tic- rilfjond to arountftngs kvUttty TO speak iO(l ti^ijl movommU; htHp is required foi eating. walk^ig, and toik-lirpj movements become abnormal ¿fui iKjit). a--J '...v.-illii'vinii i; unfiled

AD. AtiliiirniT'S Clise^i «<MflM Of (feily living, from ftfi, J?,

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