Outline

Differentiate Neurodegenerative Disorders

• Alzheimer’s disease
• Vascular disease
• Frontotemporal disorder
• Lewy body disease
• Traumatic Brain Injury

Update on Delirium

• Acute or persistent delirium
• Screening and diagnosis
• Prevent life threatening consequences
• Evidence-based medications and treatment
• Long term consequences

Diagnosis of Neurocognitive Disorders/Dementias

• Reversible dementia-like disorders and conditions
• Validated cognitive screening tools
• New diagnostic criteria and stages of dementia
• Family response to diagnosis

Pharmacologic Therapies for Neurocognitive Disorders/Dementias

• Cholinesterase inhibitors
• NMDA receptor antagonists
• Antidepressants
• Antipsychotics and other psychotropic drugs
• Evaluate new drugs and learn medications to avoid
• Consider risk, side effects, and efficacy for older adults

Behavioral and Psychological Symptoms of Dementia (BPSD)

• Vast majority of patients with one or more BPSD
• Serious negative consequences of untreated behaviors
• Tools to systematically assess the presence and severity of symptoms
• Investigation of multiple contributing factors
• Interdisciplinary creation and evaluation of a treatment plan

Interventions for Common Distressing Behaviors

• Agitation, anxiety and restlessness that lead to emotional distress and disability
• Apathy that contributes to poor prognosis and increased mortality
• Sexually inappropriate behaviors – one of the most distressing behaviors
• Frustration of changing behaviors over time

Best Practice for Unique Challenges

• Eliminate pain-inducing factors to diminish behaviors
• Nutrition and hydration challenges with disease progression
• Sleep disorders and evidence-based management
• Depression and effective therapy
• Psychotic symptoms: Nonpharmacological and pharmacological interventions

Ethical Issues

• Safety, function and autonomy
• Comfort and dignity
• Advance care planning
• Palliative care and hospice
• Genetic testing
• Disclosure of diagnosis

Patient/Family Needs Across the Disease Trajectory

• Professional and family caregivers
• Community Resources

Case Studies and Clinical Stories