Skip to main content
SpringerLink
Log in

Management of Cognitive Function in Older Adults with Dementia

  • Chapter
  • First Online:
Dementia and Chronic Disease

  • 673 Accesses

Abstract

Dementia, a chronic, progressive decline in cognition, is a significant health concern in older adults impacting 1 in 10 individuals ≥65 years of age. Treatment of dementia often includes memory specific medications, control of cardiovascular risk factors, and nonpharmacologic therapies. Older adults receiving memory specific medications should be carefully monitored and discontinuation considered in cases of side effects, financial burden, or in cases of end-stage disease. Dementia is commonly complicated by behavioral and psychologic symptoms of dementia and sundowning. These issues can be especially challenging for caregivers, and providers should screen for dementia-associated behaviors and caregiver burnout at each visit. The mainstay of treatment for behavioral and psychological symptoms of dementia and sundowning is nonpharmacologic. Older adults with delirium are also at increased risk for delirium, an acute disorder of attention and cognition. During hospitalization, nonpharmacologic multicomponent approaches for prevention of delirium should be implemented in these individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Alzheimer’s Association. Facts and figures. 2019. Accessed 17 July 2019. From https://www.alz.org/alzheimers-dementia/facts-figures.

  2. Cummings JL, Isaacson RS, Schmitt FA, Velting DM. A practical algorithm for managing Alzheimer’s disease: what, when, and why? Ann Clin Transl Neurol. 2015;2(3):307–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Lobo A, Launer LJ, Fratiglioni L, et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54:S4.

    Article  CAS  PubMed  Google Scholar 

  4. Vann Jones SA, O’Brien JT. The prevalence and incidence of dementia with Lewy bodies: a systematic review of population and clinical studies. Psychol Med. 2014;44(4):673–83.

    Article  CAS  PubMed  Google Scholar 

  5. Fujimi K, Sasaki K, Noda K, et al. Clinicopathological outline of dementia with Lewy bodies applying the revised criteria: the Hisayama study. Brain Pathol. 2008;18(3):317–25.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Arvanitakis Z. Update on frontotemporal dementia. Neurologist. 2010;16(1):16–22.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Terry AV Jr, Buccafusco JJ. The cholinergic hypothesis of age and Alzheimer’s disease-related cognitive deficits: recent challenges and their implications for novel drug development. J Pharmacol Exp Ther. 2003;306:821–7.

    Article  CAS  PubMed  Google Scholar 

  8. Cummings J, Froelich L, Black SE, et al. Randomized, double-blind, parallel-group, 48-week study for efficacy and safety of a higher-dose rivastigmine patch (15 vs. 10 cm2) in Alzheimer’s disease. Dement Geriatr Cogn Disord. 2012;33:341–53.

    Article  CAS  PubMed  Google Scholar 

  9. Raina P, Santaguida P, Ismaila A, et al. Effectiveness of cholinesterase inhibitors in the treatment of Alzheimer disease. Can J Psychiatr. 2014;59(12):618–23.

    Article  Google Scholar 

  10. Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Data base Syst Rev. 2006;1:CD005593.

    Google Scholar 

  11. Ikeda M, Mori E, Kosaka K, et al. Long-term safety and efficacy of donepezil in patients with dementia with Lewy bodies: results from a 52-week, open-label, multicenter extension study. Dement Geriatr Cogn Disord. 2013;36(3–4):229–41.

    Article  CAS  PubMed  Google Scholar 

  12. Tiraboschi P, Hansen LA, Alford M, et al. Cholinergic dysfunction in diseases with Lewy bodies. Neurology. 2000;54:407–11.

    Article  CAS  PubMed  Google Scholar 

  13. Kavirajan H, Schneider LS. Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomized controlled trials. Lancet Neurol. 2007;6(9):782–92.

    Article  CAS  PubMed  Google Scholar 

  14. Nardell M, Tampi RR. Pharmacological treatments for frontotemporal dementias: a systematic review of randomized controlled trials. Am J Alzheimers Dis Other Dement. 2014;29(2):123–32.

    Article  Google Scholar 

  15. Hogan DB. Long-term efficacy and toxicity of cholinesterase inhibitors in the treatment of Alzheimer disease. Can J Psychiatr. 2014;59(12):618–23.

    Article  Google Scholar 

  16. Renn BN, Asghar-Ali AA, Thielke S, et al. A systematic review of practice guidelines and recommendations for discontinuation of cholinesterase inhibitors in dementia. Am J Geriatr Psychiatry. 2018;26:134–47.

    Article  PubMed  Google Scholar 

  17. Herrmann N, Lanctot KL, Hogan DB. Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimer Res Ther. 2013;5(Suppl 1):S5.

    Article  Google Scholar 

  18. Cacabelos R, Takeda M, Winblad B. The glutamatergic system and neurodegeneration in dementia: preventive strategies in Alzheimer’s disease. Int J Geriatr Psychiatry. 1999;14:3–47.

    Article  CAS  PubMed  Google Scholar 

  19. Reisberg B, Doody R, Stoffler A, et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med. 2003;348:1333–41.

    Article  CAS  PubMed  Google Scholar 

  20. Grossberg GT, Manes F, Allegri RF, et al. The safety, tolerability, and efficacy of once-daily memantine (28 mg): a multinational, randomized, double-blind, placebo-controlled trial in patients with moderate-to-severe Alzheimer’s disease taking cholinesterase inhibitors. CNS Drugs. 2013;27:469–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. McShane R, Westby MJ, Roberts E, et al. Memantine for dementia. Cochrane Database Syst Rev. 2019;3.

    Google Scholar 

  22. Lo D, Grossberg GT. Use of memantine for the treatment of dementia. Expert Rev Neurother. 2011;11(1):1359–70.

    Article  CAS  PubMed  Google Scholar 

  23. Bunt CW, Hogan AJ. The effect of statins on dementia and cognitive decline. Am Fam Physician. 2017;95(3):151–2.

    PubMed  Google Scholar 

  24. Chuang CS, Lin CL, Lin MC, et al. Decreased prevalence of dementia associated with statins: a national population-based study. Eur J Neurol. 2015;22(6):912–8.

    Article  PubMed  Google Scholar 

  25. Swiger KJ, Manalac RJ, Blumenthal RS, et al. Statins and cognition: a systematic review and meta-analysis of short- and long-term cognitive effects. Mayo Clin Proc. 2013;88(11):1213–21.

    Article  CAS  PubMed  Google Scholar 

  26. Peter B, Villa-Lopez M, Winbald B, et al. Statins, risk of death and stroke in patients with dementia- a registry-based study. Presented at the 5th Congress of International Neurology, Oslo.

    Google Scholar 

  27. Gaugler JE. The process of adult day service use. Geriatr Nurs. 2014;35(1):47–54.

    Article  PubMed  Google Scholar 

  28. Thompson KH, Fletcher PC. Examining the perceived effects of an adult day program for individuals with dementia and their caregivers: a qualitative investigation. Clin Nurse Spec. 2019;33(1):33–42.

    Article  PubMed  Google Scholar 

  29. International Psychogeriatric Association. IPA complete guides to behavioral and psychological symptoms of dementia (BPSD). 2015.

    Google Scholar 

  30. Lyketsos CG, Lopez O, Jones B, et al. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA. 2002;288(12):1475–83.

    Article  PubMed  Google Scholar 

  31. Lyketsos CG, Steinberg M, Tschanz JT, et al. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry. 2000;157(5):708–14.

    Article  CAS  PubMed  Google Scholar 

  32. Zuidema SU, Derksen E, Verhey FR, Koopmans RT. Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. Int J Geriatr Psychiatry. 2007;22(7):632–8.

    Article  PubMed  Google Scholar 

  33. Kales HC, Gitlin LN, Lyketsos CG. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc. 2014;62(4):762–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cheng ST. Dementia caregiver burden: a research update and critical analysis. Curr Psychiatr Rep. 2017;19(9):64.

    Article  Google Scholar 

  35. Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ. 2015;350:h369.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kales HC, Gitlin LN, Stanislawski B, et al. Effect of the WeCareAdvisor on family caregiving outcomes in dementia: a pilot randomized controlled trial. BMC Geriatr. 2018;18(1):113.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Williams K, Blyler D, Vidoni ED, et al. A randomized trial using telehealth technology to link caregivers with dementia care experts for in-home caregiving support: Fam TechCare protocol. Res Nurs Health. 2018;41(3):219–27.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev. 2012;2:CD005562.

    Google Scholar 

  39. De Oliviera TCG, Soares FC, De Macedo ED, et al. Beneficial effects of multisensory and cognitive stimulation on age-related cognitive decline in long-term-care institutions. Clin Interv Aging. 2014;9:309–21.

    Google Scholar 

  40. Stanley MA, Calleo J, Bush AL, et al. The peaceful mind program: a pilot test of a cognitive-behavioral-therapy-based intervention for anxious patients with dementia. Am J Geriatr Psychiatry. 2013;21(7):696–708.

    Article  PubMed  Google Scholar 

  41. Kiosses DN, Arean PA, Teri L, ALexopoulos GS. Home-delivered problem adaptation therapy (PATH) for depressed, cognitively impaired, disabled elders: a preliminary study. Am J Geriatr Psychiatry. 2010;18(11):988–98.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Butler RN. The life review: an interpretation of reminiscence in the aged. Psychiatry. 1963;26:65–76.

    Article  CAS  PubMed  Google Scholar 

  43. Dempsey L, Murphy K, Cooney A, Casey D, O'Shea E, Devane D, Jordan F, Hunter A. Reminiscence in dementia: a concept analysis. Dementia. 2014;13(2):176–92.

    Article  PubMed  Google Scholar 

  44. Woods B, Spector A, Jones C, et al. Reminiscence therapy for dementia. Cochrane Database Syst Rev. 2005;2:CD001120.

    Google Scholar 

  45. Strom BS, Ytrehus S, Grov EK. Sensory stimulation for persons with dementia: a review of the literature. J Clin Nurs. 2016;25(13–14):1805–34.

    Article  PubMed  Google Scholar 

  46. Ueda T, Suzukamo Y, Sato M, Izumi S. Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis. Ageing Res Rev. 2013;12(2):628–41.

    Article  PubMed  Google Scholar 

  47. Holiday-Welsh DM, Gessert CE, Renier CM. Massage in the management of agitation in nursing home residents with cognitive impairment. Geriatr Nurs. 2009;30(2):108–17.

    Article  Google Scholar 

  48. Suzuki M, Tatsumi A, Otsuka T, et al. Physical and psychological effects of 6-week tactile massage on elderly patients with severe dementia. Am J Alzheimers Dis Other Dement. 2010;25:680–6.

    Article  Google Scholar 

  49. Barreto PS, Demougeot L, Pillard F, et al. Exercise training for management behavioral and psychological symptoms in people with dementia: a systematic review and meta-analysis. Ageing Res Rev. 2015;24(PtB):274–85.

    Article  Google Scholar 

  50. Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. N Engl J Med. 2006;355(15):1525–38.

    Article  CAS  PubMed  Google Scholar 

  51. Bessey LJ, Walaszek A. Management of behavioral and psychological symptoms of dementia. Curr Psychiatry Rep. 2019;21(8):66.

    Article  PubMed  Google Scholar 

  52. Centers for Medicare & Medicaid Services. National Partnership to Improve Dementia Care in Nursing Homes: Antipsychotic medication use data report. April 2019. Accessed July 21, 2019. From https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Antipsychotic-Medication-Use-Data-Report.pdf.

  53. Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guidelines on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatr. 2016;173(5):543–6.

    Article  PubMed  Google Scholar 

  54. Farina N, Morrell L, Banerjee S. What is the therapeutic value of antidepressants in dementia? A narrative review. Int J Geriatr Psychiatry. 2017;32(1):32–49.

    Article  PubMed  Google Scholar 

  55. Porsteinsson AP, Drye LT, Pollock BG, et al. Effect of citalopram on agitation in Alzheimer’s disease: the CitAD randomized clinical trial. JAMA. 2014;311:682–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Scoralick FM, Louzada LL, Quintas JL, et al. Mirtazapine does not improve sleep disorders in Alzheimer’s disease: results from a double-blind, placebo-controlled pilot study. Psychogeriatrics. 2017;17(2):89–96.

    Article  PubMed  Google Scholar 

  57. Hillen JB, Soulsby N, Alderman C, Caughey GE. Safety and effectiveness of cannabinoids for the treatment of neuropsychiatric symptoms in dementia: a systematic review. Ther Adv Drug Saf 2019;10.

    Google Scholar 

  58. Gallagher-Thompson D, Brooks JO, Bliwise D, et al. The relations among caregiver stress, “sundowning” symptoms, and cognitive decline in Alzheimer’s disease. J Am Geriatr Soc. 1992;40(8):807–10.

    Article  CAS  PubMed  Google Scholar 

  59. Canevelli M, Valletta M, Trebbastoni A, et al. Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches. Front Med. 2016;3:73.

    Article  Google Scholar 

  60. Fainstein I, Bonetto AJ, Vrusco LI, Cardinali DP. Effects of melatonin in elderly patients with sleep disturbance: a pilot study. Curr Ther Res. 1997;58(12):990–1000.

    Article  CAS  Google Scholar 

  61. Brusco LK, Fainstein I, Marquez M, Cardinali DP. Effect of melatonin in selected populations of sleep-disturbed patients. Biol Signals Recept. 1999;8(1–2):126–31.

    Article  CAS  PubMed  Google Scholar 

  62. Cohen-Mansfield J, Garfinkel D, Lipson S. Melatonin for treatment of sundowning in elderly persons with dementia- a preliminary study. Arch Gerontol Geriatr. 2000;31(1):65–76.

    Article  CAS  PubMed  Google Scholar 

  63. Mahlberg R, Kunz D, Sutej I, et al. Melatonin treatment of day-night rhythm disturbances in sundowning in Alzheimer disease: an open-label pilot study using actigraphy. J Clin Psychopharmacol. 2004;24(4):456–9.

    Article  PubMed  Google Scholar 

  64. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–22.

    Article  PubMed  Google Scholar 

  65. Fong TG, Davis D, Growdon M, et al. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015;14(8):823–32.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Marcantonio ER, Kiely DK, Simon SE, et al. Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc. 2005;53:963–9.

    Article  PubMed  Google Scholar 

  67. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  68. Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–8.

    Article  CAS  PubMed  Google Scholar 

  69. 4AT rapid clinical test for delirium. Accessed 24 July 2019. From https://www.the4at.com/.

  70. Bellelli G, Morandi A, Davis DHJ, et al. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalized older people. Age Aging. 2014;43:496–502.

    Article  Google Scholar 

  71. Inouye SK, Bogardus ST, Baker DI, et al. The hospital elder life program: a model of care to prevent cognitive and functional decline in older hospitalized patients. J Am Geriatr Soc. 2000;48(12):1697–706.

    Article  CAS  PubMed  Google Scholar 

  72. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49(5):516–22.

    Article  CAS  PubMed  Google Scholar 

  73. Hshieh TT, Inouye SK, Oh ES. Delirium in the elderly. Psychiatr Clin North Am. 2018;41(1):1–17.

    Article  PubMed  Google Scholar 

  74. Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: advances in diagnosis and treatment. JAMA. 2017;318(12):1161–74.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Neufeld KJ, Yue J, Robinson TN, et al. Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2016;64(4):705–14.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Section of Geriatrics and Palliative Medicine, Baylor College of Medicine, Houston, TX, USA

    Angela Georgia Catic

  2. Michael E. DeBakey VA Medical Center, Houston, TX, USA

    Angela Georgia Catic

Authors
  1. Angela Georgia Catic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angela Georgia Catic .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine, Section of Geriatrics and Palliative Medicine Baylor College of Medicine, Houston, TX, USA

    Angela Georgia Catic

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Catic, A.G. (2020). Management of Cognitive Function in Older Adults with Dementia. In: Catic, A.G. (eds) Dementia and Chronic Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-46398-4_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-46398-4_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-46397-7

  • Online ISBN: 978-3-030-46398-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation