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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Alzheimer’s Association. Facts and figures. 2019. Accessed 17 July 2019. From https://www.alz.org/alzheimers-dementia/facts-figures.
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.
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.
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.
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.
Arvanitakis Z. Update on frontotemporal dementia. Neurologist. 2010;16(1):16–22.
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.
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.
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.
Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Data base Syst Rev. 2006;1:CD005593.
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.
Tiraboschi P, Hansen LA, Alford M, et al. Cholinergic dysfunction in diseases with Lewy bodies. Neurology. 2000;54:407–11.
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.
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.
Hogan DB. Long-term efficacy and toxicity of cholinesterase inhibitors in the treatment of Alzheimer disease. Can J Psychiatr. 2014;59(12):618–23.
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.
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.
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.
Reisberg B, Doody R, Stoffler A, et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med. 2003;348:1333–41.
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.
McShane R, Westby MJ, Roberts E, et al. Memantine for dementia. Cochrane Database Syst Rev. 2019;3.
Lo D, Grossberg GT. Use of memantine for the treatment of dementia. Expert Rev Neurother. 2011;11(1):1359–70.
Bunt CW, Hogan AJ. The effect of statins on dementia and cognitive decline. Am Fam Physician. 2017;95(3):151–2.
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.
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.
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.
Gaugler JE. The process of adult day service use. Geriatr Nurs. 2014;35(1):47–54.
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.
International Psychogeriatric Association. IPA complete guides to behavioral and psychological symptoms of dementia (BPSD). 2015.
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.
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.
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.
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.
Cheng ST. Dementia caregiver burden: a research update and critical analysis. Curr Psychiatr Rep. 2017;19(9):64.
Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ. 2015;350:h369.
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.
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.
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.
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.
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.
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.
Butler RN. The life review: an interpretation of reminiscence in the aged. Psychiatry. 1963;26:65–76.
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.
Woods B, Spector A, Jones C, et al. Reminiscence therapy for dementia. Cochrane Database Syst Rev. 2005;2:CD001120.
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.
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.
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.
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.
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.
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.
Bessey LJ, Walaszek A. Management of behavioral and psychological symptoms of dementia. Curr Psychiatry Rep. 2019;21(8):66.
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.
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.
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.
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.
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.
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.
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.
Canevelli M, Valletta M, Trebbastoni A, et al. Sundowning in dementia: clinical relevance, pathophysiological determinants, and therapeutic approaches. Front Med. 2016;3:73.
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.
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.
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.
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.
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383:911–22.
Fong TG, Davis D, Growdon M, et al. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015;14(8):823–32.
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.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
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.
4AT rapid clinical test for delirium. Accessed 24 July 2019. From https://www.the4at.com/.
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.
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.
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.
Hshieh TT, Inouye SK, Oh ES. Delirium in the elderly. Psychiatr Clin North Am. 2018;41(1):1–17.
Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in older persons: advances in diagnosis and treatment. JAMA. 2017;318(12):1161–74.
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
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)