[Case of Alzheimer's disease with gastric antral vascular ectasia presenting severe anemia]

The difficulties regarding the diagnosis and treatment of physical complications of senile dementia were considered through focusing on a case of Alzheimer's disease with severe anemia. The first problem encountered is related to medical policies. Recently, there is growing concern about the lack of facilities dealing with physical complications of senile dementia. Few psychiatric hospitals can provide a complete diagnosis and treatment of such complications. In addition, it is economically very difficult to diagnose and treat them in wards for the elderly with senile dementia within the existing medical fee system. It is also very difficult in general hospitals, because most do not have the beds to deal with the behavioral and psychological symptoms of dementia. The second issue regards problems with patients. Many patients with senile dementia do not realize that they are ill. It is difficult to obtain their informed consent, and they often have a sudden change of mind. The third issue concerns problems with the patient's family. It is also difficult to obtain the family's consent because of the death of a spouse and/or children of patients with senile dementia, and/or their weak family ties. The fourth problem involves the recognition of physicians in medical departments who must diagnose and treat physical complications. Their prejudices regarding mental disorders must be brought into the open, and they may well have a similar prejudice regarding dementia. It is a considerable physical and mental load, even for medical doctors without bias in relation to dementia, to frequently obtain informed consent from elderly persons with senile dementia and their non-cooperative families. Despite the various problems mentioned above, if appropriate diagnoses and treatments of physical complications are carried out, it is natural even for the elderly with senile dementia to obtain good prognoses and QOL. Doctors must diagnose and treat physical complications of the elderly with senile dementia, considering their physical and mental conditions, giving due consideration to the treatments possibilities for various diseases, and having careful discussions with patients and their families, while making use of every available method of diagnosis and treatment. Close cooperation with other unbiased medical doctors is extremely important.