Acquired cognitive disorders of the elderly

Many gaps still exist in our understanding of the etiology and the management of dementing disorders. However, there are fairly well established guidelines for the clinical diagnosis of Alzheimer's disease, the major cause of acquired cognitive disorders in the elderly. The management of patients with dementing disorders should involve the entire family. The medical needs pale beside the functional and psychosocial issues. Therefore, a multidisciplinary approach in a team setting is ideal, where goals can be established and coordinated and communication with the family, patient, and consultants can be facilitated. Patients and family members need to know that life beyond the diagnosis can be meaningful. With the help of support groups, they learn to maximize the positive aspects and can cope with the struggle ahead. It should not be forgotten, however, that not all families had good relationships before the onset of the decline and often are in great need of counseling to manage the anger and guilt they will often experience. Future research is needed not only on the search for better medical treatments but also on the establishment of guidelines for the physician and family to deal with complex social issues such as when one is no longer safe to drive an automobile. Prospective studies on victims of head injury could establish the link of trauma to Alzheimer's disease, that has been proposed. The role of physicians in public policy for prevention of high risk behaviors (such as boxing) is controversial, but at the very least, physicians should play a major role in educating their patients of these dangers. Because of the rapid aging of our population, pressure for research and policy changes in national health and long term care financing has been growing, largely due to the impressive efforts of the Alzheimer's Association. In order to give the kind of attention that is required in the care of these patients, there must be a change in the present system of reimbursement. This will never happen, unless it can be demonstrated that lower costs of health care can be achieved by anticipating the needs of these patients and their families. It is quite possible that costs can be reduced by delaying the need for nursing home placement or decreasing utilization of emergency medical care and hospitalization. However, these assumptions must be investigated further.