Matt Farrah,

CLINICAL TOOLS

• Abstract
• Key Points
• Clinical Pearls
• Premium Content

Dr. Alykhan Abdulla, BSC, MD, LMCC, CCFP, DipSportMed CASEM, FCFP, CTH (ISTM), CCPE, Masters Cert Phys Leader, ICD.D

CLINICAL TOOLS

• Abstract
• Visual Aids
• Key Points
• Clinical Pearls
• Premium Content

Abstract: Dementia is a threat to the aging population. Although dementia cannot be reversed there is evidence that physical exercise can improve activities of daily living, balance, quality of life, funtion, strength, and mental function through various parameters. This article will focus on aerobic training, resistance training, and flexibility training.

Key Words: dementia, exercise, aerobic training, resistance training, flexibility training, exercise prescription.

• 

Approach to Exercise Prescription includes asking questions during a patient's routine visit.

1. Ask about a patient's level of physical fitness.

2. Review their activities, assessing intensity, duration, and frequency.

3. Develop a fitness goal.

Prescribing exercise to patients with dementia that includes focus on aerobic training, resistance training, and flexibility for the prevention of injuries will help reduce the symptoms of dementia and improve function.

To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.

Holly Clark, Freelance Health Writer

Dementia can be terrifying and devastating to both caregivers as well as the loved ones affected by this disease. People with this disease can now feel some relief due to technological advancement which is meant to improve the quality of their lives. This technology can enhance autonomy as well as independence, manage possible risks in homes and get rid of stress.
In this article, we are going to look at the 5 technological innovations for those with Dementia

1. Communication Aids
Interacting with others is necessary for the quality of life in memory care. Individuals with dementia can remember how an event has made them feel, even if they are unable to recall the faces and names. Technology has simplified the interaction process with loved ones. Adapted telephones are now programmed with contacts that are frequently dialed and usually have bigger buttons which simplify their usage. It's now possible to stay connected with loved ones who are distant apart via the video chat services.
"Changes in the brain caused by dementia begin years before diagnosis. And throughout this timeframe, there are no clear signs that that person has dementia." comments Jane Byrne, Project Coordinator at FirstCare.¹

2. Electrical appliance use monitoring
This innovation is meant for caregivers who do not stay together with their loved ones. It controls the use of electrical apparatuses through plugging into a power strip or wall outlet as it will notify caregivers when their appliances have been switched on or off. These technologies do not make the diagnosis of dementia easy. This disease is yet overwhelming. The dementia is now more manageable; this is due to the innovation in new technologies.

3. Reminder messages
Reminders play an important role as the caregiver does as they help to keep the loved ones safe and also retain their relationships. The recording of these messages is done on a device in the residential area and then played out loud at the most suitable time. Caregivers can record a message that when played reminds an individual to take medication at the appropriate time. Some gadgets are designed to play messages based on individuals activity. Some devices are meant to remind individuals with dementia to lock the front door when leaving home. There are other reminder messages designed to help people with dementia on when to close the door when to go to bed and provide reassurance at times when the caregiver is not present.

4. Home care robots Technological advancement has led to the invention of homecare robots which will help reduce the caregiver duty. They are not designed to replace human caregivers, but instead, they are meant to do overall housework and remind individuals who are suffering from dementia on when to take medication or notify medical experts when assistance is required. With further inventions, home care robots may replace caregivers and handle their responsibility fully.

5. In-home cameras

1. https://www.firstcare.ie/
2. http://www.scitecheuropa.eu/innovative-technology-dementia/87071/

Beyond Rasouli: What has the Supreme Court said about Late-Stage Dementia and Continued Life-maintaining Treatment?

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
With the rapidly increasing numbers of elders in North American Society, the prevalence of those living with dementia is clearly on the increase. According to the most recent document provided by the Alzheimer Society of Canada, The Rising Tide the growth in the numbers of those living with dementia will increase from 480,600 in 2008 (1.5% of Canada's population) to in the year 2038—1,125,200 people with dementia (2.8% of Canada's population).¹ All the challenges that Canadian society faces with this growing population merely mirror the enormous complexities that those living with dementia, their families and health care professional providers must increasingly contend with. Government policy makers must find ways to address this increasing population in which Dementia plays a prominent role. The result of the Supreme Court ruling on the Rasouli case has major potential implication for those facing the later stages of dementia and those under whose care members of this population will be entrusted.
Key Words: dementia, aging population, substitute decision makers.

Identification of Potential or Preclinical Cognitive Impairment and the Implications of Sophisticated Screening with Biomarkers and Cognitive Testing

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The last decade has seen an enormous growth in the interest in the recognition of and intervention in those diagnosed and living with the whole range of cognitive impairment and frank dementia. In the western world, the recognition of the impact on patients, families, health care systems, and societies that dementia poses has led to great efforts to help define the indicators for current and future dementia with the intention to treat those already afflicted even with the primarily symptomatic medications that exist and to recognize those at future risk with the hope of providing counselling to forestall its future development. The idea of "early diagnosis" appears at first glance to be attractive for the purposes of future planning and research studies, but it is not clear what the benefits and risks might be if screening processes define people at risk when beneficial interventions might not yet be determined. The ethical as well as financial implications must be explored and defined before implementation of such screening becomes a normal standard of practice.practice.
Key Words: cognitive impairment, dementia, screening, biomarkers, cognitive testing.

The Cost of Dementia in the United States

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The prevalence of dementia appears to be increasing in most western countries. That when coupled with the increased average age of the older population has leads to an expectation that projections of financial costs to individuals, families and to society will grow over the next few decades. The current study, out of the United States, based on a number of robust data bases coupled with in-depth interviews has resulted in projections of the current true costs of caring for elderly people living with dementia. It also allowed for the projection of future costs over the next three decades. The results are quite mind-boggling: "We found that dementia leads to total annual societal costs of $41,000 to $56,000 per case, with a total cost of $159 billion to $215 billion nationwide in 2010. Our calculations suggest that the aging of the U.S. population will result in an increase of nearly 80% in total societal costs per adult by 2040."

Photography: Many Windows into Memories

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

It was magical: the images coming to life at the bottom of the plastic tray filled with Kodak developer. First the blacks came and then the grays, as they coalesced into the picture I witnessed the excitement anticipated from scanning the negative and then the contact sheet that had all 24 pictures from the roll of film on it.

What's New from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD4)

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

In the winter and spring of 2012 I was privileged to be part of the executive working group that organized the fourth Canadian Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) which took place in May 2012. The process as described in both of the initial publications that came out in the fall of 2012 included many participants from all of those physician groups involved in caring for those at risk of dementia, as well as those not-for-profit organizations involved in educating the public.

You Can Manage a Dementia without Cure: Frontotemporal Degeneration

Tiffany W. Chow, MD, MSc, Baycrest Health Sciences Rotman Research Institute, and Ross Memory Clinic; University of Toronto Depts. of Medicine (Neurology Division) and Psychiatry (Geriatric Psychiatry Division).

Abstract
Much of the published clinical research in dementia has focused on diagnostic biomarkers and neuroimaging analyses that are not yet validated for routine clinical practice or on unsuccessful clinical drug trials. Primary care providers can nonetheless make a significant difference in the management of patients with dementia and their families, based on appropriate referrals of non-Alzheimer's dementia cases to specialists and supporting informal caregivers.
Frontotemporal degeneration, a non-Alzheimer's dementia that strikes in the 6th decade of life, provides many opportunities for the entire healthcare team to educate and back families up through a harrowing neurodegenerative illness. This paper is intended to highlight for primary care physicians what can be done and how to accomplish it through a team approach. Some concepts, such as a switch from medicalized views of "behavioural and psychiatric symptoms of dementia" to "Responsive Behaviours" can be generalized across dementia etiologies, but the age at onset and marked social disability and dysfunction caused by frontotemporal degeneration warrant some additional guidelines to assure the safety and highest quality of life possible for the patient and those around him. In particular, refitting a day program to accommodate clients with frontotemporal degeneration and attending to the needs of children who find themselves in informal caregiver roles are addressed.
Keywords: caregiver, dementia, frontotemporal dementia, primary progressive aphasia.

Mild Cognitive Impairment