Alzheimer Disease and Other Dementias
Cognition changes with age, such that older adults experience delays in processing and recall. These changes may be distressing to patients, but are not indicative of pathological cognitive dysfunction. Cognitive disorders exist on a spectrum. Preclinical changes manifest as subtle neurostructural changes or changes in biomarker levels without clinical signs or symptoms; this stage of disease is a focus of ongoing research. Mild cognitive impairment is defined as cognitive changes beyond what is expected from normal aging but with preserved function, and dementia is defined as cognitive dysfunction across multiple domains with impaired functioning. Alzheimer disease is the most common cause of dementia. Early detection of dementia can help patients and caregivers make appropriate long-term arrangements, and allow for interventions that may slow cognitive decline, although there are no disease-modifying treatments available. Treatment should be person-centered, multidisciplinary, encompass the patient’s psychosocial context, and focus on enhancing wellbeing. Attention should be paid to promoting safety, providing caregiver support, and focusing early on advanced care planning.
