Faculty Bibliography

Pertinent legal and clinical issues related to Alzheimer's disease (AD) are reviewed in this article. The processes of competency determination and guardianship appointment are examined, particularly in regard to the special needs of patients with AD. The authors suggest an operational definition of AD, and outline the steps of progressive cognitive decline in this illness. This framework is utilized to recommend appropriate and flexible medicolegal guidelines

Limited information is available regarding the incidence, nature, and treatment of behavioral problems in Alzheimer's disease (AD). A chart review of 57 outpatients with a diagnosis of AD was conducted to examine these issues. Thirty-three (58%) patients had significant behavioral symptomatology (most commonly delusions, nonspecific agitation, and diurnal rhythm disturbances). Twenty-seven were treated with thioridazine (10-250 mg/day), 15 (55.6%) of whom were judged to have a positive response (mean maximum dose = 55 mg/day). Information regarding the characteristic phenomenology of the behavioral symptoms studied was used to design a clinical rating instrument for AD patients, the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), which should be useful in prospective studies of behavioral symptoms as well as in pharmacologic trials

Elderly controls and probable Alzheimer's disease patients underwent serial positron emission tomography (PET) studies during a baseline condition and while performing a verbal memory task. For the temporal lobes, all 7 Alzheimer patients demonstrated a relative shift in glucose metabolic rates to the right hemisphere during the memory condition relative to baseline, and 5 of 7 controls showed a shift to the left hemisphere. Baseline absolute regional metabolic rates replicate previous findings and were somewhat less useful than the memory challenge in differentiating patients from controls. These results indicate that a temporal lobe abnormality in Alzheimer's disease is related to memory performance.

Although home-care of Alzheimer's disease (AD) patients is more cost-effective than institutionalization, there is limited knowledge concerning the causes and prevention of institutionalization. The goal of this project was to determine the circumstances related to institutionalization of AD patients and to determine if a family counseling program can reduce these precipitating factors. In Study 1, we surveyed 109 family members of institutionalized AD patients. Primary precipitating factors included difficulties with patient behavior, insufficient auxiliary help and respite, financial difficulties, and caregiver emotional and physical complaints. In Study 2 we evaluated the effectiveness of an enhanced counseling program which included specific intervention techniques to cope with precipitating factors. For 41 AD family members who were seriously contemplating institutionalization, the precipitating factors prior to counseling were similar to those found in Study 1. After six months of individual counseling, home visits, and participation in caregiver support groups, there was only one placement, and a consistent reduction in the precipitating factors. These preliminary results suggest that a specially designed counseling program may delay or forestall institutionalization