Dementia and Alzheimer's disease - Part 2: Standards of care for patients and caregivers

PURPOSE: To review different aspects of supportive care and their importance for patients with dementia in the primary care setting. EPIDEMIOLOGY: Alzheimer's disease is increasing in prevalence and is predicted to affect 13.2 million adults by 2050. More than two thirds of those affected live at home and are cared for by family members. REVIEW SUMMARY: This article is the second in a series that discusses the diagnosis and management of dementia in primary care. There is, a review of guidelines from the American Psychiatric Association and the American Academy of Neurology regarding supportive care for the dementia patient and their caregiver, as well as a discussion of resources from the American Medical Association. The essential elements of supportive care for dementia patients include comfort and emotional support, safety, structure and activities, planning for and assistance with decision making, and management of medical comorbidity. For caregivers, emotional support and comfort, education, skills development, problem solving, and respite are recommended. Reassessment of supportive care should take place at least twice a year to adjust for changes in disease progression. TYPE OF AVAILABLE EVIDENCE: Nationally recognized treatment guidelines, cohort studies, some controlled trials. GRADE OF AVAILABLE EVIDENCE: Fair to good. CONCLUSION: With attention to supportive care for both patient and caregiver, the quality of life of persons with dementia can be maximized.