The challenge of supporting care for dementia in primary care

Figures & data

Table 1 Dementia symptomatology

Cognitive impairment:	Functional disability:
–Memory deficit	–Basic ADL disability
–Language deficit	–IADL disability
–Executive deficit
–Visuospatial deficit
–Stimulation recognition deficit (agnosia)
Behavioral and psychological symptoms:	Caregiver burden
–Apathy	–Sleep problem
–Depression/Dysphoria/Irritability	–Mood problem
–Anxiety	–Coping problem
–Agitation/Aggression
–Delusions/Hallucinations
–Elation/Euphoria
–Disinhibition
–Aberrant motor behavior
–Sleep disturbance
–Appetite/Eating disorders

Table 2 The status of dementia in primary care (Callahan CM et al 2006 Schubert CC et al 2006).

Variable	% or Mean (SD)
Mini mental status examination score	17.5 (5.2)
Number of chronic disease	2.4 (1.40)
Number of prescribed medications	5.1 (3.8)
Suffer from behavioral and psychological symptoms	80%
Emergency visit or hospitalization within last 6 months	38%
Recognized cases	<25%
Receiving cholinesterase inhibitors	<10%
Receiving at least one psychotropic medication	>20%
Receiving at least one definite anticholinergic medication	>20%

Table 3 Pharmacological management of Alzheimer disease

Class	Cognition	ADLs	BPSD
ChEI	+	+	+/−
Memantine	+	+	+
Neuroleptics	−	−	+/−
Antidepressants	NE	NE	+
Anticonvulsants	−	−	+/−

− ChEI: Cholinesterase inhibitors; +: significant positive effect; +/−: possible positive effects; −: negative effect; NE: no effect; All of the neuroleptics are not FDA approved for use in Dementia.

Table 4 Key characteristics of complex adaptive primary care system

Members/Agents	Semi-autonomous clinicians, administrators, clerks, and patients who have the capacity to exchange information with other individuals and with their surrounding environment and subsequently change their behaviors.
Interconnections/Relationships	The system members interact locally in nonlinear pattern that lead to rich relationships and network of interrelated individuals
Self-organization	A process that allows the system’s members to mutually adjust their behaviors to cope with changing internal and external environmental demands. Results in a new structures and patterns over time
Emergent patterns/Emergent behaviors	The system self-organizing process may induce the birth of new system properties, features, patterns, and relationships that are distinct from the members’ identities, properties or features
Co-evolution	A process of reciprocal makeover of both the system members and their surrounding environment that leads to the creation of interdependency of the present and the past system’s experiences.

Figure 1 The Outline for PREVENT program in primary care.

CallahanCMBoustaniMAUnverzagtFW2006Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trialJournal of American Medical Association295214857

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SchubertCCBoustaniMCallahanCM2006Comorbidity profile of dementia patients in primary care: are they sicker?Journal of American Geriatric Society541049

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