This month's issue of Psychiatric Annais, guest edited by Vi nod Kumar, MD, MRCPsych, DPM, deals with Alzheimer's disease. Psychiatrists in practice are very likely to find themselves dealing with making the diagnosis, managing the psychiatric complications, or advising the families or spouses cast into the role of caring for a loved one who has developed Alzheimer's dementia symptoms. Because, at this point in time, we have no effective treatment for the progressive symptoms of Alzheimer's disease, we are all in the position of managing, as best we can, its complications, doing the best we can to maximize the life quality, and minimize the suffering of both the afflicted patient and the loved ones left with the paradoxes, conflicts, uncertainties, and pain oí' caring for the afflicted one.
The first contribution in this series, "Diagnosis of Alzheimer's Disease," by J. Wesson Ashford, MD, PhD. Frederick A. Schmitt, PhD, and Vinod Kumar, MD, MRCPsych, DPM, deals with the differential diagnosis, use of brain imaging studies, the clinical course, psychiatric complications as well as the genetics and neuropathology, and early recognition prospects. This useful overview is followed by the contribution "Depression in Alzheimer's Disease" by James B. Duffy, MB. ChB, and C. Edward Coffey, MD, that addresses the current status of the evidence of the effectiveness of antidepressant treatments in Aizheimer patients as well as taking into account the treatment of the caretakers of individuals with Alzheimer's. A very important review of "Management of Psychosis, Agitation, and Other Behavioral Problems in Alzheimer's Disease/' by J. Thad Lake, MD, and George T. Grossberg. MD, follows. The authors begin by quoting the results of a study finding that the prevalence of one or more troublesome behaviors were reported in 83% of Alzheimer's patients. They review the assessment and pharmacologie management of these complications including some promising newer approaches. Dr. Kumar and Marc Cantillon. MD, give us an "Update on the Development of Medication for Memory and Cognition in Alzheimer's Disease." Lastly, Carl Eisdorfer, PhD, MD, discusses the social reality and emotional impact on families with loved ones who develop dementias. His advice is well taken: "Among the most important lessons to learn in caregiving is noi to be a hero or heroine - the more help you can get, the hotter off you Eire likely to be and your loved one is likely to be."
Perhaps one of the greatest ironies of our extension of lifespan through economics, public health, and advances in medical science is the occurrence of dementia and the management of terminal illness. These are not the most pleasant considerations, but not problems we can escape. With whatever state-of-the-art we have available, it's important that we can apply whatever helping interventions we have (limited as they may be at this stage) with as much expertise as possible to reduce suffering and maximize life quality to the extent possible for our patients and their loved ones. Hopefully, wo will soon advance the state-of-the-art - I hope to be able to celebrate that with you in a future issue.