By John C. Morris, James E. Galvin, David M. Holtzman

An updated survey of the most important dementing problems, this advisor presents the latest scientific, epidemiological, and neurodiagnostic info with regards to the care and therapy of dementing illnesses-addressing topics of significant value comparable to ethics, neuropsychology, neuroimaging, and neuropathology to face because the preferable consultant at the subject.

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Arch Intern Med 1994; 154:909–913. 82. Reilly BM, Magnussen CR, Ross J, Ash J, Papa L, Wagner M. Can we talk? Inpatient discussions about advance directives in a community hospital. Attending physicians’ attitudes, their inpatients’ wishes, and reported experience Arch Intern Med 1994; 154:2299–2308. 83. Hirsohman KB, Joyce CM, Jamps BJ, Xie SX, Casarett D, Karlawish JHT. Would caregivers Alzheimers disease patients involve their relative in a decision to use an AD slowing medicine? AM J Geriatr Psych 2005; 13:1014–1021.

Finally, there is the claim of what is the point of disclosure because nothing can be done. But even though there is no magic bullet treatment, a lot can be done. First, long before biomedicine took an interest in dementia as a disease, people still lived with it. Disclosure is a first step to making meaning out of the experience of an illness. Patients have kept diaries (42,43) and can participate in support groups (44). Insight can last far into the disease. The writer Jonathan Kozol records how his father, a neurologist who diagnosed himself with Alzheimer’s disease, even at a stage when he lived in a nursing home would struggle to explain how he had selective confusion because certain neurons had degenerated (45).

Core symptoms of depression focus on mood: dysphoria, suicidal ideation, self-criticism, guilt, pessimism, and hopelessness. Educating the family about which syndromes the patient is experiencing guides the value of disclosure. A patient whose depression is actually insight arguably knows what is going on and deserves the virtue of kind, hopeful but honest disclosure of the problem. In contrast, a patient with marked apathy may simply not understand or appreciate a diagnostic disclosure. They are not in denial.

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