Comprehensive management of geriatric syndrome in demented elderly

Takashi Sakurai

Center for Comprehensive Care and Research on Memory Disorders National Center for Geriatrics and Gerontology

Incidence of dementia is over 14% in the community-dwelling eldelry in Japan. After diagnosis of dementia, patients and their caregivers are still suffering from physical illness and behavioral and psychological symptoms of dementia (BPSD). To achieve the comprehensive care of demented elderly, we have raised a new program. Our goal is j maintenance of cognitive function, k treatment of BPSD and physical illness, limprovement of life function, m reduction of caregivers' burden, n providing information on care-service in neighborhood, o hospital admission for acute illness. This review briefly summarizes the several geriatric syndromes in each clinical stage of dementia. As the bridge connecting geriatric symptoms and brain, we are interested in cerebral white matter lesions (WMLs) and metabolic/nutritious state. Regional WMLs closely associates with balance and gait function in demented elderly. Geriatric syndrome such as dysphagia, urinary incontinence, fainting, headache, edema, numbness, ADL decline also associate with WMLs. Finally, changes of body weight and metabolic/nutritious state in demented disease are described. We would emphasize the roles of insulin resistance and vitamin D in view of progression of cognitive decline and geriatric syndrome. Based on these clinical data, a strategy for comprehensive management of elderly with cognitive decline should be discussed.

Address correspondence to Dr. Takashi Sakurai, Center for Comprehensive Care and Research on Memory Disorders National Center for Geriatrics and Gerontology (35 Gengo, Morioka-cho, Obu 474-8511, Japan)