Comparative Effectiveness Of An Advanced Dementia Treatment Protocol Versus Usual Care: Revisiting Fundamentals | 12485
Journal of Alzheimers Disease & Parkinsonism
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The urgent need for a more effective approach to treatment of dementia, regardless of underlying pathology, is obvious.
Current medications demonstrate only limited benefit; experimental drugs to date not only failed to slow progression, but,
most recently, as in the case of semagacestat, worsened clinical measures of cognition. 44
This compares the cognitive effects of a comprehensive assessment and treatment protocol developed in a communitybased
dementia-focused practice on a diagnostically heterogeneous group (N=362) of community-dwelling, cognitively impaired
patients compared with a similar group of patients (n=224) treated by other providers.
The analysis strongly suggests:
1. That diagnosis and aggressive sustained treatment of reversible and highly prevalent conditions in cognitively impaired
patients, such as hypoxia, hyper homocysteinemia, and iron deficiency, can contribute significantly to stabilization and/or
improvement of cognition over time
2. That treatment of common metabolic derangements in these patients optimizes the effectiveness of existing medications,
allowing them to maintain a higher level of cognition and function longer
3. Those primary care providers, without specialty training, can better care for their cognitively impaired patients with the
diagnostics and therapeutics currently available to them until disease-reversing therapeutics are available.
Emily Clionsky, M.D graduated from Jefferson Medical College, is dually trained in internal medicine (Mercy Hospital/UPMC Pittsburgh, PA) and
in psychiatry (Dartmouth Hitchcock Medical Center). Her practice is dementia- focused, with over 3,000 patients. She has presented research
on hypoxia and dementia at AAIC in 2012, has published in peer-reviewed journals, and with Mitchell Clionsky, Ph.D., co-developed the Memory
Orientation Screening Test//MOST-96120. Emily Clionsky is the Director of Clinical Strategies for Lincare, Inc. a subsidiary of Linde AG. She is the
co-editor in chief of the Journal of Alzheimer?s Disease and Parkinsonism.
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