AFTER THE DIAGNOSIS

Expert management of progressive dementia stretches all the capabiliti es of the physician and of the healthcare system. For the physician, p rescribing appropriate medication is certainly an essential role, as i s involvement with social services and other health professionals to h elp patients and families make the best decisions related to use of re sources and, sometimes, to placement in a care facility. Physicians de aling with progressive dementia should remember the following basic pr inciples: Care is best provided by a loosely organized ream consisting of health professionals, nonprofessional healthcare providers, and th e family (or a substitute for it). The overall objective of management is to prevent or delay functional decline.The patient's safety is an early and continuing concern. The environment, even when it is changed temporarily, must be appropriate to the patient's level of function. Coexistent disease (the presentation and management of which may be al tered by cognitive impairment) must be diagnosed and treated promptly and efficiently.Advance directives and healthcare surrogates should be determined early, while the patient can still have input.