Treating nondementia illnesses in patients with dementia

Physicians increasingly are called on to provide primary care for the growi ng population of people with Alzheimer-type dementia, However, little atten tion has been paid to the care of nondementia illnesses in this group of pa tients. To illustrate how presence of dementia can alter the risk-benefit r atio of treatment of a common medical problem, we present a case study in w hich a patient with dementia developed disastrous adverse effects to a drug commonly used to treat osteoporosis. This case and 2 composite vignettes i lluminate how presence of dementia should influence the decision-making pro cess for treatment of nondementia illnesses. We address issues such as decr eased decision-making capacity, problems with reporting adverse effects, de creased cognition leading to problems with treatment adherence, and the rol e of screening and basic questions about acceptable burdens of treatments i n patients with limited prognosis. We Suggest ways to improve communication with patients with dementia in an effort to minimize complications and imp rove care, as well as policy changes to include patients with dementia in c linical trials.