Clinical Management of Dementia: An Overview (2)

This chapter sets out a perspective on the management of dementia based on experience in the United Kingdom. The corresponding chapter based on experience in Israel is chapter five. In 2010, it was estimated that 35.6 million people lived with dementia worldwide, with numbers expected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050 (Prince et al, 2013). In 2010, 58% of all people with dementia lived in countries with low or middle incomes, with this proportion anticipated to rise to 63% in 2030 and 71% in 2050 (Prince et al, 2013). Dementia has an enormous economic impact with global expenditure of US$604 billion in 2010 (World Health Organization and Alzheimer’s Disease International, 2012). There are at present no disease-modifying treatments. This chapter reviews: (a) the role of primary care in dementia (and is supplemented by the perspective in chapter ten); (b) current and future potential pharmacological interventions (introduced in chapter five; (c) the use of medication in behavioural and psychological symptoms in dementia (introduced in chapter five); (d) psychosocial interventions in dementia (introduced in chapter five); and (e) medication concordance and appropriateness in dementia. The focus is on practice in the UK.