AAFP-ACP Guidelines for Drug Treatment of Dementia: What Do You Think Of The AAFP's Photo?

When my father was struggling with memory loss, his doctors prescribed both Aricept and Namenda. If they helped his memory and thinking, I couldn’t tell. For Dad, the side effects of these medicines didn’t seem to be worth any benefit.

Dad and my nephew Chris play the piano

But for other people with memory loss, these drugs seem to be very helpful, and the side effects are generally tolerable. This wide variety in benefits and side effects may be what the American Academy of Family Practitioners (AAFP) and the American College of Physicians (ACP) were trying to address when they published new guidelines about drug treatment of dementia last month.

The guidelines are based on a meta-analysis of previous studies of the cholinesterase inhibitors Aricept, Razadyne, Exelon and tacrine (no longer commonly prescribed) as well as memantine (Namenda).

The news item on the AAFP site summarizes the guidelines for doctors this way:

If you're considering pharmacological therapy for a patient with dementia, be aware that there's only modest evidence of clinically meaningful benefit for the average patient. Therefore, conduct an individualized assessment of your patient and his or her situation, in consultation with caregivers, to determine if a trial of drug therapy is appropriate. If you decide to prescribe, choose one of the five FDA-approved drugs for dementia based on cost, ease of use, tolerability and side effects, because currently there's no convincing evidence that any one of the drugs is more effective than another.

I’m not sure there’s anything new in this recommendation. But the bleak photo accompanying the news on the AAFP site started me thinking. It shows an older woman staring blankly out a kitchen window. She looks lonely, unhappy, and disengaged. Is this how doctors see people with Alzheimer’s and dementia? Maybe this stock photo is an accurate portrayal of the average memory loss patient, but it’s not typical of many I know. Their lives are far richer and meaningful than what the photo implies. This more positive view is addressed in a soon-to-be-published paper by Renee Beard (a geriatric sociologist at the University of Illinois - Chicago), Don Moyer and Jenny Knaus.

My father’s love of family, friends and animals, along with his fascination with music, sailing and gardening, defined him much more than his memory loss did. But did his doctors just see a male version of the stock photo? It’s hard to say.

Maybe I’m overreacting to the picture on the AAFP site – let me know what you think.

Comments

[Gail Rae Hudson]

Nope, I don't think you're overreacting. I've think you've hit a very troublesome nail squarely on its bent head. I also think it's not just the medical community that suffers from this perspective; I think it includes anyone who has not had (or has not allowed themselves to come into) contact with those who have some form of dementia. Mona, this applies even to my sisters. They see my mother so rarely that they are always surprised that she is, well, an engaged and engaging person with observations, perspectives, interests and eccentricities JUST LIKE THEM!!!!
I do find, though, that this misperception is limited to those who keep themselves tidily away from those with dementia; and am always amazed at how those who haven't shied away from those they know with dementia are also free of this misperception.

[Mona Johnson]

Check out Gail's post on The Mom and Me Journals at http://themomandmejournals.blogspot.com/2008/04/very-tardy-review.html - a much more eloquent expression of the same idea!

Mona