Websites to visit on Alzheimer's disease

Dr Keith Barnard recommends websites relating to this week's Clinical Review.

Website of the week
The Alzheimer's Society has an excellent website about all aspects of dementia, but this tutorial is aimed at healthcare professionals. It takes you through steps that deal with definition, diagnosis, the role of the GP, management of common problems - wandering, aggression, incontinence - and the needs of the carer. The notes are brief and there is much here even for an experienced GP. The test cases are particularly useful.

I particularly liked the assessment tools page, where you will find examples of the Clifton assessment procedures for the elderly, the mini mental state examination and abbreviated mental test score, complete with instructions for their use.

It ends with a framework for good practice, which makes clear how you should handle dementia cases.

Why go there: excellent learning material
Downside: none
Information from: Alzheimer's Society
Address: Please click here 

NICE guidelines
Most of the publicity surrounding NICE and Alzheimer's disease has been its reluctance to allow the use of acetylcholinesterase inhibitors for those with mild symptoms. Some people's ire has been raised to such an extent that perhaps NICE should be renamed the National Association to Stop Treating You.

Against this background I had to smile when I read one of the first statements that reads: 'People with dementia should not be excluded from any services because of their diagnosis, age, or coexisting learning disabilities.' Unless of course, NICE says it's OK.

But I still recommend you to visit this site and go to page 14, which discusses the therapeutic interventions that are available, because if you read this carefully, I think you might find the odd loophole.

Acetylcholinesterase inhibitors are recommended only for patients with a mini mental state examination test score of 10-20, but at the foot of the page it tells you what exceptions are permitted. I think these may be open to a certain amount of interpretation.

Why go there: might give you ideas.
Downside: at 28 pages, it's not a quick reference.
Information from: NICE.
Address: Please click here

An interesting debate
This is an article about a plan in Florida - where else? - to inject silicone chips into Alzheimer's patients in case they get lost in a hurricane, or maybe Wal-Mart. The chip contains their ID and medical history.

Arguments for and against the procedure range from likening it to a violent invasive act akin to rape, that it is giving patients the 'mark of the beast', as described in the Bible, to a safety net that could save the lives of people who cannot explain what is medically wrong with them.

All very entertaining, but I can't see NICE recommending this, either.

Why go there: a good coffee-break read.
Downside: lots of adverts.
Information from: New Scientist.
Address: Please click here

Handling a dementia patient's affairs
Quite a find, this. We are often asked about problems with dealing with the affairs of those who can no longer manage their own.

This PDF discusses what constitutes mental incapacity, and goes from relatively simple problems like collecting someone's pension or benefits to more complex issues such as power of attorney.

Make of note of this site and recommend it to patients.

Why go there: good advice.
Downside: none.
Information from: Community Legal Service.
Address: Please click here

Alternative treatments
I was going to resist the temptation to see what alternative medicine offered Alzheimer's sufferers, but I weakened.

This site offers tests of heavy metal toxicity and comprehensive hair analysis, and then sells you heavy metal chelators and detoxifying clay to sort your problems out. One customer responded so well that his proven cerebral atrophy and dementia were completely reversed, defying doctors by still being alive 15 years later when they predicted he would shuffle off his mortal coil in only seven. Must be good, then.

Why go there: to be certain the heavy metal does not involve Iron Maiden
or Metallica.
Downside: may make you foam at the mouth.
Information from: Evenbetter now Natural Health Solutions.
Address: Please click here

Dr Barnard is a former GP in Fareham, Hampshire

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