State Plan for Alzheimer’s Disease and Related Dementias in Maine

Overview
Comprehensive Roadmap for
Dementia Diagnosis and Treatment in Maine
Drafted by John J. Campbell, MD, FANPA
Medical Director, General Hospital Psychiatric Services, Maine Medical Center
Over the next 10 years, the number of individuals living in Maine who are older than 65 years of age will increase
by 43% from the current 37,000 to over 53,000. During this time the 65 to 74 year old group will grow by over
70% and the number of Mainers aged 85 and above will grow by 11%, or 3,000 additional persons. With age
being the greatest risk factor for dementia, Maine clinicians will be confronted with an ever enlarging population
of patients experiencing cognitive and functional decline.
The current health delivery system, ranging from the ambulatory care of independent older persons to the provision
of care to persons residing at the nursing home level, is already stretched. Ongoing financial constraints will
limit the ability of the State and Federal governments to provide sufficient resources to deal with this unfolding
health crisis. Under these circumstances it will be essential for health care providers in Maine to provide the best
possible care to this aging population to minimize the morbidities and escalating costs of dementia on individuals,
families, and the community. This will require early detection of cognitive decline and effective care to persons
who become symptomatic with dementia.
This document is offered as a means for clinicians in Maine to provide a uniformly high standard of care for dementia.
All citizens of Maine, regardless of their geographical location or financial status, can and should receive
the best possible care for dementia and its sequelae. The guidelines provided here represent the most up-to-date
studies and best practices in an effort to guide clinicians statewide in our effort to minimize the terrible impact
of this health crisis. It is our hope that clinicians can agree to follow these guidelines and assist in their future
development as new information becomes available.
A Review of Dementia
Mild cognitive impairment and dementia can be diagnosed with simple office tests and routine studies. Yet the
opportunity to diagnose remains complicated by many factors including reluctance to report cognitive problems
due to fear and embarrassment, a lack of sensitive and efficient office tools to assist with cognitive assessment,
a confusing lexicon for dementia and the diseases that cause dementia, and therapeutic nihilism on the part of
clinicians who do not feel that existing treatments are useful.
The diseases that commonly cause dementia include amyloidopathies (neuritic plaques) and/or tauopathies
(neurofibrillary tangles), synucleinopathies (Lewy bodies), prionopathies (spongiform degeneration), or strokes
(cerebrovascular disease). These pathological entities destroy cortical and subcortical grey matter and produce
impairment in various cognitive domains depending primarily on which specific areas are damaged. Cognitive
impairments usually present in patterns and these patterns, or syndromes, are identifiable in the office. The
earliest signs of dementia are in the form of mild cognitive impairment and personality changes such as becoming
more irritable or apathetic. When the threshold of dementia is crossed, the cognitive impairments are obvious.
The final stage is the loss of abilities to independently perform basic activities of daily living such as toileting,
hygiene, dressing, and eating.
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