November

Case 1

Mr G. was a 74-year-old retired car salesman who was first seen at the clinic in May 1998. At that time he complained of declining memory for the past 3 years, said he had lost interest in playing golf, seemed to have lost his sense of direction, and was less energetic in activities. He was sleeping more, with prolonged daytime naps.

Alzheimer disease (AD) is not a disease of cognition alone. A wide array of behavioral and psychological problems are associated with it. In fact, delusional jealousy, paranoia, auditory hallucinations, screaming, and agitation were all prominent features of the dementia described by Alzheimer in his original report.[1] Behavioral disturbances may be the most challenging problems for caregivers to deal with and often lead to a need for institutional care. The origin of the problems needs to be understood before defining patient-centred management strategies.

Alzheimer disease (AD) is a progressive, neurodegenerative illness and its prevalence increases with age.[1] The Alzheimer Society of Canada uses a staging system that divides the progression of AD into early, middle, and late disease.[2] No single pathognomonic clinical event has been found to characterize late AD. Features of late disease are summarized in Table 1.

In the September BCMJ, (2004;[7]:322) under Personal View, you published a letter from a Dr A.M. Krisman in which he offers a simplistic solution to “cream skinners.” Of further interest is Dr Krisman’s own admission that he is not a GP and regards it as a very difficult area of medicine. It also appears that he did not actually go in and check out the dreaded walk-in clinic in the old Eaton’s store.