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Alzheimer's Disease & Dementia
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An elderly person has the same right to treatment and improvement as a younger person. Too many people are written off as ‘non-functioning’ when they can, in fact, be cured.
Herzog Hospital is currently the only facility in Israel to combine neurological, behavioral and social approaches in treating the full range of geriatric illnesses.
The Center for Neurobehavioral and Neurogeriatric Disorders integrates clinical, research and public education activities in geriatric neurology, neuropsychology, psychogeriatrics and complementary paramedical and social fields. The services are based on innovative methods of evaluation and treatment of the elderly.
Recent studies show that neurological disability and dementia in the elderly can actually be prevented or the rate of their progression decelerated by early detection and comprehensive treatment.
The cause of more than fifty per cent of functional disorders in old age involves disorder in the central and peripheral nervous system. Neurological diseases like stroke, Parkinson’s disease, Alzheimer’s disease, and other dementias are only a part of the enormous number of disorders which affect the elderly. Improving neurological evaluation and treatment by combining diverse medical and paramedical fields, i.e. geriatric neurology, behavioral neurology, geriatrics, neuropsychology, psychiatry, psychology, social work and occupational therapy, can significantly improve the functioning level and the quality of life of the elderly, including memory, aches and pains and sleep.
Causes of failure to treat and prevent neurological disorders in the elderly are as follows:
a) Lack of multi-disciplinary approach.
In geriatric neurology, as well as in other fields of geriatric medicine, medical problems have multiple causes e.g. a walking disorder might be caused by both Parkinson’s disease and spinal cord disorder, by disease of the joints or by low blood pressure. Even if one particular cause is identified, the diagnosis does not end until all additional potential causes have been investigated. Each patient’s diagnosis must be ‘customized’.
b) Lack of experience in behavioral neurology.
A large proportion of the elderly suffer from neurobehavioral disorders, e.g. memory disturbances, lack of concentration or language and depression, all of which are caused by brain lesions which doctors have overlooked. Many neurobehavioral patients receive a diagnosis of irreversible disease like Alzheimer’s while, in fact, they suffer from remediable conditions like vitamin or thyroid deficiency, etc.
c) Underestimation of the role of non-medical support systems.
Caregivers and family members are natural support systems, as well as social and creative resources. Frequently, they are the first to notice a change in the patient, they are the most sensitive to the course of the disease and are a key resource in the treatment and rehabilitation process. Their partnership in the medical process should be encouraged and their energy should be actively exploited. The medical team should support them and be available to listen to their needs. For this reason, it is necessary to integrate social services and diverse rehabilitation professionals into the medical team.
Objectives of the Center for Neurobehavioral and Neurogeriatric Disorders:
Return senior patients to a normal, independent, creative life.
Coordinate treatment of neurological and behavioral psychogeriatric medical problems with paramedical and social services.
Initiate a pro-active medical approach to delay and minimize the severity of aging syndromes by intensive medical check-ups, tests, planned treatment and follow-up, in order to prolong healthy living for the elderly.
Develop and implement a framework of supportive services for the gradual transition of patients from the hospital back to their homes.
Functions of the Center
Out-patient and Community Care Division
- Multi-disciplinary clinical services for elderly citizens (including
Holocaust survivors) which enable them to remain at home while receiving necessary treatment as neurogeriatrics, neurobehavior and psychogeriatrics, and regulation of medication.
- Information center and supportive services for families of elderly patients.
- Outreach programs to increase public awareness of strategies for early intervention and improvement in the quality of life.
- Prevention clinics including dementia, over-medication control.
In-patient Division
Acute 40-bed in-patient division:
- General geriatric neurology – e.g. acute Parkinson’s, recurring falls etc.
- Neurobehavioral and psychogeriatric unit – e.g. severe agitation, depression etc.
- Neurobehavioral rehabilitation
- Ambulatory admission – including all services of the acute in-patient department
- Family and social services – comprising family therapy, home visits, support groups and individual consultation.
- 24-hour hotline in several languages including real-time emergency response, counseling and services such as medical second opinion, hiring a caregiver, support groups and choosing a nursing home.
Crisis and Transit Services Division including:
Emergency room for geriatric behavioral neurology, geriatric neurology and psychogeriatrics
Geriatric medical and social work staff
Geriatric treatment van
Research and Evaluation Division
Ongoing evaluation and refinement of services provided by all three divisions.
Development of new diagnostic and therapeutic strategies using a neurobehavioral approach.
Continuing research on clinical topics and brain-behavior that can be applied to both geriatric and non-geriatric populations.
Expansion of current research on early indicators of Alzheimer’s Disease and other dementias.
Conducting clinical research on psychogeriatric syndromes and the influence on these of different therapeutic treatments.
The head and founder of the program is Dr. Eli Wertman, behavioral neurologist and head of the Neuropsychogeriatric Department at Herzog Hospital for the past seven years. Dr. Wertman earned his medical degree at Hadassah Medical School, Hebrew University, Jerusalem in 1978. He later became a senior resident at the University Hospital after specializing in Behavioral Neurology in the Department of Neurology of the University of Florida, Gainesville, Florida. In addition to his devotion to elderly patients, Dr. Wertman is actively involved in many research projects focusing on clinical aspects of neurological disorders related to aging and especially to Alzheimer’s disease.
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