Dementia
Reducing Medicare Costs: The Risk, Prevention, and Treatment of Cognitive Impairment
Introduction
Reducing Medicare costs will be an important enterprise in the future as the baby boom generation retires. In the Medicare Prescription Drug Improvement and Modernization Act of 2003, Congressional debate was as much about “limiting government’s future exposure to cost increases”1 as it was about creating a new prescription drug benefit for Medicare. Grassroots efforts to reduce costs through incentives to physicians have been attempted, but without much success. An actuarial team from the Centers for Medicare & Medicaid Services (CMS) reported in 1998 that when...
Is This Patient Demented and Delusional? The Importance of Language and Culture in Evaluation and Diagnosis
CASE PRESENTATION
A 66-year-old widowed male comes to a psychiatrist with his daughter, who acts as a translator and informant. The daughter and patient are concerned that he is “taking too many medications and not getting better.” They are worried about the medical care that he has received, and provide a very detailed history. The patient is a native of Brazil, who immigrated to the United States 40 years ago. He retired from his job as a construction worker at age 63 after being seriously injured at work, suffering a depressed skull fracture requiring insertion of a metal plate...
