Dementia Health Article

Treatment

The goal of treatment is to control the symptoms of dementia. Treatment depends on the specific condition causing the dementia. Some people may need to stay in the hospital for a short time.

Stopping or changing medications that make confusion worse may improve brain function. Medicines that contribute to confusion include anticholinergics, analgesics (painkillers), cimetidine, central nervous system depressants, and lidocaine.

Medical conditions that can lead to confusion should be treated. Such conditions include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. Treatment of co-existing medical and psychiatric disorders often greatly improves a person's mental functioning.

Medications may be needed to control behavior problems. Possible medications include:

• Anti-psychotics, given at night
• Serotonin-affecting drugs (trazodone, buspirone)
• Dopamine blockers (haloperidol, risperdal, olanzapine, clozapine)
• Cholinesterase inhibitors such as donepezil (Aricept), rivastigmine (Exelon), or galantamine (Razadyne, formerly called Reminyl) for Alzheimer's-type dementia
• Mood stabilizers such as fluoxetine, imipramine, or Celexa
• Stimulants such as methylphenidate to increase activity and spontaneity

A person's eyes and ears should be checked regularly. Hearing aids, glasses, or cataract surgery may be needed.

Psychotherapy or group therapy usually does not help because it may further confuse a person with dementia.

LONG-TERM TREATMENT:

A person with dementia may need monitoring and assistance at home or in an institution. Possible options include in-home care, boarding homes, adult day care, and convalescent homes.

Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may help a family care for a patient with dementia. In some communities, support groups may be available (see elder care - support group). Family counseling can help family members cope with home care.

In any care setting, there should be familiar objects and people. Lights can be left on at night to reduce disorientation. The activity schedule should be simple.

Behavior modification may help some people to control unacceptable or dangerous behavior. This consists of rewarding appropriate behaviors and ignoring inappropriate ones (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may also help reduce disorientation.

Advance directives, power of attorney, and other legal actions may make it easier to decide about the care of the person with dementia. Legal advice should be sought early in the course of the disorder, before the person with dementia is unable to make such decisions.

Expectations (prognosis)

The outcome varies. Dementia usually gets worse and often results in a decreased quality of life and decreased life span.

Complications

Complications depend on the cause of the dementia, but they may include the following:

• Loss of ability to function or care for self
• Loss of ability to interact
• Increased infections anywhere in the body
• Reduced life span
• Abuse by an overstressed caregiver
• Side effects of medications used to treat the disorder

Calling your health care provider

• Call your health care provider if dementia develops or a sudden change in mental status occurs.
• Call your health care provider if the condition of a person with dementia gets worse.
• Call your health care provider if you are unable to cope with caring for a person with dementia at home.

Prevention

Most causes of dementia are not preventable. The risk of vascular dementia, which is caused by a series of small strokes, can be reduced by quitting smoking and controlling high blood pressure and diabetes. Eating a low-fat diet and exercising regularly may also reduce the risk of vascular dementia. Vascular dementia may also play a role in the progression of Alzheimer's disease.

References

Alva G. Alzheimer disease and other dementias. Clin Geriatr Med. 2003; 19(4): 763-76.

American Academy of Neurology. About Dementia. Neurology. 2004; 63(10); E20.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:283-286.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 705-708.