Dementia

Dementia is a cognitive disorder that includes both deterioration of intellectual ability and alterations in the persons emotional and personality functions. Alzheimer’s disease, vascular dementia, general medical conditions (brain tumors, brain trauma, metabolic disorders, kidney, liver, heart, or lung disoders) or multiple etiologies all cause dementia.

A neurologist and a psychiatrist should closely follow persons with this disorder. Medication is often needed to reduce agitation and assist in controlling acting out behavior and wondering. Confusion is common in dementia as is psychotic behaviors. While dementia patients can become floridly psychotic, illusions, paranoia, and agitation are most common. Often a very small dosage of Neuroleptic is useful to control agitation and psychosis.

Often, a consultation will be arranged with a neuropsychologist who will continue to follow the patient. It is the job of the neuropsychologist to monitor the mental status of the patient. Often, baseline tests are conducted to monitor change in mental status over time. It is also imperative to monitor and control the patients environment so as not to ad to their confusion. The patient’s room should have a large calendar in a primary location. A sign identifying the patient’s current location (e.g., such and such hospital, “this is Donna’s room in the harbor manner nursing home, etc.) helpful. Items the patient is familiar with should be available. Keeping a stable and consistent environment will help to minimize confusion and agitation.

Dementia is usual a chronic and progressive disorder. Alzheimer’s is usually evenly progressive over time, while vascular dementias are often stepwise. In Alzheimer’s, the patients family may not notice changes for a long time. However, when asked to think back, they can usually identify significant changes in memory or personality that they chose to ignore, or chalk up to old age. Alzheimer’s has an insidious course, beginning with memory loss, confusion and personality changes and eventually leading to death. After the first signs of Alzheimer’s are identified, a patient will generally live no more than 5 to 10 years. Alzheimer’s type dementia is considered untreatable. No form of psychosocial or medical therapy has been shown successful in slowing the progression of the disease. Other untreatable dementias include Huntingtons Chorea and Parkinsons Disease among others. Huntingtons and Parkinsons are especially tragic in that patients suffer significant distress and depression as the disease progresses. Alzheimer’s patients often only suffer in the early stages, as they generally loose higher cortical functions and self-awareness as the disease progresses.

Vascular dementia on the other hand is considered treatable. Vascular Dementia has rapid onset often due to a significant cerebral event (e.g., multiple thromboemolic episodes or cerebral infarctions). The course of vascular dementia is usually stepwise, more focal in area of impairment, and may be less insidious in course.

The goals associated with Dementia are to assess the level of impairment, ensure the person is getting the appropriate medical care and establish relationships with the caretakers and the patient.

When doing the assessment it should cover adaptive, behavioral, cognitive and emotional functioning. It will also be necessary to obtain releases for prior assessment results and medical records. Make sure the client has received a full medical evaluation to rule out obvious medical conditions. Also, ensure that the client is receiving appropriate physical care.

In the elderly, depression often mimics dementia. Patients can develop anxiety, and hypochondriacal disorders as well. Major Depression in the elderly is often called pseudodemetia. Further, delirium can appear similar to dementia. Hence, it is important to differentiate dementia from other psychological conditions.

Unlike dementia, depression usually has a more rapid onset and the patient complains of memory loss. When tested, memory loss is usually mild when the patient is encouraged and supported depressed patients often give up easily but do better when encouraged. With encouragement, normal memory and orientation can usually be seen. These patients often focus on their failings and have significant affective changes. The depressed patient often answers memory questions with “I don’t know”, while dementia patients usually attempt to answer. In addition, depressed patients often show psychomotor retardation while dementia patients do not (depending on type).

Delirium is differentiated from dementia by a very short onset and consciousness that fluctuates throughout the day. However, delirium and dementia can co-exist. The clinician must wait for delirium to clear before diagnosing dementia.

Supportive treatment should include making sure that there is good physical care. Nutrition, glasses, hearing aids, etc should be provided. The patient should be maintained in s familiar environment and should be involved in structured activities and if possible, current events. While there is no current drug treatment for dementia, some drugs can help with memory problems and slow the progression of some dementia symptoms. Other psychotropic drugs can be very effective in the treatment of symptoms and can be effective in helping patient be more comfortable and improve their overall mental status.

Supportive psychotherapy will be helpful to the family in adjusting to the situation. While there are no psychological treatments that are very effective with dementia patients, and personal contact by an interested person may be helpful. Reminiscent therapy may help the patient feel more connected to the world (early memories remain intact much longer than recent or short term functioning).

You will also need to explore what assistance is needed and whether there is family support and what types of community resources are available.