Dementia
Alternative names:
chronic brain syndrome
Treatment:
The goal of treatment is to control the symptoms of dementia. Treatment varies with the specific disorder. Hospitalization may be required for a short time. The underlying causes should be identified and treated, including treatment for reversible organic lesions (such as tumors).
Stopping or changing medications that worsen confusion, or that are not essential to the care of the person, may improve cognitive function. Medications that contribute to confusion include anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications.
Disorders that contribute to confusion should be treated. These include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often greatly improves mental functioning.
Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required.
Medications that may be considered for use include: - anti-psychotics, given at night
- beta blockers if dementia is related to central nervous system lesions
- serotonin-affecting drugs (lithium, trazodone, buspirone, clonazepam)
- dopamine blockers (such as haloperidol)
- carbamazepine, particularly in senile dementia, Alzheimer's type
- fluoxetine, imipramine, may help to stabilize mood
- cerebral vasodilators (variable results reported)
- stimulant drugs (such as methylphenidate), may improve mood
- ergotoxine alkaloids, may improve mood and self care without altering cognitive function
- cholinergic stimulators (such as tacrine phosphatidyl choline) have been effective for some persons with senile dementia, Alzheimer-type
Sensory function should be evaluated and augmented as needed by the use of hearing aids, glasses, or cataract surgery.
Formal psychiatric treatment (psychotherapy, group discussions, etc.) is seldom effective because it may overload limited cognitive resources in the person with dementia.
Long term treatment:
The provision of a safe environment, control of aggressive or agitated behavior, and the ability to meet physiologic needs may require monitoring and assistance in the home or in an institutionalized setting. This may include in-home care, boarding homes, adult day care, or convalescent homes.
Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful in caring for the person with organic brain syndrome. In some communities, there may be access to support groups. (See elder care - support group)
In any care setting, there should be familiar objects and people. Lights that are left on at night may reduce disorientation. The schedule of activities should be simple. Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation. Family counseling may help in coping with the changes required for home care.
Legal advice may be appropriate early in the course of the disorder, before the person becomes so incapacitated that he or she cannot make decisions. Advance directives, power of attorney, and other legal actions may make it easier to make decisions regarding the care of the person with dementia.
Expectations (prognosis):
The outcome varies. Acute disorders that cause delirium may coexist with chronic disorders causing dementia. Chronic brain syndromes are often progressive and usually result in decreased quality of life and decreased life span.
Complications:
Complications vary depending on the specific disorder: - loss of ability to function or care for self
- loss of ability to interact
- increased incidence of infections anywhere in the body
- reduced life span
- abuse by an over-stressed caregiver
- side effects of medications used to treat the disorder
Calling your health care provider:
Call for an appointment with your health care provider if
dementia develops or sudden change in mental status occurs.
Call for an appointment with your health care provider if the condition of a person with dementia deteriorates to the point where you are unable to cope with care of the person in the home.
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