Multi-infarct dementia

Treatment:

There is no known definitive treatment for MID. Treatment is based on control of symptoms. Other treatments may be advised based on the individual condition.

Initial diagnosis and treatment:
The person should be in a pleasant, comfortable, nonthreatening, physically safe environment for diagnosis and initial treatment. Hospitalization may be required for a short time. The underlying causes should be identified and treated as appropriate, including treatment for atherosclerosis and hypertension.

Discontinuing or changing medications that worsen confusion or that are not essential to the care of the person may improve cognitive function. Medications that may cause confusion include anticholinergics, analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications.

Disorders that contribute to confusion should be treated as appropriate. These may 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 the 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 may include antipsychotics, beta-blockers, serotonin-affecting drugs (lithium, trazodone, buspirone, or clonazepam), fluoxetine, imipramine, or others.

Sensory function should be evaluated and augmented as needed by hearing aids, glasses, or cataract surgery.

LONG-TERM TREATMENT
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. Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful in caring for the person with MID. In some communities, there may be access to support groups.

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 persons 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.

Legal advice may be appropriate early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with MID.

Expectations (prognosis):

The disorder is characterized by a downward course with intermittent periods of rapid deterioration. Death may occur from stroke, heart disease, pneumonia, or other infection.

Complications:

• stroke
• atherosclerotic heart disease
• pneumonia
• infection
• reduced life span
• loss of ability to function or care for self
• loss of ability to interact
• increased incidence of infections anywhere in the body
• abuse by an over-stressed caregiver
• side effects of medications

Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if a sudden change in mental status develops. This is an emergency symptom. Call for an appointment with your health care provider if the condition deteriorates to the point of inability to care for the person in the home.