Senile dementia/Alzheimer's type
Alternative names:
Alzheimer's disease; diffuse brain atrophy; primary degenerative dementia
Treatment:
There is no known definitive (proven to be effective) cure for SDAT (Alzheimer's). Treatment is aimed at relief of symptoms and protection from the effects of the deteriorating condition.
Tacrine and/or cognex may be used, and the results vary. Other treatments may be attempted, but most are considered experimental or have had variable results.
Stopping or changing medications that worsen confusion or that are not essential to the care of the person may improve cognitive function. This may include medications such as anticholinergics, analgesics, cimetidine, central nervous system depressants, and other medications.
Underlying disorders that contribute to confusion should be identified and treated as appropriate. These include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. The correction of coexisting medical and psychiatric disorders often greatly improves the patient's mental function.
Medications may be required to control aggressive or agitated behaviors or any behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required. Some of the medications that may be considered for use include the following: - anti-psychotics
- serotonin-affecting drugs (lithium, trazodone, buspirone, clonazepam, etc.)
- carbamazepine
- cholinergic stimulators (such as tacrine phosphatidyl choline) have been effective for some persons with SDAT
An anticonvulsant medication may be needed for seizures.
The patient's sensory functions should be evaluated and augmented as needed with such things as hearing aids, glasses, and cataract surgery.
Psychotherapy is seldom effective because it may overload the patient's limited cognitive resources.
Eventually, 24-hour monitoring and assistance may be required to provide a safe environment, control aggressive or agitated behavior, and meet physiologic needs. This may include in-home care, boarding homes, adult day care, or convalescent homes.
General nutrition and health maintenance is important, but special diets or nutritional supplements are usually unnecessary. Exercise is important and should be encouraged.
Practical assistance early in the disorder may include frequent reminders, notes, lists of routine tasks, or directions for daily activities.
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.
Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful in caring for people with SDAT. In some communities, there may be access to support groups. See Alzheimer's - support group and elder care - support group.
Legal advice may be appropriate early in the course of the disorder. Advance directives, a power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of an SDAT patient.
Expectations (prognosis):
The probable outcome is poor. The disorder is usually not acute, but progresses steadily. Total disability is common. Death normally occurs within 15 years, usually from an infection or a failure of other body systems.
Complications:
- loss of ability to function or care for self
- complications caused by immobility
- decubitus (bedsores)
- broken bones
- muscle contractures (loss of ability to move joints because of loss of muscle function)
- loss of ability to interact
- increased incidence of infections anywhere in the body
- failure of body systems
- reduced life span
- abuse by an over-stressed caregiver
- side effects of medications
Calling your health care provider:
Call your health care provider if someone close to you experiences symptoms of senile dementia/Alzheimer's type.
Call your health care provider if a person with this disorder experiences a sudden change in mental status (may indicate other illness).
Discuss the situation with your health care provider if you are caring for a person with this disorder and the condition deteriorates to the point where you can no longer care for the person in your home.
|
