Dementia is a syndrome which accompanies activities such as deterioration in memory, thinking, behaviour and a reduced ability to perform everyday activities. This disorder is typically prevalent among older adults. However, it is not a normal process of ageing. Dementia gradually affects memory, learning capacity, thinking, orientation, comprehension, calculation, language, and judgement. The impairment in cognitive function is accompanied and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.
Not only does it involve physical, social and emotional turmoil of the patient undergoing this disease but also the family, caregivers and society at large. Dementia can be overwhelming for the families of affected people and their caregivers.
Treatment and Care
For most of the progressive cases of dementia, including Alzheimer’s, there is no cure or treatment currently available that completely slows or stops its progressive course. Several new treatments are being investigated in various stages of clinical trials. Treatment of dementia varies according to its cause. But there are drug treatments that may temporarily contribute towards improvements in the symptoms. Non-drug therapies can also alleviate some symptoms of dementia.
The following medications, under psychiatrist guidance, are used to temporarily improve dementia symptoms.
Cholinesterase Inhibitors. These medications donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) work by boosting levels of a chemical messenger involved in memory and judgment. These medications might also be prescribed for other dementias, including vascular dementia, Parkinson’s disease dementia and Lewy body dementia although it was primarily used to treat Alzheimer’s disease. Side effects can include nausea, vomiting, diarrhoea, slowed heart rate, fainting and sleep disturbances.
Acetylcholinesterase Inhibitors. These medicines prevent an enzyme from breaking down acetylcholine in the brain, which helps nerve cells communicate with each other.
Memantine. Memantine, also known as Namenda works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory. Memantine is advisable for people with dementia who cannot take or are unable to tolerate acetylcholinesterase inhibitors. It works by blocking the effects of an excessive amount of a chemical in the brain, glutamate. Side effects can include headaches, dizziness and constipation.
Donepezil (also known as Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are useful for the treatment of the symptoms of mild to moderate Alzheimer’s disease. It is also used to treat more severe Alzheimer’s disease. However, rivastigmine may be preferred if psychotic symptoms such as hallucinations are one of the main symptoms. Side effects can include nausea and loss of appetite.
Therapies
There are times when prescribing medicine is not appropriate due to other health conditions associated with the patient. In such cases, several non-drug approaches are used to treat dementia symptoms:
Occupational therapy. An occupational therapist can assist in teaching coping behaviour. He/she also shows how to make your home safer. The purpose is to teach skills or ideas that can prevent accidents, such as falls; manage behaviour, and prepare for the dementia progression.
Modifying the environment. Decluttering and noise reduction can make it easier for someone with dementia to maintain focus and function. Objects such as knives, keys, or other such objects are to be kept safely. Monitoring systems can alert as soon as the person with dementia starts to wander.
Simplifying tasks. Instead of concentrating on failures, the focus should be made on what can be done. By breaking tasks into easier steps, a lot of confusion in people with dementia can be reduced.
Cognitive Stimulation Therapy
Cognitive stimulation therapy (CST) involves taking part in group activities and exercises where simple tasks are designed to improve memory, problem-solving skills and language ability. CST has been proved to be beneficial for people with mild to moderate dementia.
Cognitive Rehabilitation
This technique involves working with a trained professional, such as an occupational therapist, and a relative or friend to achieve a personal goal, be it learning to use a mobile phone or call an emergency number or other everyday tasks. Cognitive rehabilitation works by stimulating the parts of the brain that are working to provide support for or proxy the parts that are not. In the early stages of dementia, this technique can help to cope better with the condition.
Reminiscence and life story work
Reminiscence work involves talking about things and events from the past of the patient with dementia. It usually involves the use of props such as photos, favourite possessions, music or anything the person is fond of or previously had an interest in. Life story work might also involve a compilation and revisit of photos, notes and keepsakes from childhood to the present day. These approaches are sometimes combined. Evidence shows that such practice can help in improving mood and wellbeing. They also help the person suffering from dementia and those around them to focus on their skills and achievements rather than on the disease.
Other contemporary therapies
There are cases where treatment shows rather slower progress or no progress at all. At times as such, the following techniques may help reduce agitation and promote relaxation in people with dementia to a great extent.
Music therapy, which involves listening to soothing music, light exercise for body movements, pet therapy, which involves the use of animals, such as visits from dogs, to promote improved moods and behaviours in people with dementia, aromatherapy, which uses fragrant plant oils, massage therapy for relaxation, art therapy, which involves creating art, focusing on the process rather than the outcome, coping and support. Being diagnosed with dementia can be overwhelming. Minute details need to be considered to ensure that you and those around you are prepared for dealing with a condition that’s unpredictable and progressive. In case coping strategies do not work, antipsychotic medicines may be prescribed for those showing persistent aggression or extreme distress.
Risk factors and prevention
Dementia does not exclusively affect older people, cases of young-onset dementia are also registered. Studies show that people can reduce their risk of dementia by getting regular exercise, avoiding smoking, avoiding alcohol abuse, maintaining a healthy weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels. Additional risk factors include depression, low educational attainment, social isolation, and cognitive inactivity.
Dementia symptoms and behaviour problems will progress over time. As a caregiver, it is important to try to enhance communication, encourage exercise, engage in physical activity and keep a calendar to help your loved one remember upcoming events, daily activities and medication schedules. You can help a person cope with the disease by listening, reassuring the person that he or she still can enjoy life, being supportive and positive, and doing your best to help the person retain dignity and self-respect.
*Disclaimer- This article is for informational purposes only. Please consult a medical professional for advice. This is not a replacement for medical consultation.TCV shall not be responsible for any damage.