Prognosis and treatment of dementia
Dementia usually has a progressive course. However, the rate (rate) of progression varies widely and depends on a number of reasons. Dementia shortens the expected life expectancy, but the survival score varies.
Activities that provide security and provide appropriate environmental conditions of life are extremely important in the treatment, as well as the care of the guardian. Some medications may be helpful.
Occupational therapy and physiotherapy determine the safety of the patient at home; The aim of these measures is to prevent accidents (especially falls), manage behavioral disorders and plan corrective actions in case of progressing dementia.
It should be evaluated to what extent the patient can function in different circumstances (in the kitchen, in the car). In case the patient is found unable to perform these actions and he remains in the previous situation, some protective measures (including not included gas / electric stove, restriction of access to the car, confiscation of keys) may be necessary. Some situations may require the doctor to inform the Department of Traffic Management about a patient with dementia, because under certain circumstances such patients can no longer continue driving. If the patient has a tendency to leave home and wander, installation of a monitoring alarm system is necessary. Ultimately, assistance (home helpers, home health care services) or changing the environment (providing daily activities without stairs and steps, assisting devices, assistance of professional nurses) may be required.
Measures to modify the environment
Providing suitable for a patient with dementia environmental conditions can help in gaining a sense of confidence in the ability to self-service and in his own personality. Such activities include orientation training in the room; bright lighting, bright, familiar environment, minimizing new influences and regular, with a small number of stresses, the patient's activity.
A large calendar and clock should become the usual condition for daily activity and help with orientation; Medical personnel should have a large registered badge and be presented repeatedly to the patient. Changes in the patient's environment, established (established) order must be carefully and simply explained to the patient, while avoiding emergency procedures. Patients need time to comprehend and familiarize themselves with the changes that have occurred. Explaining to the patient the sequence of his actions (for example, visiting a bath or eating food) is necessary to prevent resistance or wrong reactions. Often visits by medical personnel and familiar people support patients in a socially adapted state.
The room should be sufficiently illuminated and contain sensory stimuli (including radio, television, night lighting) in order to help the patient stay focused and concentrate his attention. It is necessary to avoid silence, darkness, placing the patient in isolated rooms.
Activity helps patients to function better, those with specific interests prior to dementia have a more favorable prognosis. Activity should be fun, supported by a certain stimulation, but do not involve too many choices (alternatives) and complex tasks. Physical exercises help to reduce excessive motor activity, impaired stability and maintain the necessary tone of the cardiovascular system, and therefore must be performed on a daily basis. Exercises can also help in improving sleep and reducing behavioral disorders. Occupational therapy and music therapy help maintain accurate motor control and support non-verbal stimulation. Group therapy (in this system reminiscence therapy, socialization of activity) can help to maintain conversational and interpersonal experience.
Medicines against dementia
The exclusion from use or restriction of dosages of drugs that affect the central nervous system often improves the functional state of the patient. Sedation and anticholinergics should be excluded, with a tendency to worsen the course of dementia.
Cholinesterase inhibitors such as donepezil, rivastigmine and galantamine are somewhat effective in improving cognitive function in patients with Alzheimer's disease or dementia with Levy bodies and may be useful in other forms of dementia. These drugs, by inhibiting acetylcholinesterase, increase the level of acetylcholine in the brain. Such new drugs as memantine can help slow the progression of mild or severe dementia and can be used in conjunction with cholinesterase inhibitors.
Other drugs (including antipsychotics) are used to control behavioral disorders. Patients with dementia and signs of depression should be treated with drugs from the group of non-anticholinergic antidepressants, preferably from the group of selective serotonin reuptake inhibitors.
Help the nurse
The closest family members bear great responsibility for caring for a patient with dementia. Nurses and social workers can train them and other caregivers how to better meet the needs of patients (including how to distribute day care and conduct financial calculations), training should be continuous. Other sources (including support groups, educational materials, the Internet) should be available. Nurses may experience situational stress. Stress can be caused by anxiety about protecting the patient and a sense of frustration, exhaustion, anger and resentment for having to take so much care of someone. Health care professionals should pay attention to early symptoms of stress and depression in caregivers and, if necessary, support in the provision of care (including social workers, nutritionists, nurses, and home care professionals). If patients with dementia develop unusual lesions, an assessment of possible ill-treatment of the elderly patient is necessary.
The End of Life
Due to the fact that criticism and thinking in patients with dementia are steadily deteriorating, there may be a need to appoint a family member, guardian or lawyer to manage financial affairs. In the early stages of dementia, before the patient becomes incapacitated, his wishes for custody must be clarified and his financial and legal affairs (including the reliability of the lawyer and the reliability of the lawyer leading the medical cases) brought to the necessary order. After these documents are signed, the patient's capacity should be assessed, and the results of this assessment are fixed.
Treatment of dementia