Age related illnesses | May 23, 2014 | Author: The Super Pharmacist
Dementia is defined as disturbances of cognitive functions or memory, typically associated with advancing age. These disturbances can affect job performance and activities of daily living.
Cognitive functions include:
Dementia may include one or all of these disturbances and is usually associated with a certain degree of memory impairment. The result is confused thinking, memory lapses, unusual behavior, personality changes and communication problems, all of which affect a person’s ability to cope with daily life situations.
While dementia is typically associated with advancing age, it has to be understood that it is not an essential feature of aging.
A majority (almost 80%) of the people who suffer from dementia have underlying Alzheimer’s disease which is a progressive irreversible condition.
Alzheimer’s disease is so commonly the cause of dementia; the two terms are often used interchangeably. However it should be kept in mind that there are other causes of dementia as well and some of them are reversible.
The most common cause of progressive dementia:
Some reversible causes of dementia:
Some causes of progressive dementia:
It is important to identify the cause of dementia. If the cause is reversible, the dementia is treatable. If it is a progressive cause, cure is currently not achievable. Treatment options still exist for progressive dementia to slow progression of the disease process, alleviate patient symptoms and solve patient problems.
The emphasis in treatment options for dementia especially Alzheimer’s disease is care not cure.
The first step is absolutely essential to rule out reversible and hence curable causes of dementia.
This can be done by the attending physician through a proper history, physical examination, mental state examination and a panel of appropriate investigations.
For the reversible dementias, the key is to find and treat the underlying cause. If this is done, there will be a remarkable improvement in the patient’s symptoms and if the cause can be fully cured, so can the dementia.
For the progressive dementias, most common of these being Alzheimer’s disease, there is no cure. But much can be done for the care of these patients. This means appropriate medications and non-pharmacological interventions such as certain lifestyle changes, adequate social support, cognitive therapies and a trial of alternative approaches may improve overall quality of life. Correct identification of the underlying etiology is still important as different causes of dementia would differ in specific treatment plans. Some general management measures are helpful in all cases of dementia irrespective of cause.
A prudent management plan for progressive dementias, including Alzheimer’s disease, would consider:
Dementia such as Alzheimer’s disease is a chronic progressive condition. While this means that the condition worsens over time, it is a gradual process, spanning over years and it offers opportunity to the patient and caregivers to plan and prepare in advance. Some of the steps that can make a real difference in the long run are:
Medications are an important aspect of dementia and Alzheimer’s disease management. However it should be understood that dementia treatment involves many levels of care and the best results can be achieved when medications are combined with non-pharmacological interventions.
The important drug groups are:
Drugs for cognitive symptoms These do not cure but help improve symptoms and slow the progression of disease. They are typically used in treating Alzheimer’s disease but can help with the other dementias as well. There are two main categories:
Since the two drug groups differ in mechanism of action, they can be used in combination for added benefits.
Drugs for mood and behavioural disorders As a rule the first thing to do is to determine what is upsetting or agitating the patient and take care of the problem. Behavioural and mood drugs are employed only after knowing that the patient’s needs are otherwise met.
Many steps can be taken to improve sleep hygiene before resorting to drugs. Antidepressants or anxiolytics may help with sleep problems too. If nothing else works, a “sleeping pill” such as temazepam can be tried.
People with dementia and Alzheimer’s disease frequently present with depression, upset mood, agitation or restless behavior. A number of alternative approaches can help, with variable success, to soothe them, reduce their anxiety levels and improve their sense of well-being. These approaches include aromatherapy, using plant oil fragrances, music therapy and massage therapy.
These are non-pharmacological interventions aimed at improving cognitive function and memory impairment.
Cognitive stimulation therapy (CST) involves providing triggers to assist in recall; mental stimulation and encouraging communication.
Cognitive training is about mental exercises and games that are intended to enhance brain activity.
Cognitive rehabilitation is individualized and employs learning strategies.
Cognitive therapies are the latest trend in the management of dementia and Alzheimer’s disease, with some studies claiming almost as good results as with medications. However, available evidence is still inconclusive and results of further studies are awaited.
Alzheimer’s disease is a significant global problem and therefore a focus of worldwide medical research. Amyloid plaques and neurofibrillary tangles are the histological hallmarks of Alzheimer’s disease and are being studied extensively to gain insight into the disease process. Some believe we are close to finding a vaccine or drug that will be able to cure Alzheimer’s disease for good.
Many foods, dietary supplements and herbal remedies are presented as alternative treatments having beneficial effects on memory and cognitive brain functions. They are thought to be helpful for patients with dementia and Alzheimer’s disease.
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