Dementia Management

Management of Patients with Dementia

Key Definitions and Concepts

  • Dementia: A change in intellectual functioning without a change in arousal and alertness. It may include any combination of the following cognitive aspects:

    • Memory

    • Abstract thinking

    • Judgment and problem-solving

    • Language

    • Personality

Causes of Dementia

  • Dementia is associated with various factors, which include:

    1. Neurodegenerative Conditions:

      • Alzheimer’s disease

      • Parkinson’s disease (PD)

      • Huntington's disease (HD)

    2. Infectious Diseases:

      • Syphilis

      • Tuberculosis (TB)

      • Acquired Immunodeficiency Syndrome (AIDS)

    3. Vascular Conditions:

      • Stroke

      • Anoxia

      • Multi-infarct dementia

    4. Metabolic Disturbances:

      • Hyponatremia

      • Dehydration

      • Hypoglycemia

      • Vitamin B12 deficiency

    5. Depression

    6. Medications

  • If underlying causes are treatable or modifiable, related dementia may be reversible; however, dementias related to neurodegenerative conditions are typically not easily treated.

Stages of Alzheimer's Disease

  • Early Stage: May be subclinical for years.

  • Mild/Moderate Stage: Identifiable and evolving symptoms.

  • Severe Stage: Pronounced symptoms that significantly impact daily functioning.

Cognitive Changes in Alzheimer's Disease

  1. Memory Loss:

    • Interferes with daily living—frequently misplacing common objects.

    • Forgetting events and new information.

  2. Difficulty Planning and Solving Problems:

    • Struggles with basic tasks, such as cooking and bill paying.

  3. Difficulty Performing Familiar Tasks:

    • Challenges with familiar games and driving to known locations.

  4. Disorientation:

    • Difficulty tracking dates and seasons; may get lost.

  5. Difficulties with Visual Images and Spatial Relations:

    • Issues with reading, judging distance, visual contrast, and recognizing people.

  6. Word-Finding Problems:

    • Communication deficiencies.

  7. Poor Judgment:

    • Inability to handle money and maintain self-care.

  8. Social Withdrawal:

    • Reduced interaction with others.

Mood and Behavior Changes

  • Mood swings and personality changes.

  • Symptoms of fear, anxiety, suspicion, irritability, and progressive apathy.

  • Difficulty coping with change.

  • Denial of any issues or problems.

Speech and Language Implications

  • Common Issues:

    • Pronounced word finding difficulty (Anomia).

    • Loss of comprehension.

    • Nonsensical conversation and loss of engagement in conversation.

Motor Impairments in Severe Alzheimer's Disease

  • Loss of coordination.

  • Disequilibrium and bradykinesia (slowness of movement).

Medical Intervention

  • It is crucial for medical professionals to rule out other causes of dementia, particularly pharmaceutical causes.

  • Pharmaceutical interventions are generally symptomatic and may assist in improving cognitive functioning and potentially have modest effects on slowing the rate of progression.

  • Current Medications:

    • Aricept: Effective in all stages.

    • Leqembi, Kisunla: Effective in mild stages.

    • Razadyne, Exelon, Cognex: Effective in mild to moderate stages.

    • Namenda: Effective in moderate to severe stages.

Treatment of Comorbid Conditions

  • Addressing comorbid conditions may improve overall functioning, including:

    • Depression

    • Vision and hearing impairments

    • Urinary Tract Infections (UTI)

    • Cardiovascular diseases

  • Regular physical activity can improve overall physical health and behavior in dementia patients.

  • Dietary interventions may also be neuroprotective.

Exercise and Dementia

  • According to a systematic review published in 2022, all types of exercise have been noted to be effective in increasing or maintaining global cognition.

  • Resistance Exercise: Has the highest probability of being the most effective intervention in slowing the decrease in global cognition, executive function, and memory.

  • Regular exercise can slow the progression of Alzheimer’s Dementia by approximately 20%.

Prognosis of Alzheimer's Disease

  • Average time from onset to death ranges from 7 to 11 years.

  • Death typically occurs from secondary causes:

    • Respiratory infections

    • Dehydration

  • Support and assistance for caregivers and loved ones is critical for those caring for dementia patients.

Role of Physical Therapy

  • Physical activity has been shown to improve brain function and memory, especially for healthy older adults or those with mild cognitive problems.

  • Regular exercise can delay the onset of Alzheimer’s disease in healthy older adults.

  • Regular exercise may also delay declines in performing daily tasks in Alzheimer's patients by improving their strength, balance, and walking ability.

Tips for Communicating with People with Dementia

  • Ensure patient comfort.

  • Plan communication and check your own mood before interacting.

  • Practice active listening.

  • Pay attention to body mechanics during communication.

  • Allow the person extra time to respond.

  • Let them express their feelings freely.

  • Speak clearly and calmly; may require a slightly slower pace.

  • Use short, simple sentences.

  • Ask one question at a time to facilitate understanding.