Dementia: treatment and therapy
Dementia is incurable. Nonetheless, some therapeutic measures can offer relief and postpone the evolution of the illness.
These measures aim at maintaining, for as long as possible, the capacities and the autonomy of people with dementia.
Dementia and its causes
Accounting for about 60% of all dementia cases, Alzheimer is the most frequent form of dementia. This illness is characterized by the loss of functional capacities of the neurons and their eventual death. Around 20% of affected people suffer from vascular dementia, a form that is due to cerebral blood circulation disorders. At the present stage, dementia is incurable. Damages that have occurred cannot be restored.
For this reason, the treatment aims rather at slowing down the progression of dementia and at maintaining the capacities of the patient. Diverse therapeutic approaches also differ according to which form of dementia the patient is suffering from. This emphasizes the importance of consulting a specialist physician as soon as the first symptoms appear, so that he can establish a diagnostic and make his recommendations as to which measures are most appropriate.
Medication treatment of dementia
In the case of vascular dementia, medication can be used to help thin out the blood, thus improving the blood circulation of cerebral vessels. However, the effect of anti-dementia drugs such as Donepezil, Rivastigmine or Galantamine can vary from people to people.
Clinical experience demonstrates that while some patients react very positively to these medications, other do not. In order to establish which medication is the most appropriate, the patient should undergo neuropsychological tests on a regular basis. This allows to establish whether the dementia has worsened, in which case the doses of the medication will be modified, or a new medication be prescribed.
Apart from medication in the form of tablets, plasters can also be used. These distribute the active substances evenly, and allow for a higher dosage while minimizing eventual side effects. One of the main objectives of this treatment being the maintaining of cognitive capacities, sedative medications, for example those against sleep disturbances, can have a counterproductive effect. For this reason, such side effects need to be discussed with the physician in charge.
Apart from treatments that involve medication, many other approaches aim at improving the cognitive faculties of people with dementia, or at least to maintain them. Among others, memory training can help to stabilize memory processes. This can be achieved for example by showing the patient photos of relatives or images of familiar objects.
Biography work can help to find out about the meaning of certain types of behavior that are typical for people with dementia. During the course of their lives, people often adopt certain rituals that determine their own behavior. For example, a glass of wine before going to bed. The more these behavioral patterns are known of, the better are the relatives or the caregivers able to take them into account.
Communication is also very important for people with dementia. On the one hand, it ensures that social contacts are maintained, which in turn contribute to a feeling of security. On the other hand, it allows for the language faculties to be maintained. In this regard however, it is most important not to pay attention to eventual mistakes that can be said. The cognitive faculties of the patient being increasingly less available, words can be forgotten or articulation difficulties can arise.
Whoever tries to address directly this kind of mistakes, or tries to correct them, will most likely provoke feelings of sadness. People with dementia are usually quite aware of their gradual loss of physical and mental faculties. In order not to emphasize or to worsen these, it is very important for the relatives not to pay attention to such weaknesses, or at the very least to provide advice with care not to hurt their feelings. People with dementia should have the feeling that they are considered as equals.
Other therapeutic approaches involve Basal stimulation, which aims at preventing the loss of stimulations which people with dementia often suffer from. Training and stimulating the perception and orientation of people with dementia can also bring positive results, especially in the early stages of the illness. As a way of training and improving the perception faculties of people with dementia, musical or artistic therapy approaches have proven to be quite effective. For example, art therapy, music therapy or dance therapy. Which activities are most helpful will depend mostly on the interests of the person and on the stage of dementia this person is in.
Ergotherapy is a therapy that aims at training the motor abilities of people with dementia. This therapy approach allows the patients to improve their bodily perception while pursuing their individual interests, as it offers a variety of physical exercises which take into account their personal preferences (such as manual or handicraft activities).
Apart from approaches that aim at activating certain processes, relaxation can have a beneficial effect on the overall health condition of people with dementia. For example, aromatherapy can improve depressive moods, which people with dementia often suffer from. However, in order to avoid any undesired side-effect, any therapeutic measure should be discussed previously with the physician in charge.
Text: Philipp Jauch – 09/2012
Translation: MyH – 03/2015