Dementia resident survival guide

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Dementia Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D.

Synonyms and Keywords: dementia management, dementia workup, dementia approach, approach to dementia, dementia treatment

Overview

Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. It should be distinguished from delirium which involves an acute onset, and usually is reversible. Dementia may affect several cognitive areas, such as memory, attention, language, and problem-solving. In advanced stages of the condition, affected persons may be disoriented in time, place, and/or in person. The diagnosis of dementia is primarily clinical and involves the ruling-out other conditions by imaging and laboratory tests. It is important to always screen for depression, especially in older people, since this may be the underlying problem.

Causes

Life Threatening Causes

There are no identified life-threatening causes in dementia that may lead to death within 24 hours since all conditions are chronic.

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of amnesia according to the the American Academy of Neurology guidelines:[1]


 
 
 
 
 
 
 
 
Progressive decline in cognitive function with chronic onset
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Severe disimpairment in social functioning?
Decline from previous levels of functioning and performance?<be>Symptoms are not explained by major psychiatric disorder?
 
No
 
Normal aging
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dementia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measure vitamin B12, and folate, and TSH
 
Abnormal?
 
Yes
 
Vitamin deficiency, hypothyroidism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive for SIGE CAPS questionary?
 
Yes
 
Depression
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take history and perform physical examination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Initial short term memory loss
 
Vascular risk factors, imaging evidence of cerebrovascular involvement
 
Young age, behavioral symptoms or language impairment
 
 
Bradikinesia or features of parkinsonism,

fluctuating cognition, [[visual

hallucinations]]
 
 
 
Dementia occuring 1 year after onset of Parkinson disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Alzheimer disease
 
Vascular dementia
 
Frontotemporal dementia
 
 
Dementia with Lewy bodies
 
 
 
Parkinson's disease
 
 


Treatment

Treat the underlying cause:


General management of dementia for maintaining brain health according to the American Neurological Asociation is as follows:[2]

Recommendations for maintaining brain health in elderly patients with and without AD
  • Consider following a Mediterranean-style diet, with fish, vegetables, legumes, fruit, cereals, unsaturated fatty acids (e.g., olive oil), and a limited amount of meat or dairy products.
  • Consider taking supplements containing omega-3 (particularly docosahexaenoic acid), B-complex vitamins (including B12, B6, folic acid), and vitamin E.
  • Keep alcohol intake to a low-to-moderate level (e.g., one glass of wine per day with dinner).
  • Engage in regular physical activity.
  • Maintain leisure and social activities – keep socially engaged.
  • Continue or take up activities that help to stimulate the brain, e.g., Tai Chi, dancing, puzzles.
  • Become educated about dementia and seek support from others with dementia, e.g., the Alzheimer's Association, Keep Memory Alive, and other community groups.
  • Include music in daily life – listening to music, playing an instrument, singing.
  • Maintain regular sleep patterns.
  • Manage stress – stop doing things if they are becoming too stressful (e.g., volunteer work, answering the telephone), keep to a regular daily schedule, and include relaxing activities (e.g., playing with pets, massage, and aromatherapy).


Do's

Don'ts

References

  1. Jahn H (December 2013). "Memory loss in Alzheimer's disease". Dialogues Clin Neurosci. 15 (4): 445–54. PMC 3898682. PMID 24459411.
  2. 2.0 2.1 Cummings JL, Isaacson RS, Schmitt FA, Velting DM (March 2015). "A practical algorithm for managing Alzheimer's disease: what, when, and why?". Ann Clin Transl Neurol. 2 (3): 307–23. doi:10.1002/acn3.166. PMID 25815358.
  3. Folstein MF, Folstein SE, McHugh PR (November 1975). ""Mini-mental state". A practical method for grading the cognitive state of patients for the clinician". J Psychiatr Res. 12 (3): 189–98. doi:10.1016/0022-3956(75)90026-6. PMID 1202204.
  4. Borson S, Scanlan JM, Chen P, Ganguli M (October 2003). "The Mini-Cog as a screen for dementia: validation in a population-based sample". J Am Geriatr Soc. 51 (10): 1451–4. doi:10.1046/j.1532-5415.2003.51465.x. PMID 14511167.
  5. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (April 2005). "The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment". J Am Geriatr Soc. 53 (4): 695–9. doi:10.1111/j.1532-5415.2005.53221.x. PMID 15817019.
  6. Schmitt FA, Saxton JA, Xu Y, McRae T, Sun Y, Richardson S, Li H (2009). "A brief instrument to assess treatment response in the patient with advanced Alzheimer disease". Alzheimer Dis Assoc Disord. 23 (4): 377–83. doi:10.1097/WAD.0b013e3181ac9cc1. PMID 19571727.
  7. Schmitt FA, Saxton JA, Xu Y, McRae T, Sun Y, Richardson S, Li H (2009). "A brief instrument to assess treatment response in the patient with advanced Alzheimer disease". Alzheimer Dis Assoc Disord. 23 (4): 377–83. doi:10.1097/WAD.0b013e3181ac9cc1. PMID 19571727.
  8. Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, Lopez OL, DeKosky ST (2000). "Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory". J Neuropsychiatry Clin Neurosci. 12 (2): 233–9. doi:10.1176/jnp.12.2.233. PMID 11001602.
  9. Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N, Small GW, Miller B, Stevens JC (May 2001). "Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 56 (9): 1143–53. doi:10.1212/wnl.56.9.1143. PMID 11342678.
  10. Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST (May 2001). "Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 56 (9): 1133–42. doi:10.1212/wnl.56.9.1133. PMID 11342677.
  11. Squire LR, Zouzounis JA (December 1988). "Self-ratings of memory dysfunction: different findings in depression and amnesia". J Clin Exp Neuropsychol. 10 (6): 727–38. doi:10.1080/01688638808402810. PMID 3235647.
  12. Hack, Jason B.; Hoffman, Robert S. (1998). "Thiamine Before Glucose to Prevent Wernicke Encephalopathy: Examining the Conventional Wisdom". JAMA. 279 (8): 583. doi:10.1001/jama.279.8.583a. ISSN 0098-7484.

CME Category:Psychiatry