Treatment Strategies for Dementia

**Topics in Geriatrics:** Treatment Strategies for Dementia

Dementia is not specifically a disease but is a word describing a grouping of symptoms that are associated with a decline in memory ultimately disrupting ones ability to function daily2. Around 50 million people worldwide have dementia with it being a leading cause of disability1. There is currently no cure for dementia but various treatments and interventions have been shown to be effective4.

**Objectives**

1.) Learn about what to expect with patients who have dementia

2.) Learn about treatment options for dementia

3.) Learn about physical therapy and dementia

4.) Learn how to communicate with patients who have dementia

**Common Characteristics One Displays with Dementia**

Individuals with dementia can have a wide array of symptoms affecting their cognition as well as eventually physical function. People with dementia will have difficulty with memory, mainly short term memory and difficulty with recalling information2. Their ability to focus and pay attention may be impaired as well as reasoning and judgement and they may become emotional or agitated easily4. Eventually communication and language may be impaired2.

**What are the different treatment options?**

* Medications prescribed from medical provider
	+ The most common types of medications include: antipsychotics and cognitive enhancers including cholinesterase inhibitors (Aricept, Exelon, Razadyne) and memantine (Namenda)7.

* Alternative Treatments
	+ Herbal and dietary supplements; Ginkgo blob, Omega-3 fatty acids, Phosphatidyserine, Huperzine A, Caprylic acid and coconut oil2.

**Exercise3**

* Evidence shows that exercise prevents the secondary impairments that occur due to the decline in function associated with dementia. Exercise has even been shown to improve cognitive function as well as physical function. Functional, endurance, and mobility exercises ranging from light walking to lower body strengthening, have shown the most benefit allows for a feeling of independence.

**Communication Strategies6**

* Speak clearly and calmly
* Refrain from "baby talk"
* Avoid loud and distracting environments
* Refer to individuals by their name
* Talk about one thing at a time and avoid intense questioning
* Use nonverbal communication – maintain eye contact and smile
* Avoid arguing with individual if conversation does not make since
* Have patience and listen

**Physical Therapy and Dementia8**

* Patients with dementia can benefit from physical therapy interventions by treating the deficits that one may have in order to better improve function. Treatments should also focus on educating caregivers on how to take care of their loved ones. Deficits can include the following;
	+ Difficulty with bed mobility or gait, decreased strength or endurance or decreased balance promoting fall risk

**Outcome Measures5**

* Accessing cognitive function prior to treatment:
	+ Mini Mental State Exam

* Accessing activity:
	+ The Six Minute Walk, Timed Up and Go and 6 Meter Walk

**Additional Resources**

* https://www.alz.org/alzheimers-dementia/what-is-dementia
* https://www.aplaceformom.com/blog/communication-with-a-loved-one-with-dementia/
* https://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=48d29ec1-3159-45d3-bf6e-ea31ab7c978a
* https://www.youtube.com/watch?v=Yd7uycTX7mg
* https://www.youtube.com/watch?v=P4fccDAY2qs
* https://www.youtube.com/watch?v=ZfSaSmXqs6Q

**References**

1. Dementia. (2017, December 12). Retrieved July 11, 2017 from http://www.who.int/news-room/fact-sheets/detail/dementia

2. What is dementia? (2018) Retrieved July 11, 2018 from https://www.alz.org/alzheimers-dementia/what-is-dementia

3. Heyn P., Abreu B.C., Ottenbacher K.J. (2004). The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis.*Archives of Physical Medicine and Rehabilitation*, 85  (10) , pp. 1694-1704. Retrieved July 11, 2018 fromhttps://www.archives-pmr.org/article/S0003-9993(04)00397-1/fulltext

4. Perng, C., Chang, Y., & Tzang, R. (2018). The treatment of cognitive dysfunction in dementia: A multiple treatments meta-analysis.*Psychopharmacology, 235*(5), 1571-1580. doi:http://dx.doi.org/10.1007/s00213-018-4867-y

5. Bossers, W. J. R., van der Woude, L. H. V., Boersma, F., Scherder, E. J. A., & van Heuvelen, M. J. G. (2012). Recommended Measures for the Assessment of Cognitive and Physical Performance in Older Patients with Dementia: A Systematic Review. *Dementia and Geriatric Cognitive Disorders EXTRA*, *2*(1), 589–609. http://doi.org/10.1159/000345038

6. Jeff Anderson. (2015, October 09). Communication Strategies for Dementia. Retrieved July 11, 2018 fromhttps://www.aplaceformom.com/blog/communication-with-a-loved-one-with-dementia/

7. Medications for Memory. (2018) Retrieved July 11, 2018 from https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory

8. Eric Ries. (2018, January). Improving the Lives of People with Dementia. *PT in Motion.*Retrieved July 11, 2018 from http://www.apta.org/PTinMotion/2018/3/Feature/Dementia/