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Dementia Treatment And Care

Early diagnosis is helpful so that the caregiver can be better equipped to deal with the disease and to know what to expect. A diagnosis is the first step towards planning for the future. There is no simple test to make a diagnosis. The diagnosis of AD is made by taking a careful account of the person’s problems from a close relative or friend, together with an examination of the person’s physical and mental state. It is important to exclude other conditions or illnesses that cause memory loss, including depression, alcohol problems and some physical illnesses with organic brain effects.

Currently there are no treatments that cure dementia. There is, however, evidence that drugs (cholinesterase inhibitors), in some cases but not all, temporarily decelerate the progressive cognitive decline that occurs in AD, and maybe in other forms of neurodegenerative dementia.

These drugs act on the symptoms but not on the disease itself; they make only a small contribution to maintaining function. Evidence-based drug therapies are available for psychological symptoms such as depression, anxiety, agitation, delusions and hallucinations that can occur in people with dementia. There are modestly effective drugs (neuroleptics) available for the treatment of associated behavioural problems such as agitation. All of these drugs should be used with caution (the doctrine being “start low, go slow”), particularly tricyclic antidepressants (because of anticholinergic side-effects, therefore SSRI antidepressants ó selective serotonin reuptake inhibitors ó should always be preferred) and neuroleptics (because of anticholinergic side-effects, sedation, and an increased risk of stroke and higher all-cause mortality).

It is important to recognize that non-drug interventions are often highly effective, and should generally be the fi rst choice when managing behavioural problems. The fi rst step is to try to identify and treat the cause, which could be physical, psychological or environmental. Psychosocial interventions, particularly the provision of information and support to carers, have been shown to reduce the severe psychological distress often experienced by carers. Carers are also greatly assisted by a network of community health and social services; self-help organizations, especially Alzheimer associations, can also help them to fi nd appropriate help.

Carers can be educated about dementia, countering lack of understanding and awareness about the nature of the problems faced. They can also be trained to manage better most of the common behavioural symptoms, in such a way that the frequency of the symptoms and/or the strain experienced by the carer is reduced. Above all, the person with dementia and the family carers need to be supported over the longer term. People with dementia need to be treated at all times with patience and respect for their dignity and personhood; carers needs unconditional support and understanding ó their needs should also be determined and attended to.

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