Treatment of Dementia Patients is very important.With the obvious exception of the specific treatments for curable clinical conditions, the issue of treatment of the demented patient is most often the issue of management of particular symptoms rather than reversal of a pathologic process. Often, a clinical trials are based on some research finding is proposed for the degenerative disorders only to prove of little value when employed in a clinical trial. Thus the discovery that cerebral oxygen consumption is reduced in Alzheimer’s disease led to treatments with both oxygen inhalation and hyperbaric chambers.
But these treatments failed to produce significant improvement, almost certainly because the observed reduction in oxygen consumption is due to a reduction in the number of viable neurons rather than to an inadequate oxygen supply. Any treatment that is proposed for these distressing conditions is liable to be uncritically acclaimed, with eventual disappointment. The importance of the clinical trial with double-blind technique in assessing these treatments cannot be exaggerated.
Some general principles of management of the dementia patient can be emphasized. First, complicating medical conditions such as congestive heart failure, dehydration, iron deficiency anemia, infections, and electrolyte imbalance can, even if not severe in themselves, make the mental condition of a patient with degenerative brain disease much worse.
A meticulous correction of all medical complications will do much to aid in management. Second, much of the emotional unrest in demented patients is caused by fear produced by their disorientation, misidentifications, and misinterpretations of their situation. Great relief of these symptoms can come from a willingness of nurses and doctors to explain repeatedly to the patient his surroundings and the proper interpretation of what is happening.
Changes in surroundings and in nursing personnel should be minimized, distracting shadows should be avoided, well lighted rooms, preferably with familiar possessions, serve best, and an attitude toward the patient that demonstrates an appreciation of his personal style will do much to assist him. Third, considerable help for individual symptoms can be gained by the use of pharmacologic measures.
Sleep disturbances in demented patients are best treated with chloral hydrate, up to 1.0 to 1.5 grams at night. Acute confusional aggression or agitation can be relieved by phenothiazine medication, and thioridazine in doses of 50 to 100 mg. three or four times daily has been effective. Depressive symptoms can respond to antidepressant medication (imipramine, 50 mg. three times to four times per day).
All these drugs should be used sparingly, as the patient with cerebral degeneration may demonstrate toxic signs at much lower doses than normal patients. Drug toxicity can worsen the condition severely.In general, the management of the demented patient rests on an appreciation of the nature of his difficulties and the application of medical and nursing principles. The response to this management is often gratifying.
