Wednesday, July 8, 2015

Background On Dementia by Alicia Conlon, RN

What is Dementia?

Dementia is a term used to describe a group of symptoms that affect a person’s memory, thinking and reasoning skills, and social skills in a manner that is serious enough to interfere with daily life. Dementia is not a specific disease, but rather a term that describes a variety of symptoms of impaired cognitive function.



What Causes Dementia?

Dementia is caused when some form of damage occurs to the brain, impairing its function.

The most common types of dementia are irreversible, meaning once a patient has been diagnosed, the dementia will never go away. Alzheimer's disease is the most common form of dementia, accounting for over 60% of dementia cases. The second most common form of dementia is referred to as vascular dementia, which occurs after a person has a stroke. 

Some causes of dementia are potentially reversible, such as infections, certain illnesses, nutritional deficits, poisoning, brain tumors, impaired oxygen levels, and reactions to medications. These causes of dementia are more rare than the irreversible causes.

Some studies have shown that heavy alcohol consumption, diabetes, high blood pressure, high estrogen levels, obesity, smoking, and high cholesterol levels may contribute to the development of dementia.



What Are The Signs & Symptoms of Dementia?

Signs and symptoms of dementia include:
  • Memory Loss
  • Difficulty Completing Daily Activities (Eating, Getting Dressed, Bathing)
  • Difficulty With Communication & Language
  • Problems With Vision
  • Difficulty Focusing & Paying Attention
  • Difficulty Planning & Organizing
  • Problems with Disorientation
  • Impaired Reasoning & Judgement Skills
  • Personality Changes
  • Inappropriate Behavior
  • Inability to Reason
  • Paranoia
  • Agitation
  • Hallucinations

Dementia is degenerative, meaning it gets worse as time passes. Symptoms usually start out very slowly and are not significant enough to impair a person’s function. As time passes, the signs and symptoms of the disease get dramatic enough to severely impair a person’s ability to function independently.

Early diagnosis of dementia is key to getting the best results from treatment options. If you or a loved one are suffering from any of the above symptoms, please make an appointment with a physician.




How Common Is Dementia?

In the United States, dementia affects people ages 65 and older. It is estimated that more than 5 million Americans are currently living with some form of dementia. It is estimated that 1 in 9 citizens over the age of 65 in the United States have dementia. These staggering numbers indicated that dementia is extremely common, especially in people over the age of 65.



What Impact Does Dementia Have on the Lives of the Patient & Their Family?

Because the signs and symptoms of dementia come on slowly, the impact the disease will have on a patient and their family will not be extreme at first. As the disease progresses, the degenerative nature of dementia causes the person to rely more and more on the assistance of others to help them function on a daily basis. Personality changes can be difficult to handle for the loved ones of dementia sufferers, as well as the loved one's loss of memory about their family members.

Often, people with moderate to severe dementia require constant care be provided to them by a caregiver. Family members of dementia suffers will frequently consider putting their loved ones in a professional care facility due to the immense amount of care that they require. These difficult decisions can be stressful on the family members of patients affected by dementia. A dementia diagnosis is life changing for the patient and their family members. 



Why Should You Pay Attention to Dementia?

It is estimated that between the years 2000 and 2030, the world's population of persons aged 65 years and older will increase from 420 million to almost 1 billion. Because dementia is associated with increased age, this massive increase in the population of elderly citizens will likely result in a drastic increase in the number of citizens living with dementia. This means that it is likely that you or a family member will be affected by dementia either directly or indirectly during your lifetime.


References

1. Alzheimer's Association. What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

2. Dementia Society of America. Retrieved from http://www.dementiasociety.org/

3. U.S. National Library of Medicine (2015). Dementia. Retrieved from http://www.nlm.nih.gov/medlineplus/dementia.html

4. Qiu, C., Kivipelto, M., & von Strauss, E. (2009). Epidemiology of Alzheimer’s disease: occurrence, determinants, and strategies toward intervention. Dialogues in Clinical Neuroscience, 11(2), 111–128.

5. Mayo Clinic (2014). Diseases and Conditions: Dementia. Retrieved from http://www.mayoclinic.org/diseases-conditions/seo/basics/definition/CON-20034399?p=1

6. National Institute of Neurological Disorders and Stroke (2015). NINDS Dementia Information Page. Retrieved from http://www.ninds.nih.gov/disorders/dementias/dementia.htm

Current Pharmacological Treatments for Dementia by Rebecca Bori, RN


What Are Common Medications Used for the Treatment of Dementia?

There are currently 5 drugs that are approved by the Food and Drug Administration (FDA) to specifically treat dementia. They are:

donepezil (Aricept)

galantamine (Razadyne)

rivastigmine (Exelon)

tacrine (Cognex)

memantine (Namenda)




What Do These Medications Do To Manage The Symptoms of Dementia?

The first four medications listed above all belong to the same classification of medicine, called anticholinesterase inhibitors. They all function similarly by acting on certain neurotransmitters in the brain. Memantine, an NMDA receptor antagonist, is the most recently approved drug to treat dementia and works differently than the others mentioned. However, none of these medications has been proven to “cure” dementia, as it was mentioned previously that dementia is incurable. The purpose of these medications is to ease symptoms and slow down the decline of an individual’s mental status.


How Effective Are These Medications?

The effectiveness of these pharmacological treatments for dementia is questionable. Studies have shown that compared to those who take a placebo—or “fake” pill—most of those who take these medications do not show much improvement or a meaningful delay in the worsening of symptoms. In fact, according to a team of researchers, it has been calculated that for every three to seven people, only one will benefit from taking these medications.




What Are the Common Side Effects of These Medications?

All medications come with a risk of undesirable side effects. Cognex, for example, has been shown to cause liver damage and should therefore be avoided. It is now prescribed very rarely, seeing as that half of the individuals who took Cognex developed abnormal liver functions. Because the benefits of the other four medications are limited, their side effects may outweigh those benefits. Some of the relatively minor side effects that will usually go away in time are nausea, diarrhea, insomnia, and headaches. The potentially severe side effects may include a slow heartbeat, sudden weight loss, lack of appetite, yellowing of skin, and persistent dizziness. It is worthy to note that about 20-25% of dementia patients will stop taking these medications because of side effects.



Should You or A Loved One Take These Medications?


Choosing whether or not to try these medications calls for the consideration of many different factors, especially because of the small benefits these drugs offer. Many newly diagnosed dementia patients will be strongly motivated to maintain brain function and independence, thus taking the gamble of using one of these medications. In early stages, these drugs may indeed delay decline, but as the disease progresses, the benefits of the medications may begin to disappear. Always consult with your doctor about treatment options, as they are most familiar with your individual case and will have the best answers for you.


Are there other pharmacological options to manage the symptom of dementia?

To help in controlling some of the behaviors associated with dementia, doctors will sometimes prescribe other medicines such as antipsychotics, antidepressants, and anxiety medications. If used appropriately, these medications may be helpful. Antipsychotic drugs have been shown to help ease aggressive outbursts, agitation, and hallucinations, but just as any other medication, it can come with side effects. These may include weight gain, diabetes, and even an increased risk of death.

         

It is difficult to choose a medication that will guarantee a benefit to a patient with dementia due to evidence indicating that most people will not benefit from their use. The decision to pursue avenues of treatment for dementia can be overwhelming for the patient and their family. Keeping in mind cost, side effects, and limited effectiveness, there may be other non-pharmacological interventions that can bring about better results with less risk. It is important to acknowledge that medicine is just one component of care; non-medical treatment and psychological support are just as significant in the care of individuals with dementia. Again, always consult with your doctor about treatment options, as they are most familiar with your individual case and will have the best answers for you.


Reference

1. Consumer Reports (2012). Treating Alzheimer’s disease: surprising facts about the effectiveness and safety of these commonly used drugs. Retrieved from http://www.consumerreports.org/cro/2012/07/evaluating-drugs-to-treat-alzheimer-s-disease/index.htm

The Use of Alternative (Non-Pharmacological) Therapies to Manage Dementia by Tanya Hasvold, RN

What Are Alternative Therapies?

Alternative therapies are non-pharmacological treatments used to promote a person’s well-being and treat or prevent illness. Since there is no cure for dementia, the main goal of using alternative therapies is make the symptoms manageable for the patient by treating and reducing the underlying side effects. These methods are referred to as “non-conventional medicine”. More and more people are finding that medications are not adequately treating the symptoms of dementia and instead are turning to alternative therapies such as dietary supplements, herbs, music therapy, aromatherapy, pet therapy, massage, and many others. As of 2008, approximately 38% of adults in America and approximately 12% of children were using complementary and alternative medicine (CAM) as a means of treating various ailments. 


Why Choose Alternative therapies?

There are many challenging and terrible side effects that occur with dementia. These symptoms change and worsen as the condition progresses. The best way to treat this problem is to assess the individual’s specific symptoms and finding the alternative therapy that would best benefit the patient. Because every person and every case is different, each patient will need different therapies and have different results and outcomes. Treatment can include things like improving memory through positive interaction or promoting relaxation through healthy activities and outlets.


What Are the Pros & Cons of Alternative Therapy?

Pros:
·        Generally non-invasive
·        Rarely cause dangerous or lasting side effects
·        A natural approach to managing symptoms of dementia

Cons:
·        Little research has been done that supports the effectiveness and benefits
·        Supplements can react dangerously with current medications
·        Due to limited research, the risks and safety is not well understood


Alternative therapies have not been often used previously because of the minimal amount of research done on their effectiveness. No research statistics could be found to verify the benefits of CAM. Current research is being done on alternative therapies for dementia, but it is important to talk to the patient’s doctor before starting any alternative therapies. Your physician will be able to better assess what is the best option and be able to recommend the best alternative treatment. It is also important to continue to get check-ups from your health care provider to see if the methods are effective or need to be changed due to any negative problems or non-therapeutic results. There is still much to learn about the benefits of alternative therapies.


References

1. Kelley, B. J., & Knopman, D. S. (2008). Alternative Medicine and Alzheimer’s Disease. The Neurologist, 14(5), 299–306. doi:10.1097/NRL.0b013e318172cf4d

2. Alzheimer's Society. (2014). Complementary and alternative therapies. Retrieved from http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=134

3. Posadzki, P., Ernst, E., & Lee, M. S. (2012). Complementary and alternative medicine for Alzheimer's disease: an overview of systematic reviews. Focus on Alternative and Complementary Therapies, 14(4), 186-191. doi:10.1111/fct.12001

4. National Center for Complementary and Integrative Health (2015). The Use of Complementary and Alternative Medicine in the United States. Retrieved from https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm

Alternative (Non-Pharmacological) Therapies for Dementia by Kailey Larsen, RN



Aromatherapy & Massage

People with dementia can use essential oils as a method of treating their symptoms. Essential oils are derived from plants and are said to have healing powers. They can be applied directly to the skin through massage, put in the bath, or heated in an oil burner to produce a pleasant odor. The use of essential oils is thought to improve relaxation and reduces stress in dementia patients. 



Music Therapy & White Noise

Music therapy and white noise can help dementia patients with outbursts of shouting and agitation. Music can have a powerful influence on a person’s state of mind. Music therapy uses music and sound to revive and improve physical and mental well-being. White noise is produced by the combination of different sound frequencies. It has the ability to mask other sounds and can be combined with natural calming sounds such as waves crashing on the beach, birds chirping, or the sound of crickets. Treatment consists of playing music for at least 30 minutes in a quiet room. Another person should be present in the room to ensure that the person receiving the treatment is happy and comfortable with the level of sound and type of sound. It is also best if you encourage the patient to participate, such as singing along with the music or joining in with the rhythm by clapping or tapping their feet.



Bright Light Therapy

Bright light therapy helps dementia patients by reducing restlessness and improving sleep. Many people with dementia can become more confused and restless when the sun goes down due to melatonin levels changing in their bodies. These behavioral changes can continue throughout the night, impairing sleep for the patient and causing problems for the caretaker. For patients who have limited exposure to sunlight on a daily basis, this lack of sun exposure can increase agitation and interfere with sleep cycles.
In bright light therapy, a person will sit in front of a light box that produces 30 times more light than the average light bulb for a period of approximately 2 hours. This relaxation technique has been shown to be successful in helping to calm agitation and help with insomnia.



Pet Therapy

Frequent exposure to therapy animals, specifically dogs, has been proven to reduce agitation, improve eating, improve interactive behavior, and increase pleasure for dementia patients. The animal must be friendly, have a suitable temperament, and well trained. Under the observation of animal educators, 90 minutes sessions once per week of petting, holding, walking, talking to, and playing with therapy animals has been shown to improve a person’s perceived quality of life and manage some symptoms of dementia.



Acupuncture

Trained acupuncture practitioners will insert a various amount of fine needles into the skin to stimulate several nerves within the target area. Acupuncture can help reduce pain and some of the symptoms of dementia.



Transcutaneous Electrical Nerve Stimulation (TENS)

The TENS machine is a small device used to electrically stimulate nerves. Its use involves electrodes being applied to the skin that send mild electrical currents throughout the nerves of the body. It has a prickling sensation but it is not painful. It is thought to be able to alter brain activity, reduce neural degeneration, and stimulate cognitive aspects that are often impaired with dementia.  



Herbal Remedies

Herbal medications consist of naturally occurring plants and other substances that are thought to have the ability to restore or maintain health.

Choto-san: Contains 11 medicated plants and is thought to improve the range of learning and memory in those with dementia.

Kami-Umtam-To: Contains 13 different plants and is thought to be able to slow the cognitive decline of dementia sufferers.

Ginkgo Biloba Extract: This has antioxidant and anti-inflammatory properties that can protect brain cells from breaking down. This is thought to reduce cognitive decline and slow the onset of dementia.

Huperzine A: This is an active ingredient taken from Chinese club moss. It is thought to improve cognitive function.


Coconut Oil

The brains of dementia patients produce less glucose, the substance that our cells need to function properly. This lack of glucose leads to inadequate energy levels. Coconut oil acts as an alternative energy source and is thought to treat signs and symptoms of dementia. Adding it to your daily diet may reduce symptoms.

Coconut oil is high in fats and could potentially elevate cholesterol levels. 

Below is a video that talks about some of the benefits of coconut oil.




*DISCLAIMER*

Before beginning ANY alternative therapy to manage dementia, consult with your physician about the safety and effectiveness of this choice. Do not ever discontinue taking prescribed medications without first consulting your physician. Every case of dementia is different, and your physician will know what is best for you and how to best approach your treatment.


References

1. Alzheimer's Society (2005). Non-pharmacological therapies for the treatment of behavioural symptoms in people with dementia . (pp. 1-8). London: Gordon House

2. Alzheimer's Society (2015). Coconut oil . Retrieved from http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=2211&pageNumber=4

3. Alzheimer's Society (2015). Complementary and alternative therapies . Retrieved from http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=134

4. Mayo Clinic Staff. (2014, November 22). Alternative medicine . Retrieved from http://www.mayoclinic.org/diseases-conditions/dementia/basics/alternative-medicine/con-20034399     


6. Barrick, A. L., Sloane, P. D., Williams, C. S., Mitchell, C. M., Connell, B. R., Wood, W., & ... Zimmerman, S. (2010). Impact of ambient bright light on agitation in dementia. International Journal Of Geriatric Psychiatry, 25(10), 1013-1021.

7. Moretti, F., De Ronchi, D., Bernabel, V., Marchetti, L., Ferrari, B., Forlani, C., & Attil, A. R. (2011). Pet therapy in elderly patients with mental illness. Psychogeriatrics, 11(2), 125-129. doi:10.1111/j.1479-8301.2010.00329.x