Sunday, November 07, 2004

Dementia: memory loss is only the beginning...

Good article in NYT about behavioral symptoms of dementia. Most families expect a demented person to be forgetful and disoriented. But personality changes and disinhibited, agitated behavior can be unexpected and unendurable. Medications help modestly. Antipsychotics sometimes reduce agitation, and anticonvulsives can reduce explosive outbursts. Newer treatments may improve behavior, but they can also make a formerly apathetic patient begin to wake up and think, "Wait a minute - what's going on here? I don't get it, I don't know what's happening," and so on. More agitation can ensue. These patients are also exquisitely sensitive to side effects.
Sometimes the best solution is an environment tailored to the demented patient: wandering paths for the wanderer, rummaging rooms for the rummager. Absolutely essential is a skilled, available staff who understand "dementia behavior." Staff must know something about the perspective of a person in these frightening stages of the illness.
This is exceptionally hard to learn. Imagine, if you can, being a demented person with no short-term memory, and no longer able to recognize home or family. No capacity to comprehend where you are, or what is going on. No one allows you to come and go as you please. Nothing is familiar. Nothing makes sense. Strangers give you orders: "Come here, don't do that." But the desire for familiarity and control may persist...indeed, it may grow stronger. A healthy person would soon become enraged in these circumstances. A demented person, with less control over emotions and actions, can respond with violence.
Trained, understanding staff can prevent or mitigate such reactions. They use distraction and suggestion to redirect the patient. They avoid giving direct orders. They give choices. They use "time-outs," defusing situations, and let everyone calm down. They call the doc when things are getting out of hand.
Staff like this are golden. They are lifesavers. They are hard to find. Burnout can be severe.
Some resources:
The Alzheimers Association
Alzheimers Disease Education and Referral Center
WebMD Guide to Alzheimer's Disease

Rush Alzheimer's Disease Center
Johns Hopkins Alzheimers Disease Research Center
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