Dementia: Diagnosis and treatment

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Dementia affects a person's brain function in terms of memory, thinking, judgement and behaviour. In many cases, dementia is irreversible and patients need round the clock care.

Dementia - treatment and diagnosisDementia diagnosis

A thorough history from the patient and family as well as a mental status examination will point towards the correct diagnosis. A thorough general and neurological examination must be done to exclude other possible causes. A personal history should include past or present history of substance or alcohol abuse.

The diagnosis is made by the physician after tests for other possible diagnosis are negative. There is no single test to identify dementia. The doctor may conduct simple memory tests for recent, short-term or long-term memory.

Tests to detect dementia

Routine blood and urine tests as well as blood tests to detect thyroid function and infection should be done. Imaging tests like CT scan or MRI of the brain may be advised if hydrocephalus or a tumour is suspected. An EEG may be necessary to see electrical activity of the brain.

Treatment of dementia

The treatment of dementia involves a multi-pronged approach with the general physician, psychiatrist and care-giver working in close proximity.

  • Drug therapy is important to slow or arrest the process of dementia although it cannot be stopped. If other conditions like depression or anxiety occur, anti-depressants or anti-anxiety medication can be prescribed. Anti-psychotics must be prescribed with caution as they may cause delirium in a person with dementia.
  • Cholinesterase inhibitors are used primarily in Alzheimer’s to maintain the mental function but they can be tried in other types of dementia too. These drugs include donepezil, rivastigmine and galantamine. Rivastigmine has side-effects like nausea and vomiting but the other two are free from side-effects.
  • Lifestyle changes like quitting smoking, doing regular exercise and having a diet rich in fruits and vegetables is important; the latter provides anti-oxidants which can boost memory and brainpower.

Precautions to be taken by family and friends of a dementia patient

  • Small changes around the house like putting important phone numbers prominently and putting handrails in the bathrooms are important for an elderly person suffering from dementia.
  • Family should be well informed about this condition as the patient requires utmost patience, love and care from near and dear ones. It should be explained that dementia does not just go away instead taking small steps like doing the crossword, playing board games or playing scrabble and sudoku can help keep the brain fit and memory intact.
  • Counsel ling the family is important especially in cases where the dementia is not reversible like in Alzheimer’s. It is important for the family to come to terms with the present rather than remembering what the person was like in the past.
  • Before dementia progresses to advanced stages the affected person should be encouraged to make a will in case if applicable.
  • The primary care-giver may also be stressed out and some families make a choice to move the person to a nursing home where care is available 24/7. This is especially in later stages when the person needs help to dress and feed himself and cannot be left unsupervised.

Written by Dr Nisreen Nakhoda

Photograph via sxc.hu

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