Health Information

Dementia


   Studies show about 10% of people over the age of 65 and nearly 50% of those over 85 have dementia. These percentages are likely to increase as our elderly population increases. Just Alzheimer’s disease is estimated to afflict up to 4 million individuals in the United States.
   The diagnostic evaluation and management of patients with dementia is often challenging. Dementia is a chronic, significant loss of multiple cognitive domains that occur together.
Health Matters

   Cognitive dysfunction interferes with activities of daily living – work, social activities and relationships with others. The first step in the management of a patient with dementia is to identify easily, treatable forms of dementia.

Common behaviors of patients with dementia are:
· Insomnia
· Disrupted sleep cycles
· Depression
· Delusions
· Paranoia
· Hallucinations
· Falling
· Incontinence
· Change in personality
· Wandering

If the patient with dementia is having trouble sleeping, you may:
· Evaluate and treat the underlying conditions – hunger, pain, leg cramps, fear.
· Eliminate disruptions in the sleep environment – noise, extreme room temperatures, light.
· Encourage moderate physical exercise during the day.
· Minimize naps during the day without depriving the patient of needed rest.
· Restrict fluids after 6:00 p.m.
· Avoid diuretics in the afternoon and evening.
· Avoid caffeinated beverages and medications.
· Provide bedtime snacks with a warm beverage such as milk, decaffeinated tea, herbal tea.
· Give bedtime back rubs.
· Read to the patient at bedtime.

If the patient develops personality changes that are resistant to pharmacological treatment, you may:
· Modify your behavior.
· Avoid confrontations.
· Utilize regular routines.
· Use calmness, firmness, and a sense of authority to help minimize combative and aggressive behaviors.

If a patient with dementia is wandering, you may consider:
· Sequential locks on doors
· A fenced yard
· An alarm system set to alarm when the patient leaves the area
· Patient’s name, address, and telephone number of the responsible person placed in the patient’s wallet or purse
· A patient identification bracelet or necklace
· Address and telephone labels on the patient’s clothes
· Alerting police and neighbors to the patient’s possible wandering and need for assistance
· Caregiver keeping a photo of the patient if a search is needed
· Restraints should be avoided.

If a patient has urinary incontinence at night, you may consider:
· Restricting evening fluid intake
· Avoiding diuretics and caffeinated beverages particularly in the afternoons and evenings
· Installing a night light in the bathroom
· Providing a bedside commode
· Using a bedtime diaper

Avoid potential hazardous situations when caring for a patient with dementia.
· Medication should be adequately supervised.
· Unstable furniture and rugs should be fixed or removed.
· Access to alcohol, toxic substances, matches, cigarette lighters, stoves, and electrical appliances should be adequately supervised or restricted.
· Stairs should be well lit and have solid handrails.
· Combination locks on doors to the outside are recommended.
· Bathroom and closet locks should be dismantled.
· The bathtub should be fitted with rails and non-skid mats or appliques should be placed on the floor of the tub.
· The water temperature in the water heater should be adjusted to avoid scalding.
· Objects that can be used as a weapon should be placed out of reach of the patient.
· Firearms should be removed from the home.
· Driving should be restricted if judgement, emotional control, or motion function are significantly impaired.

If you have additional questions about dementia, contact Dr. Enawgaw Mehari in the Department of Neurology, Morehead Clinic at 606-784-6641 or e-mail him at emehari@yahoo.com.