Treatment and therapy for people with dementia

 

 

   DISC

   Oxford Dementia Centre

   Institute of Public Care

   Roosevelt Drive

   Oxford OX3 7XR

   Tel: 0845 120 4048

   www.disc.org.uk

   email: info@disc.org.uk

 

 

 

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This fact sheet offers information about treatments and therapies for people with dementia.

 

You may also find the following facts sheets helpful:

 

·        What is dementia?

·        Making your home dementia friendly

·        Getting help through financial benefits

·        Looking at your needs as a carer - having a carer’s assessment

 

What can be done?

 

Most individuals and carers report feeling shocked, but often relieved, that they have an explanation for the behaviour that has been causing difficulties.

 

Although dementia cannot be cured, there are ways of compensating for disabilities associated with dementia and reducing some of the psychological and behavioural aspects of the condition through the careful use of medication.

 

Carers do not need to cope alone.  They can:

 

1. Ask about treatment with ‘anti-dementia’ drugs.

 

These drugs are not a cure but they are helpful for some people with mild to moderate Alzheimer’s disease.  Ask your GP about the suitability of your relative for this medication, and if they agree, they will make a referral for specialist assessment.  At the end of this a decision may be made to prescribe one of the ‘anti dementia’ drugs.  There are now three drugs licensed by the National Institute for Clinical Excellence (NICE) for people in the early stages of dementia:

 

·         Aricept (Donepezil)

 

·         Exelon (Rivastigmine)

 

·         Galantamine (Reminyl)

 

·              A fourth drug – Memantine (Ebixa) – is also used but not widely available

 

You can find out more about how these drugs work by consulting your GP, the internet or a good medical reference book.

 

2. Getting the right treatment for the diagnosis

 

Vascular Dementia

 

The second most common form of dementia is caused by damage which occurs when a person has a stroke or ‘mini’ stroke (TIA).  Unfortunately there is no way to reverse damage to the brain once it has occurred.  However, the right treatment may make it is possible to limit or delay decline in the person you care for.  The important thing is to prevent further damage occurring.

 

People who have been diagnosed with vascular dementia will be treated for the disease that has led to the impairment.  For example, high blood pressure can be controlled through diet and lifestyle, as well as with drugs. People at risk of stroke or who have had a stroke may be prescribed drugs that thin the blood to prevent further blood clots forming.

 

Most importantly, we know that it is possible to reduce the risk of developing vascular dementia.  People who have a diet high in saturated fats, smoke or do not take exercise are at a greater risk of stroke.  The risk of high blood pressure, stroke and vascular dementia can be reduced by:

 

·              Not smoking

·              Drinking moderate amounts of alcohol

·              Reducing your intake of salt and saturated fat

·              Taking regular exercise

·              Having a GP check your blood pressure at least once a year

·              Having your blood fat levels measured by your GP

 

 

3. Coping with Dementia with Lewy Bodies (DLB)

 

If your relative has DLB they may well experience symptoms that include visual hallucinations, fluctuation of the illness, stiffness and walking problems.  However, where DLB is suspected, diagnosis should be made as people with DLB have been shown to react badly to certain forms of medication, particularly neuroleptics (strong tranquillisers).

 

When caring for someone with DLB, it is important to be as flexible as possible, bearing in mind that the symptoms of DLB will fluctuate.  People may be apparently quite able in the morning but by the afternoon their capacity can deteriorate dramatically.  Sometimes this can change from hour to hour.

However, there is much that can be done to ease symptoms.  Knowing more about the disease and why the person is behaving as they are can be helpful in planning the day’s activities.  Carers may be able to develop coping strategies, such as avoiding confrontation and working round fixed ideas and behaviour rather than trying to change the behaviour of those affected.

 

4. Ask about access to therapies that can help with symptoms of dementia and other mental health problems

 

Besides dementia, those affected also experience other mental health problems. They might feel low, paranoid (have irrational thoughts), or angry and agitated and any of these can increase the stress of dementia.

 

Depression, for example, may be overlooked, as the focus is on the dementia.  If depression is diagnosed, your GP or consultant may offer one or a combination of all of the following:

 

·              Prescribe psychotropic drugs which affect a person’s mood

·              Make a referral to a service, which provides psychological therapies such as counseling or cognitive behavioural therapy for depression while the person with dementia still has insight into their condition

·              Refer an older person for an assessment of need, which can be accessed via the local authority social services department.  This may enable you to access services such as a ‘befriender’ coming into the house to sit with the person with dementia; a day centre offering activities or lunch clubs to combat isolation and loneliness

 

5. Ensure that any health needs are met

 

The GP can identify any physical and sensory needs and put you in touch with specialist services.  Poor hearing or eyesight, pain, sore feet, incontinence or bowel problems can all exacerbate the problems caused by dementia.

 

Getting the person for whom you care to have their teeth checked regularly may prevent problems in the future.  Toothache can add to the distress of memory loss, and loose fitting dentures can make chewing food much more difficult.

 

6. Obtain an assessment of need

 

Ensure that your GP or other health care professional either arranges for you and the person you care for to have your needs assessed by the local authority or they should provide the information for you to do this yourself. If you are eligible for help, you will be offered support services.

 

 

 

 

Therapies developed for use with older people with dementia

 

Reality Orientation.

 

The primary focus of reality orientation therapy is to orientate the person to place, time and person, by providing information in a way that can compensate for memory loss and thinking difficulties.  When a person with dementia is living in their own home, they have more familiar cues and clues to help them, but if they become more confused, carers might consider making the cues more obvious by:

 

·              Mounting a large clear clock on a wall that will make it easier to see the time

·              Putting up a large calendar for the same reason

·              Displaying photographs of family members with their names visible

·              Reflecting important events such as birthdays, festivals and holidays and the changing of the seasons through indoor decoration and arrangements of various items associated with these

·              Writing down when people have visited or when they are to visit again

 

Reminiscence

 

Older people with dementia are often able to remember the past much more successfully than the present, as damage to the brain initially affects short term rather than long-term memory.  Carers can provide opportunities for relatives who have mild to moderate dementia to access well rehearsed memories through the presentation of stimulating materials such as:

 

·              Photos

·              Songs, especially hymns, which are usually remembered word for word

·              Clothes

·              Household items

·              Newspapers

·              Scents and smells

·              Items connected with the person’s former employment

 

It may be helpful to construct a small life storybook using photographs with titles, which can go to and from any facilities (like a day centre) used by the person with dementia.

 

Sensory therapeutic activity

 

Sensory activities aim to help older people with dementia engage in activities and receive stimulation through their senses rather then through thinking, reasoning and language.  Senses and emotions are likely to remain intact even when all verbal communication has gone.

 

 

 

Communication through touch, sound, light, moving air is made use of in therapies such as massage and aromatherapy.  Try varying smells, sounds and textures in your contact with the person with dementia and see if there is any beneficial effect.

 

 

 

 

This fact sheet can be made available in large print.

 

We are constantly looking to improve our information.  It helps if you let us know whether the information in this fact sheet was/was not useful and if there are other fact sheets that you would have found helpful that we have not yet provided.

 

While the information contained in this fact sheet is believed to be correct, DISC does not accept liability for any error/s it may contain.