Nonpharmacologic Management of Behavioral Symptoms in Dementia

Abstract

Mr P is a 93-year-old bachelor who has lived in the United States since emigrating from Mexico at age 8. He began to have memory problems 13 years ago such as forgetting why he walked into a room or whether he had taken his medications. Mr P sought treatment in 2004 and scored 29 of 30 points on the Mini-Mental State Examination (MMSE; normal cognition score Ͼ24). His memory impairment, coupled with results from brain computed tomography showing white matter changes and bilateral and frontotemporal atrophy, led to diagnosis of mild cognitive impairment due to brain vascular disease. By 2010, Mr P's score had declined by 8 points (MMSE, 21/30) and his course of illness was considered consistent with mild progressive dementia. Mr P lives with Mr C, a cousin who is also his primary caregiver. Mr P has no children and all other family lives in Mexico. His caregiver is employed full time, which requires that Mr P stay at home alone. Mr P relies on his caregiver to organize and administer his 13 medications and to perform instrumental activities such as shopping and cooking. He dresses and bathes independently.Mr P maintained a positive mood as his disease progressed. He lacked insight into his memory problems. Neuropsychological testing revealed major impairments in executive function, verbal and spatial memory, wordfinding ability, and recall. His other diagnoses included hypertension, type 2 diabetes mellitus, lower extremity peripheral neuropathy, and coronary artery disease. Mr P's dementia progressed, he napped excessively during the day, experienced nighttime restlessness, and frequently awakened Mr C. Additionally, he withdrew from gardening and other previously enjoyed activities and reported feelings of insecurity and loneliness.CME available online at www.jamaarchivescme.com and questions on p 2041.

Sintomas neuropsiquiátricos na doença de Alzheimer: frequência, correlação e ansiedade do cuidador

“…Além do quadro demencial, diversos fatores psicológicos e ambientais, como dificuldade de comunicação com o cuidador e ambientes ruidosos, estão relacionados com o surgimento de sintomas hiperativos. 23 Desta forma, a adequada identificação e a modificação dos fatores que desencadeiam os sintomas podem reduzir a necessidade de tratamento farmacológico.…”

Knowing Versus Doing: Education and Training Needs of Staff in a Chronic Care Hospital Unit for Individuals With Dementia

“…To manage behaviors, staff frequently rely on pharmacological agents, which have limited benefits and present risk for adverse events (Gitlin, Kales, & Lyketsos, 2012;Kales, Gitlin, Lyketsos, & Detroit Expert Panel on the Assessment and Management of the Neuropsychiatric Symptoms of Dementia, 2014;Sadowsky & Galvin, 2012). Although nonpharmacological approaches to managing behaviors are endorsed by medical organizations as frontline treatment, they are not typically used because of a lack of knowledge of their evidence, a lack of training in using nonpharmacological strategies, the perception that such strategies require more time, and a lack of supportive clinical environments for their use (Kolanowski, Fick, Frazer, & Penrod, 2010).…”

<b>Vivências de Cuidadores Familiares de Pessoas Idosas com Doença de Alzheimer / Experiences of Family Caregivers of Elderly with Alzheimer's Disease<b>

“…Esses sintomas comportamentais podem ser extremamente estressantes para os cuidadores, principalmente porque muitos deles não estão preparados para lidar com essas alterações de comportamento provocadas pela DA. A literatura aponta para os benefícios de intervenções educativas e treinamento de habilidades com os cuidadores visando reduzir os sintomas comportamentais em pessoas portadoras de demências (17) . Outra questão evidenciada no relato dos cuidadores foi a infantilização do idoso no cuidado, uma vez que o portador de DA passou a se portar tal qual uma criança.…”