Which of the following outcome criteria is appropriate for the client with dementia?

Diagnosis

Diagnosing dementia and its type can be challenging. To diagnose the cause of the dementia, the doctor must recognize the pattern of the loss of skills and function and determine what a person is still able to do. More recently, biomarkers have become available to make a more accurate diagnosis of Alzheimer's disease.

Your doctor will review your medical history and symptoms and conduct a physical examination. He or she will likely ask someone close to you about your symptoms as well.

No single test can diagnose dementia, so doctors are likely to run a number of tests that can help pinpoint the problem.

Cognitive and neuropsychological tests

Doctors will evaluate your thinking ability. A number of tests measure thinking skills, such as memory, orientation, reasoning and judgment, language skills, and attention.

Neurological evaluation

Doctors evaluate your memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes and other areas.

Brain scans

• CT or MRI. These scans can check for evidence of stroke or bleeding or tumor or hydrocephalus.
• PET scans. These can show patterns of brain activity and whether the amyloid or tau protein, hallmarks of Alzheimer's disease, have been deposited in the brain.

Laboratory tests

Simple blood tests can detect physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. Sometimes the spinal fluid is examined for infection, inflammation or markers of some degenerative diseases.

Psychiatric evaluation

A mental health professional can determine whether depression or another mental health condition is contributing to your symptoms.

Treatment

Most types of dementia can't be cured, but there are ways to manage your symptoms.

Medications

The following are used to temporarily improve dementia symptoms.

• Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.

  Although primarily used to treat Alzheimer's disease, these medications might also be prescribed for other dementias, including vascular dementia, Parkinson's disease dementia and Lewy body dementia.

  Side effects can include nausea, vomiting and diarrhea. Other possible side effects include slowed heart rate, fainting and sleep disturbances.

• Memantine. Memantine (Namenda) works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory. In some cases, memantine is prescribed with a cholinesterase inhibitor.

  A common side effect of memantine is dizziness.

• Other medications. Your doctor might prescribe medications to treat other symptoms or conditions, such as depression, sleep disturbances, hallucinations, parkinsonism or agitation.

In 2021, the Food and Drug Administration (FDA) approved aducanumab (Aduhelm) for the treatment of some cases of Alzheimer's disease. The medicine was studied in people living with early Alzheimer's disease, including people with mild cognitive impairment due to Alzheimer's disease.

The medicine was approved in the United States because it removes amyloid plaques in the brain. But it hasn't been widely used because studies about its effectiveness at slowing cognitive decline are mixed and coverage is limited.

Another Alzheimer's medicine, lecanemab, has shown promise for people with mild Alzheimer's disease and mild cognitive impairment due to Alzheimer's disease. It could become available in 2023.

A phase 3 clinical trial found that the medicine slowed cognitive decline in people with early Alzheimer's disease by 27%. Lecanemab works by preventing amyloid plaques in the brain from clumping. This study was the largest so far to look at whether clearing clumps of amyloid plaques from the brain can slow the disease.

Lecanemab is under review by the FDA. Another study is looking at how effective the medicine may be for people at risk of Alzheimer's disease, including people who have a first-degree relative, such as a parent or sibling, with the disease.

Therapies

Several dementia symptoms and behavior problems might be treated initially using nondrug approaches, such as:

• Occupational therapy. An occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior and prepare you for the dementia progression.
• Modifying the environment. Reducing clutter and noise can make it easier for someone with dementia to focus and function. You might need to hide objects that can threaten safety, such as knives and car keys. Monitoring systems can alert you if the person with dementia wanders.
• Simplifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine also help reduce confusion in people with dementia.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Dementia symptoms and behavior problems will progress over time. Caregivers and care partners might try the following suggestions:

• Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present one idea or instruction at a time. Use gestures and cues, such as pointing to objects.

• Encourage exercise. The main benefits of exercise in people with dementia include improved strength, balance and cardiovascular health. Exercise might also help with symptoms such as restlessness. There is growing evidence that exercise also protects the brain from dementia, especially when combined with a healthy diet and treatment for risk factors for cardiovascular disease.

  Some research also shows that physical activity might slow the progression of impaired thinking in people with Alzheimer's disease, and it can lessen symptoms of depression.

• Engage in activity. Plan activities the person with dementia enjoys and can do. Dancing, painting, gardening, cooking, singing and other activities can be fun, can help you connect with your loved one, and can help your loved one focus on what he or she can still do.

• Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on in the bedroom, hall and bathroom to prevent disorientation.

  Limiting caffeine, discouraging napping and offering opportunities for exercise during the day might ease nighttime restlessness.

• Keep a calendar. A calendar might help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one.

• Plan for the future. Develop a plan with your loved one while he or she is able to participate that identifies goals for future care. Support groups, legal advisers, family members and others might be able to help.

  You'll need to consider financial and legal issues, safety and daily living concerns, and long-term care options.

Alternative medicine

Several dietary supplements, herbal remedies and therapies have been studied for people with dementia. But there's no convincing evidence for any of these.

Use caution when considering taking dietary supplements, vitamins or herbal remedies, especially if you're taking other medications. These remedies aren't regulated, and claims about their benefits aren't always based on scientific research.

While some studies suggest that vitamin E supplements may be helpful for Alzheimer's disease, the results have been mixed. Also, high doses of vitamin E can pose risks. Taking vitamin E supplements is generally not recommended, but including foods high in vitamin E, such as nuts, in your diet, is.

Other therapies

The following techniques may help reduce agitation and promote relaxation in people with dementia.

• Music therapy, which involves listening to soothing music
• Light exercise
• Watching videos of family members
• Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia
• Aromatherapy, which uses fragrant plant oils
• Massage therapy
• Art therapy, which involves creating art, focusing on the process rather than the outcome

Coping and support

Receiving a diagnosis of dementia can be devastating. You'll need to consider many details to ensure that you and others are as prepared as possible for dealing with a condition that's unpredictable and progressive.

Care and support for the person with the disease

Here are some suggestions you can try to help yourself cope with the disease:

• Learn about memory loss, dementia and Alzheimer's disease.
• Write about your feelings in a journal.
• Join a local support group.
• Get individual or family counseling.
• Talk to a member of your spiritual community or another person who can help you with your spiritual needs.
• Stay active and involved, volunteer, exercise, and participate in activities for people with memory loss.
• Spend time with friends and family.
• Participate in an online community of people who are having similar experiences.
• Find new ways to express yourself, such as through painting, singing or writing.
• Delegate help with decision-making to someone you trust.

Helping someone with dementia

You can help a person cope with the disease by listening, reassuring the person that he or she still can enjoy life, being supportive and positive, and doing your best to help the person retain dignity and self-respect.

Support for caregivers and care partners

Providing care for someone with dementia is physically and emotionally demanding. Feelings of anger and guilt, frustration and discouragement, worry, grief, and social isolation are common. If you're a caregiver or care partner for someone with dementia:

• Learn about the disease and participate in caregiver education programs
• Find out about supportive services in your community, such as respite care or adult care, which can give you a break from caregiving at scheduled times during the week
• Ask friends or other family members for help
• Take care of your physical, emotional and spiritual health
• Ask questions of doctors, social workers and others involved in the care of your loved one
• Join a support group

Preparing for your appointment

Most likely, you'll first see your primary care provider if you have concerns about dementia. Or you might be referred to a doctor trained in nervous system conditions (neurologist).

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything that needs to be done in advance, such as fasting before certain tests. Make a list of:

• Symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
• Key personal information, including any major stresses or recent life changes and family medical history
• All medications, vitamins or supplements you take, including the doses
• Questions to ask the doctor

Even in the early stages of dementia, it's good to take a family member, friend or caregiver along to help you remember the information you're given.

For dementia, basic questions to ask the doctor include:

• What is likely causing my symptoms?
• Are there other possible causes for my symptoms?
• What tests are necessary?
• Is the condition likely temporary or chronic?
• What's the best course of action?
• What alternatives are there to the primary approach being suggested?
• How can dementia and other health issues be managed together?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

The doctor is likely to ask questions, such as:

• When did your symptoms begin?
• Have symptoms been continuous or occasional?
• How severe are symptoms?
• What, if anything, seems to improve symptoms?
• What, if anything, appears to worsen symptoms?
• How have the symptoms interfered with your life?

Oct. 12, 2022

Which of the following best describes dementia *?

What is the best goal the nurse can expect from a client with Alzheimer's disease?

Which of the following will you use when communicating with a client who has cognitive impairment?

Which benefit does a client gain by Confabulating?