Reduced risk of dementia related to psychotic behavior

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Dementia or memory impairment is a chronic, total and often irreversible cognitive decline. Clinical and laboratory tests are often used to determine the cause. However, treatment is supportive only, with the important thing being to reduce the risk of dementia related to psychotic behavior.

1. What is dementia?

Dementia is not a specific disease, it is a combination of many symptoms and of which memory loss is the most common manifestation. People with dementia often have difficulty remembering, learning, and communicating.
The process of cognitive disorders has started long before the clinical manifestation, so the term cognitive disorder was introduced to refer to the disease process with a mild degree and an earlier stage to detect prevention. prevention and treatment before progression to dementia.
Along with the increasing proportion of elderly people in the aging stage, accounting for about 10% of Vietnam's population in 2017 is 95 million, there are up to 9.5 million elderly people and the proportion of the community of the elderly. dementia will be 5% of people aged 60 and over will be 475,000. Therefore, current dementia management strategies focus on risk-reducing treatment, early diagnosis, and early intervention.
Dementia has a silent onset with reduced memory and other cognitive functions, but patients often have measures to adapt, compensate, and deny the disease. The illness can be recognized by loved ones when they notice communication difficulties, personality changes, and psychosis.

2. How is dementia related to psychotic behavior?

To understand psychosis or dementia-related psychosis. Some experts now refer to dementia as a "neurocognitive disorder". But doctors still use the word dementia. It is a broad term that covers a wide range of conditions caused by changes in the brain.
Alzheimer's disease is perhaps the best known form of dementia. However, that's not all, there are other forms of dementia including:
Lewy body dementia Frontal dementia Vascular dementia These conditions make patients suffers from a decline in thinking and problem-solving abilities and often makes it difficult for everyday living and independent living. Common symptoms of dementia include:
Memory loss (such as forgetting the names of loved ones, forgetting things you did or people you met...) Impaired attention span, easily distracted Difficulty communicating (eg using unusual words to refer to familiar objects)

In general, psychosis is when a person has difficulty recognizing what is real and what is not. People with psychosis may suffer from delusions, like a certain mistaken belief that someone is trying to kill them. They may also have hallucinations of seeing or hearing something or someone that others have not seen or heard.
Dr Gary Small, director of the UCLA Longevity Center, said: “There is a lot of ignorance and knowledge about these terms. Those terms are scary to many people. Dementia sounds very serious, and terms like psychosis are scary as well. What I try to do is explain what those things are, what those phenomena are, and try to help them understand it and solve the problem."
People with dementia-related mental disorders there is a decline in thinking and problem-solving skills of dementia, as well as delusions or hallucinations of psychosis but delusions are more common.All of which can cause problems Other topics, like:
Indifference to things Excessive worry Aggression Insomnia Insomnia Excitability Lack of restraint The first step to finding out if a person has a dementia-related mental disorder is to make sure that the hallucinations or delusions they experience are not the result of another medical condition. For example, a uterine infection can lead to hallucinations
Diagnosing prolapse-related psychosis. Dementia is primarily about gathering information; ruling out other causes; then observing, listening, and questioning
Dr. George Grossberg, Director of Geriatric Psychiatry at the School of Medicine Saint Louis University, said: "I never meet personally with the person I need to diagnose, but with at least one person in charge of their care." People with dementia may hide their symptoms, because fear of stigma often accompanies mental health problems. Nurses, doctors, and professional caregivers may not recognize the signs for a variety of reasons. That makes it even more important to observe, talk, and ask the right questions for everyone involved.

3. Treatment of dementia related to psychotic behavior, emotional disturbance

3.1. Non-pharmacological treatment Non-pharmacological interventions are important adjuncts to psychiatric agents and have been shown to be effective in patients with dementia. These interventions can be used for most patients with dementia-related behavioral disorders.
Before an intervention is initiated, the behavioral problem or symptom must be identified and quantified in terms of frequency and severity. It is essential to identify and eliminate the causes of interference. Goals of care should be negotiated with carers; Targeted behavior often cannot be completely eliminated, but it can be reduced to an acceptable or acceptable level.
Approaches for carers Carers of dementia patients need to be educated about the course of the disease and the manifestations it presents. In most situations, coping strategies include staying calm and using familiar touch, music, toys, and personal items. Helping caregivers understand the patient's unintentional behavior is also essential.
Behavioral approach It's a good idea to try methods that have worked in the past at first. It is better to distract angry or aggressive patients than to try to reason with them. Ask closing questions (e.g., “Do you want cereal for breakfast?”) instead of open-ended questions (e.g., “What would you like for breakfast?”). May be less confusing and stressful for the patient. Confirmation therapy focuses on responding to emotions rather than the content of what the patient says.
Additionally, using reminiscence therapy to recount pleasurable experiences and using therapeutic activities such as dance, art, music, and exercise has been shown to be helpful. Practical orientation is not recommended except in the early stages of the disease. When non-threatening hallucinations or delusions are reported, caregiver reassurance may be the only treatment needed.
Changing the environment Patients with physically inactive behaviors, such as brisk walking and lounging, may respond to creating a safe environment where they can walk without risk ro. Items such as guns and knives should be discarded. Making the environment safe is a business that always needs attention and changes as the disease progresses. For patients in the later stages of the disease, a safe environment can only be achieved in specialized settings such as Alzheimer's units or long-term care facilities.
Sensory Intervention Sensory intervention may be beneficial in many older adults with delusions. Music therapy and therapy may also be helpful in this case by creating a home-like environment in nursing homes, which seems to reduce the behaviors associated with psychosis and to elevate the mood. improve the patient's quality of life.

3.2. Atypical antipsychotics Atypical antipsychotics are the most well-studied class of drugs for patients with dementia and the most commonly used in clinical practice. They are better tolerated than typical neuroleptics, with less risk of extrapyramidal syndrome (EPS). In the absence of a contraindication, such as severe extrapyramidal dysfunction (eg, EPS, parkinsonian), atypical neuroleptics should be initiated at the lowest effective dose and titrated. weekly level.
Tremor, rigidity, dystonia, and dyskinesia are identified in a substantial number of patients at baseline and may be aggravated by the use of atypical antipsychotics, particularly when those This is used in higher doses. Physicians must exercise caution when increasing dosage and observe patients closely for the presence of EPS. Based on the results of clinical trials, there appears to be a short time frame for determining an exact, effective tolerable dose.
All of these drugs can be taken once daily, usually at night to take advantage of their sedative effects. Two randomized controlled trials found that risperidone (Risperdal) is effective in managing the psychiatric disturbances of dementia. However, a retrospective analysis of the results of 17 placebo-controlled studies of the use of atypical antipsychotics for the treatment of behavioral disorders in patients with dementia found that mortality increased. Most deaths are due to cerebrovascular accident or infection. This has led the US Food and Drug Administration to issue a safety warning for all agents that fall into this class. Quetiapine (Seroquel) is a drug that is less likely to increase symptoms in patients with Parkinson's or EPS. Intramuscular injection of olanzapine (Zyprexa) has been tested in patients with severe agitation, responding favorably compared with patients receiving placebo and lorazepam (Ativan). When symptoms are controlled to an acceptable level, medication should be used only when needed.
Anticonvulsants Anticonvulsants are often used when psychotic behaviors lead to aggressive behavior. There is growing evidence to support the use of divalproex (Depakote) or carbamazepine (Tegretol). These drugs are recommended as the second most common in patients who do not respond adequately to antipsychotics. Several small, relatively short-term trials have demonstrated anticonvulsants to be effective and well tolerated.
However, in practice, adverse events, drug interactions, and narrow therapeutic windows may limit the use of carbamazepine. Data suggest that patients receiving divalproex have continued to improve their symptoms at steady doses over time, although this effect may reflect a natural history of behavioral disturbances. Sedation is a common side effect of these drugs and may limit their use. Most of the data on gabapentin (Neurontin) is not very clear.

Acetylcholinesterase inhibitors Acetylcholinesterase inhibitors such as donepezil (Aricept), galantamine (Razadyne: formerly Reminyl), and rivastigmine (Exelon) are associated with a reduction in problem behaviors in patients with dementia. However, these drugs should not be considered first-line agents in the treatment of psychiatric disorders but only as adjunctive therapy. Cognitive function data in patients receiving acetylcholinesterase inhibitors consistently show an institutional time delay, which may reflect improved behavior, a delay in the onset of behavioral symptoms or maintain functionality.
Anti-aging medications Distinguishing depression from psychotic manifestations and dementia symptoms can be problematic, especially in patients with a history of depression or negative symptoms. other highlights. The researchers suggest that the use of selective serotonin reuptake inhibitors and trazodone (Desyrel) may be effective and may be considered in selected patients.
Anxiolytics Benzodiazepines should not be considered first-line therapy for the management of chronic behavioral disorders of dementia, even in patients presenting with fairly severe anxiety. However, community surveys suggest that these drugs are commonly used in dementia patients.
Chronic use of benzodiazepines may worsen abnormal behavior because of the amnesia and inhibitory effects of these drugs. In clinical practice, the use of benzodiazepines should be limited to the management of acute symptoms unresponsive to diversion or other agents. Short-acting benzodiazepines should be discontinued once symptoms are controlled with other agents. The use of benzodiazepines with short half-lives, no active metabolites, and little potential for drug interactions is recommended.
In summary, mental disorders can pose a greater challenge than cognitive impairment to patients with dementia and their caregivers. The nature and frequency of psychotic symptoms vary over the course of the disease, but in most patients these symptoms occur more frequently in the later stages of the disease.
Therefore, management of mental disorders requires a holistic nonpharmacological and pharmacological approach, including accurate assessment of symptoms, awareness of the environment in which they occur, identification of substances precipitates and how they affect patients and their caregivers. Non-pharmacological interventions include:
Counseling caregivers about the unintentional nature of psychotic manifestations and providing coping strategies; Patient approaches to behavioral change; Appropriate use of sensory intervention; environmental safety; Maintain consistent routines such as providing meals, exercise, and sleep; Pharmacological treatments should be adjusted according to a low-to-high philosophy that is, only gradually increasing the dose when absolutely necessary;
References: www.webmd.com, www.aafp.org