Practical approach to pharmacological treatment and nonpharmacological intervention of dementia
Year: 2014
Type: article
Abstract: a t m e n t r e q u i r e s a comprehensive multidimensional approach, which i n c l u d e s 1 ) m a n a g i n g t h e d i s e a s e , 2 ) t r e a t i n g the symptoms, 3) supporting the patient, and 4) supporting the caregiver.Pharmacological and nonpharmacological interventions are equally important.Given early in the course of illness, these strategies help maintain or improve functioning and quality of life. Pharmacological TreatmentAD is a progressive degenerative brain disease.More than 200 agents have been investigated for diseasemodifying potential, but none was successful.The mainstay of current management of AD involves drugs that provide symptomatic relief. 1 The US Food and Drug Administration (FDA) have approved acetylcholinesterase inhibitors (AChEIs) and N-methyl-D-aspartate (NMDA) receptor antagonist for the treatment of cognitive symptoms in AD.For other drugs such as aspirin, steroids and non-steroidal anti-inflammatory drugs (NSAIDs), nicotine, hormone replacement and thiamine, the evidence for benefit on cognition is limited.[2][3][4][5] For Ginkgo biloba, the results are conflicting.6 The best treatment involves concurrent a p p l i c a t i o n o f b o t h p h a r m a c o l o g i c a l a n d n o npharmacological modalities. Strategic Pharmacological Intervention for Dementia: Case Illustration HistoryMadam Lam, aged 81 years old, presented with progressive deterioration of short-term memory for 3 years, followed by recent problems in operating home electrical appliance, deranged cooking technique, and change in personality.She became argumentative, defensive and emotional when poor performances were pointed out by the others.Despite the cognitive deficit, she remained independent in self-care and was not depressed. AssessmentMini-Mental State Examination (MMSE) score was below cut-off (18/30).Neurological examination was remarkable.Targeted blood tests did not reveal any abnormality.CT scan of brain showed cerebral atrophy. DiagnosisAlzheimer's disease (AD) of mild-to-moderate severity. ManagementOral rivastigmine 1.5 mg bd, gradual titration to 4.5 mg bd over 4 months.
Authors: S. K. Tam, Nym Lee, Ghy Wong
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2246611019