Dementia: Therapy

General measures

When caring for persons suffering from dementia, consideration should be given to:

  • Presentation of the patient to a psychiatrist or neurologist for clarification of differential diagnoses (e.g., pseudodementia in severe depression)
  • Aim to maintain normal weight! * Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis.
    • Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight (supply of a fully balanced diet for the dietary treatment of persons with catabolic metabolic state – underweight / malnutrition).
  • Nicotine restriction (cessation of tobacco use) – smoking cessation reduces the risk of dementia to the new level of non-smokers.
  • Alcohol abstinence (abstaining from alcohol consumption).
  • Use of memory aids
  • Memory games or puzzles promote concentration – short simple tasks (do not overtax / frustrate! Forgotten remains forgotten, is not relearned!)
  • Adherence to a daily rhythm and everyday structures; change of the usual often causes uncertainty and anxiety
  • Physical exercises do not neglect
  • Review of permanent medication due topossible effect on the existing disease.
  • Sleep on and sleep through disturbances affect the regeneration of the brain and nerves. The phase of falling asleep should not exceed 30 minutes and the phase of sleeping through should be at least four and a half hours.
    • Caution: computer or cell phone use before sleep extends the time to fall asleep due to the blue light component.
  • Ensure safety
  • Observe and respond to excessive demands on caregivers (continuing education for caregivers).
  • Psychological counseling, as well as in self-help groups; especially for the relatives of affected patients.
  • Avoidance of environmental pollution:
    • Air pollution impairs thinking performance
  • Wg. fitness to drive: extent of impairment and the question of progression is crucial; if there is any doubt of fitness to drive, a driving test with a neuropsychologist is useful and advised.
  • Travel recommendations:
    • Before starting a trip participation in a travel medical consultation!
    • In principle, patients with dementia is able to travel, as long as a constant accompaniment is guaranteed.

* Dementia patients lose about four times as much body weight annually as patients of the same age without dementia due to chronic inflammation (inflammatory processes), secondary diseases and the sometimes increased urge to move.

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Pneumococcal vaccination

Nutritional medicine

  • Nutritional counseling with family members based on nutritional analysis.
  • Regular screening for malnutrition and early intervention when problems occur!
  • Even in advanced dementia, do not tube feed via percutaneous endoscopic gastrostomy (PEG; endoscopically placed artificial access from the outside through the abdominal wall into the stomach). Instead, help patients eat and hand feed them.Tube feeding makes patients agitated and increases the need for restraints such as physical restraint or administration of appropriate medications.Hand feeding has no disadvantages in terms of aspiration (in this case, inhalation of food during breathing), pneumonia (pneumonia), and mortality (death rate).
  • Dietary recommendations according to a mixed diet taking into account the disease at hand. Meaning:
    • A total of 5 servings of fresh vegetables and fruits daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grain products).
  • Observance of the following special dietary recommendations:
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training); even moderate physical activity protects against a decline in mental abilities (prevention in mild cognitive deficits and Alzheimer-type dementia; therapy: only minor effects in Alzheimer-type dementia).
  • Strength balance training for fall prevention.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Psychotherapy

  • Psychosocial procedures/measures according to S3 guideline: psychosocial therapies for severe mental illness.
    • Self-management as part of coping with the illness; in this context also references to self-help contact points.
    • Individual interventions
      • Psychoeducational intervention to increase knowledge of the disease.
      • Training of everyday and social skills
      • Artistic therapies
      • Occupational therapy – work or occupational therapy.
      • Movement and sports therapies
      • Health promotion interventions
    • Ambulatory psychiatric care (APP) as assistance in times of crisis.
  • If necessary, psychotherapy (including stress management).
  • Occupational therapy – training or exercises to maintain brain performance and motor skills (for moderate to severe dementia). The therapy shows the following medical effects:
    • Cognitive stimulation (training of mental functions such as concentration skills or memory; hardly effective in severe dementia):
      • Delays mental decline (in mild to moderate dementia).
      • Reduces behavioral problems such as aggression
    • Sensory stimulation (sensory stimulation and increased stimulus perception, for example, by light, scent or music):
      • Improvement, for example, in daily activities and social behavior (in all three stages of dementia).
    • Functional and skills training (physical as well as mental):
      • Can improve health status, mood, and quality of life (in combination with other procedures).
  • Evidence supports the efficacy of cognitive stimulation on cognitive performance in patients with mild to moderate dementia.
  • Cognitive stimulation should be recommended. Recommendation grade B, evidence level IIb, guideline adaptation NICE-SCIE 2007 74 [S3 guideline].
  • Reminiscence procedures may be used at all stages of disease because of effects on cognitive performance, depression, and quality-of-life-related factors. Recommendation grade B, evidence level IIb [S3 guideline].
  • There is evidence that occupational therapy interventions, individually tailored to patients with mild to moderate dementia and involving caregivers, contribute to the preservation of everyday functions. Their use should be offered. Recommendation grade B, evidence level Ib, guideline adaptation NICE-SCIE 2007 [S3 guideline].
  • Detailed information on psychosomatic medicine (including stress management) is available exclusively to our partners.

Complementary treatment methods

  • Aromatherapy with lavender, lemon balm, orange and cedar extracts – to alleviate dementia symptoms (Cochrane scientists were unable to find convincing evidence for this)

Training

  • Continuing education for nurses

Rehabilitation

  • For mild dementia, “rehab before care” applies. The rehabilitation program should offer cognitive training and exercises for this purpose.