I. Manifestations of dementia syndrome
A. Decreased activities of daily living:
Initially, the patient may show the inability to manage money independently, shopping.
Gradually, it becomes difficult to complete familiar activities, such as laundry, cooking, dressing, etc.; in severe cases, the patient is completely unable to take care of himself/herself.
B, Behavioral and psychological symptoms of dementia (BPSD)
Including: hallucinations, delusions, mistaken identity, depression, mania, agitation, aimless wandering, wandering, physical and verbal aggression, shouting, open defecation and sleep disorder.
C. Cognitive impairment
(1) Memory impairment: It is often a prominent symptom in the early stage of dementia.
Initially, it mainly involves recent memory, difficulty in memory retention and difficulty in learning new knowledge. The person is forgetful, forgets things he or she has just used, and loses everyday objects. Later on, distant memory is also impaired. Some patients fill in the memory gaps with misconceptions or fiction.
(2) Visuospatial impairment.
It manifests as getting lost in a familiar environment, not being able to find one’s home, or even going to the wrong room in one’s home or not being able to find the toilet. During drawing tests, they often cannot copy simple shapes.
(3) Abstract thinking disorder.
Patients with dementia have impaired cognitive functions such as comprehension, reasoning, judgment, generalization and computation. First of all, the patient has difficulty in calculation and cannot perform complex arithmetic operations, even addition and subtraction of two digits or less. The patient is unable to distinguish between similarities and differences, to read novels and movies, to perform familiar tasks and techniques, and finally to completely lose the ability to live.
(4) Language impairment (cortical function).
The earliest manifestations are hollow spontaneous speech, difficulty in finding words, inappropriate use of words, redundancy, inability to list the names of similar items. Naming is not possible, there can be sensory aphasia and inability to converse; finally the patient may be silent.
(5) Anosognosia.
The most common symptoms of anosognosia in patients with dementia are inability to recognize faces, failure to recognize their relatives and friends, and even loss of the ability to recognize themselves.
(6) Disuse disorder.
This is manifested by the inability to make continuous complex movements correctly, such as making tooth brushing movements. Dressing in the wrong order of inside and outside, front and back, left and right. They often grasp food with their hands or lick it with their mouths.
(7) Personality change.
Initial personality changes are characterized by lack of initiative, reduced activity, loneliness, difficulty in adapting to new environments, selfishness, reduced interest in the surrounding environment, and lack of enthusiasm for people. Later, the patient gradually becomes cold to people, even indifferent to relatives, irresponsible, emotionally unstable, easily irritated, angry over trivial matters, and scolding family members.
Finally, lack of shame and sense of ethics, disregard for social norms, unkempt, unhygienic, picking up rags, and taking other people’s belongings for oneself. The syndrome may be characterized by hyperactive instincts, public nudity, and even abnormal sexual behavior.
Differential diagnosis of dementia syndrome
(1) Delirium: The main manifestations are decreased clarity of consciousness, disturbed sleep rhythm, inattention and disorientation. It often shows panic and fear or excitement and agitation due to delusion and hallucination, mostly with acute onset, light fluctuations in the morning and heavy fluctuations at night, lasting from a few hours to a few days, and a few can last more than a month.
(2) Memory loss in physiological aging: mainly partial amnesia of events, no significant effect on intelligence, no impairment of social activities.
(3) Depression (pseudo-dementia): history of affective disorder before memory loss, symptoms often fluctuate from day to night, and memory impairment improves at the same time after depression treatment improves.
III. Treatment of dementia
(i) Drug treatment
(1) Pro-cognitive drug therapy to improve cognitive deficits.
A. Drugs acting on neurotransmitters
Meperidine, donepezil, carboplatin, etc.
B. Vasodilators
Nimodipine, Ciproline, etc.
C. Brain metabolic activators
Nicergoline, dihydroergotoxine, piracetam, etc.
D. Anti-hypoxic drugs: Ducoxib, etc. E. Neuropeptides: Cerebrolysin, etc.
Others: cytidylcholine, ginkgo biloba extract, etc.
(2) Pharmacological treatment for psycho-behavioral symptoms (BPSD).
The aim is to improve the cognitive and functional deficits and psycho-behavioral symptoms of dementia.
A, Pharmacotherapy
B, Behavior therapy
C, environmental therapy
D, Music therapy
F, MECT therapy
(II) Psychological/social-behavioral therapy
The aim is to preserve the patient’s level of functioning to the greatest extent possible, reduce caregiver burden, and learn to cope with the difficult problem of dementia.
Psychotherapy in a broad sense includes: establishing and maintaining appropriate therapeutic relationships with patients and their families; conducting diagnostic assessments and developing timely individualized treatment plans; mental status assessment and monitoring and timely adjustment of treatment strategies; and safety assessments and interventions.
Narrowly defined psychotherapy: treatment administered for a specific behavioral, emotional or cognitive symptom and of a specific type, with the aim of maximizing the quality of survival and preserving the level of functioning.
Behavioral therapy
Emotional treatment
Cognitive therapy
Activation therapy, etc.
(iii) Targeted treatment of partial dementia
(1) Paralytic dementia.
2 weeks of PG drip treatment
(2) Hydrocephalus/tumor dementia: surgical treatment
(3) Vitamin deficiency dementia: vitamin supplementation, etc.