Read e-book online How to Manage Dementia in General Practice PDF

By Nicholas Clarke

This functional advisor essentially exhibits every one degree within the administration of a sufferer with dementia. It covers the advanced matters surrounding dementia corresponding to spouses and households, entry to acceptable care, felony and moral matters, making plans for the longer term and "living good" and comprises the choice making technique on beginning remedy and information on how most sensible to entry the to be had services.

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Mr Finch was a 72-year-old patient with Alzheimer’s disease who would repeatedly pile up furniture in the centre of the lounge of his care home, much to the annoyance of the other residents. When his daughter came to visit she explained that her father used to be a painter and decorator and this was how he began any job. Armed with this information, the staff were able to reassure Mr Finch that he had finished decorating the room, at which point he would relax. Granted, he had to be told this repeatedly, but at least the staff could manage Mr Finch with greater understanding.

Mr Jones was a 70-year-old man with COPD of 20 years’ duration. Mrs Jones took her husband to see Dr Hans because he was ‘losing his memory’. A detailed history and examination revealed clinical cognitive impairment and Dr Hans suspected his patient was suffering with the early stages of vascular dementia. He referred Mr Jones to the Old Age Psychiatrist who confirmed the diagnosis. Over the next 5 years, Mr Jones began to present to Dr Hans with increasing frequency. Initially he would simply say he was short of breath on exertion, and Complex pictures of dementia 31 Dr Hans prescribed inhalers to control his symptoms.

Eventually Mrs Simon was maintained on a very low-dose antipsychotic, a reduced-dose antihypertensive and also a very low-dose antiParkinson’s drug which minimised side effects while maintaining the highest quality of life. The key points to take away from the case history above include: • most antidepressants other than selective serotonin re-uptake inhibitors (SSRIs) carry significant risk of postural hypotension; this is particularly true of the older tricyclics which are often used at night; • all antipsychotics carry similar risks; • beta blockers have no place in the first-line management of hypertension or anxiety in the elderly as they carry a raft of physical and psychological side effects; • cholinergic drugs may exacerbate first-degree heart block and cause bradycardia; this means that initiating these drugs in patients with a resting heart rate of less than 50 beats per minute should be viewed with caution and an electrocardiogram (ECG) should be performed before and after treatment; Complex pictures of dementia 29 • some anti-epileptics such as carbamazepine, used as mood agents, will have an effect on postural vascular tone, but the effect of benzodiazepines is negligible.

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