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Coping with Progressive Memory Loss

"Diagnosis and management of dementia"
By: Marc Evans Abat, MD, FPCP, FPCGMCoping with Progressive Memory Loss

The diagnosis of dementia doesn’t involve lab tests, but thorough physical and neurological exam by the doctor. A memory test is done to estimate the degree of deterioration in different criteria like language, visuospatial ability (e.g., perception of objects and their relation with one another in space), orientation, attention, and calculation. 

Patients who tested normal in simple memory screening tests may need to have more difficult memory battery examinations. Laboratory examinations are done to exclude other causes of memory impairment which are often either completely or partially reversible. Some conditions that need to be excluded are thyroid, liver, and kidney disorders, vitamin B deficiency, anemia, and electrolyte problems, all of which may manifest with intellectual impairment. 

In certain cases, especially if there are very pertinent neurological findings like one-sided muscular weakness, neurological imaging studies like CT scan or MRI are needed to assess for problems like stroke, tumors, or hydrocephalus (head enlargement caused by increased fluid in the brain cavities). 

Management of dementia and its associated problems is multifaceted, involving many health care professionals like geriatricians, neurologists, psychiatrists, psychologists, nurses, and therapists. 

The treatment approach should address the three important aspects of dementia care: memory, behavior, and functionality (e.g., how functional the patient is with respect to daily activities, etc.). Current medications for dementia serve to slow down the memory decline and cannot restore memory that is already lost. The drugs called cholinesterase inhibitors help to increase the amount of the neurotransmitter acetylcholine in the brain cell connections. Another group of drugs, the NMDA receptor antagonists, help slow down brain cell death. Other medications like sedatives or antipsychotics are given to selected patients to control harmful behavior like physical aggression or to provide restful sleep. Depression in dementia may be treated by antidepressants.

Non-drug treatment involves the use of music, exercise, pets, light manipulation, socialization, and even massage or aromatherapy to help maintain functionality and physical strength or to help channel physical energy to constructive activities. Wandering is often a difficult behavior to treat and may require creative solutions like allowing an older patient to walk in a secure closed-loop pathway. Not all activities are applicable for all patients, and individual response should be noted in order to select the most appropriate activity.

Dementia is an extremely depersonalizing disease, robbing a person of his humanity. With proper medical care, that older person can continue living with dignity among the people he holds dear.

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