Dementia Treatment med老年痴呆症治疗.unc.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * NGF -- see previous discussion. NGF can’t cross blood-brain barrier so must be given intrathecally. Dr Winblad in Stockholm has used it on 2 patients “strongly improved memory”, side effects include pain, anorexia and wt. loss. * * * * * * * * * * * * * * * * CAUSES OF DELIRIUM: Infectious - encephalitis, meningitis, UTI - also systemic infections with sepsis, fever Withdrawal Acute Metabolic - electrolyte changes, dehydration, blood sugsr changes, acidosis, hepatic or renal failure Trauma CNS pathology - seizures, tumors, strokes, etc. Hypoxia Deficiencies - b12, thiamine Endocrine Acute Vascular Toxins,Drugs Heavy Metals I WATCH DEATH * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Caregiver Burden Alzheimer’s caregivers spend an average of 69 to 100 hours per week providing care Caregivers of patients suffering from dementia(compared to control subjects) reported: 46% more physician visits Over 70% more prescribed drugs More likely to be hospitalized More than 50% of caregivers are at risk for clinical depression Staging of Dementias MILD: difficulties with checkbook maintenance, complex meal preparations, complicated medication schedules MODERATE: difficulties with simple food preparation, household or yard work. May need some assistance with self-care SEVERE: Need considerable assistance with feeding, grooming and toileting PROFOUND: Largely oblivious to surroundings, totally dependent TERMINAL: Bed bound; require constant care Common Associated Problems depression (occurs in 20-40% - esp. AD and VaD) psychosis (occurs in 30- 50%) - usually see paranoid delusions (theft, infidelity) wandering/purposeless activity agitation/threatening behavior sleep disturbances delirium - minor insults can lead to major decompensations DELIRIUM Definition - transient, usually reversible, dysfunction of global cerebral metabolism or physiology that has an acute or subacute onset manifes