Makindo Medical Notes

Dementia is a progressive neurodegenerative syndrome that affects memory, thinking, behaviour, and daily function. Caring for patients with dementia requires a holistic, person-centred approach, balancing medical treatment with psychological, social, and environmental support.

📊 Types of Dementia

• 🧩 Alzheimer’s disease – most common; memory-led decline, language impairment.
• 🩸 Vascular dementia – stepwise decline after strokes, executive dysfunction prominent.
• 👁️ Dementia with Lewy Bodies (DLB) – hallucinations, Parkinsonism, fluctuating cognition.
• 🗣️ Frontotemporal dementia – behavioural or language variant; often younger onset.
• 🔄 Mixed dementia – common in elderly; overlap of Alzheimer’s and vascular.

🔍 Core Principles of Dementia Care

• 👥 Person-centred care: Focus on the individual’s history, personality, and preferences.
• 📚 Education: Involve carers/families, explain disease trajectory.
• 🛡️ Safety: Falls prevention, medication review, home/environmental adaptations.
• 💊 Medication: Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) or memantine in Alzheimer’s/Lewy body types if indicated.
• 🎯 Goals of care: Maintain independence, dignity, quality of life rather than cure.

🗣️ Communication Strategies

• Speak slowly, clearly, using short sentences.
• Maintain eye contact and use calm tone.
• Allow extra time for responses; avoid rushing.
• Use visual prompts, gestures, and written reminders.
• Involve family/caregivers who know the patient best.

🛠️ Managing Behavioural and Psychological Symptoms of Dementia (BPSD)

• 😟 Agitation & aggression: Identify triggers (pain, environment, infection). Use reassurance and distraction before drugs.
• 🛏️ Sleep disturbance: Optimise sleep hygiene, avoid caffeine, encourage daytime activity.
• 👻 Hallucinations (DLB/Parkinson’s): Often benign; only treat if distressing. Avoid antipsychotics if possible.
• 💊 Medications: Antipsychotics only if risk/severe distress (haloperidol contraindicated in Lewy body dementia; quetiapine preferred).

Non-Pharmacological (First-line)

• 💬 Reassurance, reorientation, validation therapy.
• 🧑‍🤝‍🧑 Involve family/carers in care routines.
• 🎶 Music therapy, pet therapy, reminiscence therapy.
• 🌅 Optimise environment: calm, well-lit, minimise noise.
• 👓 Sensory aids: glasses/hearing aids to reduce confusion.
• 🛏️ Sleep hygiene: regular routine, avoid caffeine, day-time activity.

Pharmacological (if severe distress or risk)

• Lorazepam 0.5-1 mg PO or IM (not IV) can be useful
• 💊 Antipsychotics:
  • Haloperidol 0.5–1 mg (avoid in Lewy body/Parkinson’s).
  • Quetiapine or risperidone (short-term, lowest dose, regular review).
• 😔 Antidepressants: SSRIs (e.g. sertraline, citalopram) if depression prominent.
• 😴 Sleep disturbance: Melatonin or trazodone preferred; avoid benzodiazepines unless short-term for crisis.
• ⚠️ Cautions: Antipsychotics ↑ risk of stroke and mortality in dementia — use only if severe risk/distress, review at 6–12 weeks.

🏡 Community & Social Support

• 👩‍⚕️ Memory clinics for diagnosis, support, and follow-up.
• 🏠 Social care input for home adaptations, carers, respite services.
• 🧾 Attendance allowance, carer’s allowance, lasting power of attorney (LPA).
• 🧑‍🤝‍🧑 Dementia charities (Alzheimer’s Society, Age UK) for patient/family support.

⚖️ Safeguarding & Legal Framework

• 🧠 Mental Capacity Act 2005: Capacity is decision-specific; may fluctuate.
• 📜 Advance Care Planning: Encourage early discussions about wishes (ACP, ADRT, DNACPR).
• 🛡️ Safeguarding: Dementia increases risk of neglect, abuse, financial exploitation.
• 🚗 Driving: Mandatory DVLA notification for dementia diagnosis.

🌅 End-of-Life Care in Dementia

• Focus on comfort, dignity, and symptom control.
• Anticipatory prescribing for pain, agitation, secretions, nausea.
• Discuss preferred place of care (home, hospice, care home).
• Support family/carers through bereavement process.

📝 OSCE / Exam Pearls

• Demonstrate empathy and patience when communicating with a “confused patient”.
• Always involve collateral history from carers/family.
• Differentiate delirium vs dementia vs depression in older adults.
• Mention cholinesterase inhibitors and memantine as part of medical treatment.
• State non-drug measures first when asked about behaviour management.