Scientific prevention and treatment of senile dementia

Senile dementia refers to dementia caused by various reasons that occurs in the elderly (over 65 years old).

The cognitive impairment of patients with dementia is mostly a slow progression. The disease is divided into three different levels: mild, moderate, and severe, and then tends to be divided into a continuous spectrum of cognitive impairment: subjective cognitive decline (SCD), mild behavioral impairment (MBI) and/or mild cognitive impairment (MCI), moderate and severe neurocognitive disorders. From mild cognitive impairment to dementia is a continuous spectrum, and it is also a slow, progressive and irreversible process. The best time for early intervention is when the SCD and MCI stages have not yet reached the level of dementia.

At present, the number of dementia patients in my country accounts for more than 20% of the total number of patients in the world. Alzheimer's disease (AD) is the most common type of dementia, accounting for about 60% to 70% of dementia. The prevalence of AD in people aged 65 and above in my country is 3.21% to 6.9%, with an annual incidence rate of 0.82%, and the prevalence increases with age.

About half of the dementia burden is due to potential, modifiable risk factors, including diabetes, middle-aged hypertension, middle-aged obesity, lack of physical activity, depression, smoking and low education level. The various risk factors are not independent of each other. By strengthening education and improving lifestyle, the above risk factors can be greatly reduced or the occurrence of dementia can be reduced.

Prevention of dementia: primary prevention and secondary prevention

Primary prevention: that is, etiology prevention. The purpose is to eliminate various pathogenic factors, avoid or reduce the impact of pathogenic factors, and prevent the occurrence of dementia. It is the top priority of prevention work and the most positive and proactive preventive measure, but it is also the weak link in current prevention work. It includes physical exercise, smoking cessation, dietary intervention, drinking, cognitive training, social activities, weight, hypertension, diabetes, dyslipidemia, depressive disorders, special sensory (visual and auditory) disorders, etc.

Secondary prevention: measures taken to stop or slow the development of dementia, including early detection, early diagnosis and early treatment, hence the name “three early” prevention. It is the best window period for treating dementia.

Early screening should be conducted for high-risk groups to facilitate early diagnosis and treatment. Early intervention for patients with mild cognitive impairment and dementia is more effective. Tertiary prevention is the clinical management and life care of dementia, with the goal of providing patients with systematic treatment and care guidance to improve their quality of life. It includes standardizing clinical management, strengthening patient care, improving patients' quality of life, and assisting caregivers.

The "ABC" symptoms of dementia: decreased ability to perform daily activities, mental and behavioral symptoms, and decreased cognitive function.

The specific manifestations of ABC and their severity are of great significance in determining whether there is dementia, the severity of dementia (mild cognitive impairment or dementia), the cause of dementia, etc., and are also the basis for the rational treatment of dementia.

Treatment of dementia:

Based on classical medicine, it emphasizes multidisciplinary collaboration and rehabilitation treatment throughout the process.

Classic drug treatments for dementia are mainly based on reducing abnormal glutamatergic neurotransmission or improving the function and level of acetylcholine in the brain, mainly including NMDA receptor antagonists (memantine) and AChEIs (donepezil). Memantine can be used for moderate to severe AD, and memantine and AChEIs can also be used in combination. For patients with psychiatric and behavioral symptoms, the principle of individualized treatment should be followed, and non-drug treatment and cognitive-enhancing drugs (such as memantine) should be preferred. If the effect is not good, antipsychotic drugs can be used.

Actively carry out multidisciplinary consultation and collaboration

Elderly patients often suffer from multiple diseases. Therefore, comorbidity risk assessment, optimization of treatment plans, and active prevention and treatment of complications are beneficial to improving patients' cognitive function and quality of life. It is recommended to provide corresponding multidisciplinary treatment for dementia patients with comorbid chronic diseases such as hypertension, diabetes, and dyslipidemia to reduce cognitive impairment.

Comprehensive rehabilitation measures for dementia: Dementia rehabilitation includes a series of comprehensive rehabilitation methods and intervention measures for the core symptoms of dementia, such as cognitive, behavioral and social functioning. It is carried out under the guidance of occupational rehabilitation therapists based on a comprehensive assessment.

Follow the principle of "tailoring to the needs" to improve patients' cognition and living abilities as much as possible, improve their quality of life and self-efficacy, and maintain their independence in life.

Cognitive training and rehabilitation can improve partial or overall cognitive function of patients with dementia; non-specific occupational therapy, multidisciplinary therapy, cognitive stimulation such as music or art therapy, and physical exercise can help maintain the social participation of patients with dementia and improve caregiver satisfaction.

Adhere to personalized home care

Whether scientific patient-centered care can be provided is crucial to the quality of life of patients with dementia. Palliative care is particularly important for patients in the terminal stage of dementia.

Home care: It is recommended to take measures for serious mental and behavioral problems based on the community environment and mental and behavioral risk assessment to prevent harm to the patient, caregiver and society; it is recommended to take relevant measures for medical-related home care and deal with medication compliance issues according to specific scenarios; it is recommended to measure the patient's weight regularly and take relevant measures based on the patient's dietary and nutritional status assessment to reduce the occurrence of malnutrition and diet-related adverse events. At the same time, pay attention to safety issues during the diet process; it is recommended to make appropriate modifications based on the patient's condition and home safety environment to improve the safety and convenience of the living environment and prevent accidents; it is recommended to take measures such as wearing identification cards to prevent being lost and unable to find.

Palliative care: For patients in the terminal stage of dementia, that is, when dementia has progressed to the most serious stage, memory and other cognitive abilities are severely damaged, and the ability to live a daily life is lost, and they need complete care from others, palliative care is particularly important at this time. Palliative care is based on the principle of reducing pain and maintaining the dignity of patients, and aims to improve the comfort of patients. It provides active physical, psychological, spiritual and other aspects of care and humanistic care for patients. For example, conservative measures can be taken as appropriate for infection problems, instead of using antibiotics; oral feeding can be continued, instead of leaving a nasogastric tube or gastrostomy; medication is used for analgesia and symptomatic treatment; unhelpful drugs are discontinued; music and other methods are used to comfort patients, etc.

Empowering caregivers and reducing the burden of care

At present, dementia patients in my country are still mainly cared for at home. Long-term care for dementia patients brings a heavy burden to caregivers and seriously affects their quality of life. The psychosomatic state of caregivers determines the quality of life of patients. Therefore, it is recommended to empower caregivers, including empowerment education and supportive services; form a multidisciplinary team, including psychiatrists, psychologists, community nurses, social workers, senior caregivers, volunteers, etc. to provide empowerment education and help for caregivers. This helps to improve the self-efficacy of caregivers, promote positive psychology, and give play to their subjective initiative, thereby improving the outcome of care.