University Dementia Care Report: Treatment of Involuntary Movement

This report delves into the treatment of people with dementia, specifically addressing involuntary movement, a common symptom of the disease. It begins by defining dementia and its progressive cognitive degeneration, which can lead to impairments in movement, cognition, and behavior. The report highlights Lewy body dementia, detailing its causes, impact on movement, and the spectrum of neurodegenerative disorders it encompasses. It then explores various management strategies, including environmental modifications, occupational, physical, and speech therapies, and the use of medications like cholinesterase inhibitors and memantine. The report also discusses the management of hallucinations and sleep disorders, emphasizing the importance of empathy, psychotherapy, and environmental adjustments. Additionally, it mentions other therapies like music and art therapy, and the importance of social support and counseling. The report references key research and guidelines in the field of dementia care.

Running head: DEMENTIA CARE
DEMENTIA CARE
Name of Student
Name of University
Author note

1DEMENTIA CARE
TREATMENT OF PEOPLE WITH DEMENTIA (WEEK 2, INVOLUNTARY
MOVEMENT)
Dementia leads to progressive cognitive degeneration which interferes with the
subject’s functional independence (Chertkow, et al. 2013). Dementia symptoms are
progressive and persistent. Patients with dementia suffer from changes in cognition,
movement, sleep pattern and behavior. Dementia’s clinical presentation of dementia is often
individualistic – the cognitive deficits can express as memory loss, language and
communication impairments, agnosia (unable to recognize known objects), an impaired
execution function (judgment, reasoning, planning), apraxia (unable to perform pre- learned
tasks). Cognitive impairment can result from injury to higher cortex followed by synaptic
damage, inflammation and shift of cerebral metabolism. Lewis body dementia is associated
with movement problems, cognitive fluctuations, impaired rapid eye movement sleep and
management should be symptomatic. Lewy body dementia is a progressing
neurodegenerative disease which occurs due to aging. The disease affects over almost
100,000 Australians. Lewy body dementia causes gradual degeneration of brain structures. It
occurs due to an abnormal build up of alpha-synuclein (a protein) in brain neuronal cells.
These abnormalities spread to specific functional areas of cortex, affecting pattern of
movement, behavior and thinking. Lewy body disease with multiple pathophysiology and
complex pathways manages to manifest three neuro-degenerative disorders such as dementia
with Lewy bodies, Parkinson’s disease, Parkinson's disease dementia ("Dementia Australia |
Lewy Body resources", 2019). This overlap causes a spectrum disease.
Slow movements, shuffled walk, incoordination are chief movement problems
associated by Lewy body dementia (Walker et al., 2015).Managing movement problems
involves managing a person's behavior, calming him down and first changing the
environment to facilitate motor function. Formulating daily routines while using different

2DEMENTIA CARE
medical therapies like occupational therapy, physical therapy, speech therapy, is important to
daily care. Activities of daily life training, neuro-rehabilitation approaches Bobath
approaches can be used to re-edcation movements. Frenkel’s exercises are used as a
physiotherapy treatment to treat incoordination. Proprioceptive neuromuscular training along
with muscle relaxants can be used to management muscle stiffness. The caregivers and health
professionals should encourage activities and exercise. Planning activities for dementia
subject that he enjoys is important. Painting, gardening, dancing, re-creative activities can
help a dementia patient get on with his regular life with better presentation of motor
skills. Exercise can patients with dementia. Exercises improves cardiovascular health, blood
circulation, muscle oxygenation and strength. Exercise also assists in protective mechanism
to keep brain from the developing dementia, in combination with healthy balanced diet along
with medications preventing risk factors of cardiovascular disease.
Depression, extreme confusion, difficulty in concentrating and attention are
symptoms to be managed as a priority (Laver et al., 2016). The drugs used are cholinesterase
inhibitors that act on a neurotransmitters in the brain which are vital for memory along with
thinking processes. Acting on neurotransmitters, they improve hallucinations, delusions and
apathy (Wang et al., 2015). Rivastigmine is used to treat cognitive symptoms presented in
Parkinson dementia complex. Other drugs are still on test for possible treatments of LBD
symptoms which acts by disrupting the very underlying pathophysiology. Medications used
for Alzheimer's disease can be used in dementia to check behavioral problems and
hallucinations. Cholinesterase enzyme inhibitors like donepezil (Aricept), galantamine
(Razadyne) acts by increasing levels of the neurochemical messengers producing memory
and judgment. Memantine (Namenda) acts by regulation of glutamate – the inhibitory
neurotransmitter optimizing and regulating brain functions in a negative loop, in memory and
learning. The drug emantine can be used along with a prescribed cholinesterase inhibitor.

3DEMENTIA CARE
Hallucinations and sleep disorders (Schenck, Boeve & Mahowald, 2013) can be
dangerous to the survival of the patient. Empathy, psychotherapy, modification of
environment are the first line of treatment for hallucination. Educating and making the patient
realize about de- realization is vital to restrain danger due to hallucinations. Occupational
therapy is important to remove an object of danger from the immediate surroundings of the
patient. An occupational therapist can teach the patient about various coping behavior. The
main purpose of occupational therapy is to stop accidents and falls, managing patient
behavior, preparing the patient and his caregivers for dementia’s later progression. Sedatives
plus antidepressants is used to ensure a deep non dream sleep. Journal keeping is useful to a
patient trying to fight cognitive distortions.
Dementia is a complex neurocognitive disorder and needs to be managed holistically
with pharmacological, non-pharmacological and other therapies. Other therapies reduces
agitation, promoting relaxation in people with Lewy body or any form of dementia. Music
therapy and art therapy, which involves creating art can alter impaired brain waves to
synchronized ones, focusing on learning process, rather than the final outcome. Joining a
social group, counselling are important supplements as well.

4DEMENTIA CARE
References :
Chertkow, H., Feldman, H. H., Jacova, C., & Massoud, F. (2013). Definitions of dementia
and predementia states in Alzheimer's disease and vascular cognitive impairment:
consensus from the Canadian conference on diagnosis of dementia. Alzheimer's
research & therapy, 5(1), S2
Dementia Australia | Lewy Body resources. (2019). Retrieved from
https://www.dementia.org.au/resources/lewy-body-resources
Laver, K., Cumming, R., Dyer, S., Agar, M., Anstey, K., Beattie, E., ... & Dietz, M. (2016).
Clinical practice guidelines for dementia in Australia.
Schenck, C. H., Boeve, B. F., & Mahowald, M. W. (2013). Delayed emergence of a
parkinsonian disorder or dementia in 81% of older men initially diagnosed with
idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a
previously reported series. Sleep medicine, 14(8), 744-748.
Walker, Z., Possin, K. L., Boeve, B. F., & Aarsland, D. (2015). Lewy body dementias. The
Lancet, 386(10004), 1683-1697.
Wang, H. F., Yu, J. T., Tang, S. W., Jiang, T., Tan, C. C., Meng, X. F., ... & Tan, L. (2015).
Efficacy and safety of cholinesterase inhibitors and memantine in cognitive
impairment in Parkinson's disease, Parkinson's disease dementia, and dementia with
Lewy bodies: systematic review with meta-analysis and trial sequential analysis. J
Neurol Neurosurg Psychiatry, 86(2), 135-143.