November 1, 2016
What should complete care for neurodegenerative patients look like?

While the underlying pathology for every case of dementia is similar, personal circumstance causes an individuality within neurodegenerative disease progression that should be viewed in conjunction with the classical pathology to avoid misinterpretation of symptoms. The needs of these patients are a complex combination of psychosocial and medical treatment within a clinical support system.

 

It is vital to keep patients with neurodegenerative diseases from regressing, by sustaining all types of cognitive stimulation. Danny BenMoshe, M.D., a neurologist at Cedars Sinai Medical Center in Los Angeles, recommends that residents participate in group social activities, and individually challenging mental and physical tasks. Consistent scheduling is very important to establish memory based on routine, dependable social stimulation and lack of paradigm shift in sleep for the patient. Invariable staff assignments allow proper anticipation of the distinct patient’s needs. For patients with severe progression, fall prevention should be implemented. Recent innovations have included movement- triggered alarms on beds designed to alert nursing staff that a patient has left their bed, and easily navigable interior design.

 

Many facilities, like the Richmond Center in New York have found that it is ideal to embed a platform for therapeutic interventions on site after initial diagnosis. Resolutions for platform intervention can comprise of a separate unit or floor for neurodegenerative patients. These areas have higher staff to patient ratios, with training and certifications required. Staff at the Richmond Center, go through a Behavior Intervention Specialist Certification Program (BISCP) teaching applied behavioral analysis. The staff is trained to look at specific behaviors of the individual that manifest through their disease progression rather than relying on classical pathology, to best treat the patient. The distinctions between care at each stage of the disease progression, should lead to different care by skilled nursing staff. The challenge is not to regiment treatment and have an adaptable staff that can redirect their patients appropriately.

 

By the same token, antipsychotics should not be used to try to treat behaviors, as the behavior variance for each individual is drastic. Antipsychotics and antidepressants are commonly prescribed for dementia stimulated depression and agitation respectively. However, they are under a black label according to the Food and Drug Administration for an increase in morbidity. These medications must be closely monitored to ensure that there is no progression into cardiac complications, and so comorbidities are not masked. This can often be seen in cases of delirium. It is important to investigate the underlying cause of a delirium state rather than write off the delirium as dementia related agitation. Delirium can be the result of many problems including intestinal infection, low blood sugar, pain and dehydration, says BenMoshe.

 

Through this more complete interpretation and treatment of classical computational neurology, escalation of diseases like dementia may be slowed.

 

 

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Half of all Americans after age 80 will develop some degree of dementia.

 

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It is vital to keep patients with neurodegenerative diseases from regressing by sustaining all types of cognitive stimulation

 

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Image of Dr. BenMoshe is attached