Severe dementia: diagnosis, patient management, prevention of complications

Abstract

Timely diagnosis and the early start of therapy for cognitive impairments (CI) are extremely important. Unfortunately, there is a serious problem of belated CI diagnosis (it is often diagnosed only at the stage of severe dementia). The article discusses the current CI classification by the severity level. Special attention is paid to clinical symptoms, diagnostic criteria, and the basic principles of managing dementia patients. The differences in the severity levels of dementia are discussed in detail; special attention is given to severe dementia. It is noted that the presence of severe dementia in the patient is indicated by permanent dependence on physical assistance. The demand for structuring the clinical assessment of the state of cognitive functions and of the CI influence on daily activity is emphasized. For this purpose, it is recommended that special clinical scales listing cognitive symptoms that are most typical of various stages of cognitive deficit are used. The Clinical Dementia Rating (CDR) Scale is one of the well-proved scales. The main approaches for managing patients with severe dementia, including modern drugs for correction of CI and behavioral disorders, are discussed. The possibility and advisability are discussed for treating severe dementia with acetylcholinesterase inhibitors and/or a competitive blocker of the NMDA-receptor, memantine. Special attention is paid to behavioral disorders in patients with severe dementia. These disorders require both the medication correction and psychological support from relatives. The critical significance is emphasized for the proper patient care and for the correction of associated disorders, including pelvic disorders. Neurogenic inappropriate urination often accompanies the manifestations of CI and other neuropsychiatric disorders in patients with severe dementia. The main groups of medications that are used for drug therapy of this condition, as well as possibilities for using modern absorbents and care agents, are discussed.