Depression in Dimentia

Depression in Dimentia

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Introduction

Depression is a usual disorder that bedevils many people in the world. Research indicates that women are twice likely hit by the problem than men during their lifetime. The problem can occur at any stage of a person’s life regardless of their ethnicity, income, race, and education. Depression is a significant public health issue that brings about suffering, diminishes functioning and health and may lead to economic burden to the society, personal, and third-party payers. When proper treatment is not sought, the disorder may have a disabling influence that results in poor self-care, personal suffering, impaired personal relationships, and lack of follow-up of medical treatments, substance-use, and physical illness, loss of income, self harm, and even suicide (Storandt, 2003).

The subject under study is an elderly woman suffering from dementia. The woman was a client at Compcare. The reason for her choice is because assessment and follow-up gets easier and cheaper. Pharmacological medication is the form of treatment used for the patient. After she got diagnosed with dementia, depression set into her life. The study took a period of one month. It started on May 23rd, 2013 and ended on June 23rd, 2013. Most studies on dementia focuses on clinical recognition, prevalence, assessment, and treatment. The above study focuses on dementia and the effectiveness of various intervention methods. The client was under the supervision of a therapist and the agreement made was for her to cut down on screaming, cursing, and wandering. Counting the number of times the client defaulted those agreements formed the basis for asssessment. The subject signed an Informed Consent Form (Appemdix).

Dementia is a group of symptoms brought about by disorders and diseases that affect the brain, including (AD) Alzheimer’s disease, strokes, (PD) Parkinson’s disease, and much more. It involves continuous loss of memory and other cognitive senses such as emotional control and problem solving. Research shows that the earliest stage that one gets diagnosed with the problem is commonly called MCI (mild cognitive impairment). As the problem advances, the victim’s ability to conduct instrumental and daily activities gets impaired.

In the year 2005, nearly 24.3 million people in the world had dementia and 4.6 million new cases crop-up annually. This number, according to some scholars will double after every 20 years. WHO (world health organization) report (2003) shows AD and other dementias ranked as the fourth course of problems and burden in adults 60 years old. The other diseases that outranked dementia include chronic obstructive pulmonary disease and heart disease. AD is the most prevalent type of dementia, followed by VaD (vascular dementia), FTD (frontotemporal dementia), PD associated dementia, and DLB (dementia with Lewy bodies (Thompson, 2006).

Psychological and behavioral signs of dementia (BPSD), also called neuropsychiatric symptoms of dementia, affect almost all with dementia during illness and often manifest during the first stages. Developed classifications on dementia indicate that BPSD falls into two groups. One is behavioral and the other is psychological. Behavioral gets identified through observation of the patient, and include wandering, screaming, restlessness, sexual disinhibition, cursing, physical aggression, hoarding, shadowing, and culturally unexpected behaviors. Caregivers and patients give psychological symptoms such as anxiety, depressive moods, delusions, and hallucinations.

BPSD have adverse effects in older adults. They cut their quality of life of a patient, increase functional and cognitive decline, and get linked with increased mortality. Moreover, these symptoms give stress to caregivers, and get associated with advanced rates of depression in caregivers. They also add to the risk of institutionalization. Managing dementia costs close to a third of the total cost of caring for dementia.

Behavioral symptoms of dementia are usually more distressing and plain to observers than psychological signs, and are generally more common in medium to severe dementia. However, psychological signs may bring more harm to the patient during the earlier instances of dementia, as victims develop insight about the effect of the diagnosis on their future life.

For the patient picked, the use antidepressants and antipsychotics was the main form of medication. The woman had more adverse effects of depression in dementia compared to other patients. Men generally suffer less than women from depression in dementia.

Intervention and rationale

The symptoms exuded by the woman called for an intervention. Screaming, undesirable behaviors, wandering, and restlessness characterized her behavior. These problems formed the basis for the study and treatment. The medication options sought targeted reduction of such behaviors. The treatment option that this document discusses gets based on the most proper approach for reducing depression in dementia. Pharmacological medication is the treatment option used. The form of intervention used was for the patient to reduce most of these behaviors. The exact behaviors under study are: screaming, cursing, and wandering. A reduction in the number of undesirable behaviors would result in a handsome shopping from me and a waiver for her medication. An increase would lead to no waiver and no shopping at all. No behavioral change meant moderate help. This is the most effective method as behavioral change is accompanied by a reward. Rewarding the patient stimulated her behavioral change.

The client was under the supervision of a therapist. The therapist administered treatment to her as he checked her progress. There are both non-pharmacological and pharmacological treatment approaches for the problem. The two intervention methods help in cutting down the depression associated with dementia among older adults. Many forms of medications get used, and have varying degrees of success. Non-pharmacological treatments like structured activity programs and behavioral change programs reduce depression, but with modest outcomes. Dosing with gingko biloba extract is a new technique of intervention that has registered success (Rabins, Lyketsos, & Steele, 2005).

Pharmacological treatment got preference to other forms of treatments as it has a higher degree of success compared to other forms of treatment. It works better than non-pharmacological options, which has moderate outcomes.

Pharmacological treatment for depression in dementia

Neurotransmitters or receptors targeted by pharmacological therapists include amino acid receptors, cholinergic receptors, and catecholamine receptors. Clinicians have difficulties in treating depression with dementia. Old patients with dementia bear greater comorbid illnesses than non-demented peers, with almost three-fifths of those with AD bearing 3 or greater. This increased level of comorbidity comes from use of many medications. Therefore, polypharmacy and drug interactions help provoke depression in some patients diagnosed with dementia. Because older adults with dementia have cognitive and physical frailties, they are also susceptible to other adverse effects. Caregivers and clinicians must see patients’ behaviors carefully for evidence of adverse effects when new treatments get introduced because dementia patients communicate rarely. Medication options for the elderly should always take a slow approach. They should start slowly and continues slowly (Sarbadhikari, 2005).

Antidepressants

Antidepressants get prescribed on continuous basis for older adults with dementia. A recent analysis, in 2007, endorsed treatment of depression with selective serotonin reuptake inhibitors and tricyclic depressants in patients with dementia. The research findings of the analysis indicated that remission and patient treatment response got superior to the placebo response in the joined effort from all the studies. Other reviews support treatment with various antidepressants, such as fluoxetine, trazodone, movlobemide, and sertraline, on depression in dementia. Citalopram and sertraline get commonly prescribed. Reviews show trazadone and mirtazapine as other options but there are fewer trials that support their use.

Antipsychotics

Different categories of antipsychotics treat depression with varying levels of success. However, older adults with dementia who take haloperidol are at a significant risk of extrapyramidal signs including tardive dyskinesia and parkinsonism. Because of the above reason, most clinicians focus on “atypical” antipsychotics like olanzapine and risperidone, which have vital, thought moderate, effects, and fewer adverse effects than typical antipsychotics at lower doses.

Care is very imperative as both olanzapine and risperidone have increased risks of stroke and associated mortality, and many safety warnings limit their use for treatment of depression in older adults with dementia. There are disagreements over the real risk involved and people suggest that increased cardiac arrest occur at high doses. Other scholars claim that patients of stroke have other risk factors besides the use of risperidone in dementia (Hay, Klein, & Hay, 2003).

Reduced cholinergic activities, mainly resulting from reduced acetylcholine concenctrations brought about by dementia-linked changes; result from decreased cognitive ability in dementia, and increases in BPSD. Cholinesterase inhibitors, including tacrine and donepezil, gets used in targeting increasing levels of acetycholine, with success, especially in patients with mild to medium dementia. A review on the effects of rivastigmine on BSPD shows that there are positive effects on patients with a range of dementia, and that anxiety and apathy form the list of behavioral domains showing the most consistent positive response.

Results

The above approach forms one of the most significant methods of treating depression in dementia. After a period of six months whereby the patient was under scrutiny and medication, good results got registered. The patient improved greatly and emerged with less stress than her first state. Earlier symptoms such as restlessness and screaming ceased completely.

The use of pharmacological approach for treatment of depression with dementia is very proper and effective. Antidepressants and antipsychotics have varying levels of success on reduction of depression in dementia. The use of various forms of antipsychotics and antidepressants served the purpose. They greatly cut down on the level of depression for the elderly woman. Since the medication worked well, this paper recommends its use.

EMBED Excel.Chart.8 s

Day of the week Behaviour Total tally

screaming wandering cursing Monday 10 8 12 30

Tuesday 8 6 10 24

Wednesday 4 4 8 16

Thursday 6 3 9 18

Friday 5 3 7 15

Saturday 2 2 6 10

Sunday 2 3 4 9

References

Hay, D. P., Klein, D. T., & Hay, L. K. (2003). Agitation in Patients With Dementia: A Practical

Guide to Diagnosis and Management. Arlington: American Psychiatric Pub.

Rabins, P. V., Lyketsos, C. G., & Steele, C. (2005). Practical dementia care. New York: Oxford

University Press.

Sarbadhikari, S. N. (2005). Depression and dementia: Progress in brain research, clinical

applications, and future trends. New York: Nova Science Publishers.

Storandt, (2003). Neuropsychological assessment of dementia and depression. American

Psychological Association.

Thompson, S. B. N. (2006). Dementia and memory: A handbook for students and professionals.

Aldershot, England: Ashgate.

Appendix

CONSENT TO PARTICIPATE IN A SINGLE SYSTEM RESEARCH DESIGN

I am aware that this research design is being conducted by D.C., who is a Graduate Student in the Rutgers University School of Social Work. This intervention is to fulfill the requirements of a mandatory assignment for Research II, Section 19:910:595, with Professor Raymond Sanchez-Mayers.

The purpose is to measure the effect that moderate exercise, antipsychotics and, antidepressantswill have on my Dismentia. I am the only subject participating in this intervention.

The intervention will take 30 days to complete. The data recorded will be on Compcare wher I am recently receiving medication.

I understand that the following requirements are necessary for this intervention:

Week 1 (Days 1-6) – ingestion of antidepressants

Week 2 (Days 7-12) – ingestion of antidepressants and antipsychotics

Week 3 (Days 13-18) – ingestion of antidepressants and antipsychotics and moderate exercise

Week 4( Days 19-28)- exercise only

Every effort will be made to stick to the set schedule for my assesment. The Intervention consists of 10 minutes of warm-up, 15 minutes of brisk walking/slow jog, and 10 minutes of cool down after undergoing pharmacological medication.

I realize that there are risks involved with any exercise program. I agree to stop the intervention if at any time I feel pain, shortness of breath, or any other symptom of discomfort that seems above and beyond normal exercise symptoms.

It is understood that the benefits of exercising have been shown to parallel a healthy lifestyle, which my focus and reason for volunteering for this research project. I hope to have this be the incentive for me to continue exercising on a frequent basis.

il(student) for my participation.

If I have any questions about this research that D.C. is not able to answer, or any complaints regarding this intervention, I may contact Professor Sanchez Mayers at:

Rutgers, The State University of New Jersey

School of Social Work

536 George Street

New Brunswick, NJ 08901

(732) 932-7520 Ext. 111

Email: write email

Signature on FileSignature on File

_____________________________________________________________

D.R.L. – Research Subject D.C., Student

Date: May 23, 2013