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Chapter 15

PSYC 3140 Chapter 15 Treatment.docx

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York University
PSYC 3140
Kendra Thomson

TREATMENT: AN OVERVIEW - huge damage to brain caused by dementia o brain contains billions of neurons – damage to some can be compensated by others b/c of plasticity o limit to how many neurons can be destroyed before vital functioning disrupted o Research focused on regeneration of neruons to reverse damage caused by dementia o No known treatment for extensive brain damage - Goals of treatment o 1. Prevent conditions (eg. sub abuse) that can lead to dementia o 2. Delay onset of symptoms to inc quality of life o 3. Help ind / caregivers cope with advancing deterioration o most treatment focus on goals 2-3  bio treatments aimed at stopped cerebral detrioration, psychosocial treatments helping patients/caregivers cope - over half of caregivers of ppl w/ dementia (usually relatives) become clinically depressed o 2X likely to develop depression (compared to gen pop) o use more psychotropic meds, report stress symptoms at 3X normal rate - Film Away from Her  depics decline of Fiona’s cog abilities from Alzheimers o Burden on husband – decides to put her in nursing home for ppl w/ dementia to relieve burden Biological Treatments - Dementia due to known infectious diseases, nutritional deficiencies and depression can be treated if caught early - No known treatment for most types of dementia o Dementia from stroke, HIV, Parkinson’s disease and Huntington’s disease aren’t treatable, no effective treatment for primary disorder - Glial cell-derived neurotrophic factor (GDNF) – subs that preserve/restore neurons  maybe able to reduce/reverse progression of degenerative brain diseases - Potential bneefits of transplanting stem cells (from fetal brain tissue) into brains of ppl o Promising resutls - Dementia from strokes – might be preventable from new drugs that prevent damage caused by blood clots of stroke - Most treatment focused on dementia for Alzheimer’s type b/c if affects so many ppl - Much work directed at developing drugs that enhance cog abilities of ppl w/ dementia from Alzheimers o Effective initially, but no long-term improvements in placebo- controlled studies o Cholinesterase inhibitors –fam of drugs that have had modest impact on cog abilities in patients  Include donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl) o Tacrine hydrochloride (Cognex) – fam of drugs, rarely used today b/c can cause liver damage  Prevent breakdown of neurotransmitter acetylcholine (which is deficient in ppl w/ Alzheimer’s)  making more acetylcholine available to brain  When using these drugs, ppl’s cog abilities improve to point where they were 6 mos earlier  no permanent gain, ppl don’t stabilize on drug, cog abilities cont to decline in Alzheimers  If stop taking drug (almost ¾ of patients due b/c of neg side effects eg. liver damage, nausea) they lose the 6 mo gain - New drugs to treat Alzheimers o Drugs that target the beta-amyloid (plaques) in brain - Ginkgo biloba (maidenhair) to improve memory o Initial research – herbal remedy can moderately improve memory of ppl w/ Alzherimers – not all studies replicated benefit - effects of Vit E o large study – in inds w/ moderately severe impairment, high doses of vitamin (2000 international units per day) delayed progression compared to placebo  but didn’t prevent development of disease o other research – taking high doses of vit E can inc mortality, intervention no longer recommened - Modest slowing of progression through exercise - No medical interventions available that directly treat/ stop progression of conditions that cause cerebral damage Psychosocial Treatments - focus: to delay onset of severe cog decline o focus on enhancing lives ofppl w/ dementia/ fams - ppl w/ dementia taught skills to compensate for lost abilities o eg. making maps on own to get from place to place o eg. “memory wallets” (Bourgeois) – help ppl w/ dementia carry conversations  on white index cards inserted in plastic wallet are printed declarative statemetnts eg. “My husband John and I have 3 children” or their birthday, where they are from…  Study (Bourgeious): 6 adutls w/ dementia could, w/ min training, use this memory aid to improve conversations  3 of adults used memory wallets w/ ppl who hadn’t been involved in training (ie. Their children) - Cognitive stimulation – practice learning / memory skills – effective method for delaying onset of severe cog effects o Eg. word games, memory tests of famous / familiar faces, practice numbers (eg. how much change would you get back) o Skill-building exercises maintain cog activity, improve quality of life - Impact of medical
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