February, 2017
Estimates of the number of people suffering from dementia or Alzheimer’s disease (AD) vary widely. The National Institutes of Health’s first nationally-representative population-based study, published ten years ago, estimated that among Americans aged 71 and older, 13.9% had dementia and 9.7% had AD. With the number of Americans aged 65 and older estimated to exceed 70 million by 2030, there is an urgent need for more and better strategies to help patients and families manage these devastating conditions.
Improving outcomes in dementia and AD are top priorities of Michigan Medicine’s Geriatrics Center. Specialists in geriatric medicine, geriatric social work, geriatric psychiatry and geriatric neurology collaborate to deliver comprehensive care and compassionate support to dementia patients and their loved ones.
The Geriatric Psychiatry team provides expert diagnosis and treatment of later life mood and cognitive changes, including the Behavioral and Psychological Symptoms of Dementia (BPSD), which up to 98% of dementia patients experience at some point. These symptoms include irritability, agitation, depression, anxiety, sleep problems, aggression, apathy and delusions.
It is these behaviors, rather than the memory or physical changes associated with a given dementia type, that drive the placement of patients in long-term care facilities, increases in health care utilization, and increases in caregiver stress.
Our approach to BPSD
Changes to thinking and memory can be caused by many things. At Michigan Medicine, our first line strategy is always to detect and treat the “reversible causes” of these changes, including:
- Depression, bipolar illness, schizophrenia or anxiety
- Medication interactions or side effects
- Substance use
- Undiagnosed medical issues like thyroid disease, anemia, autoimmune, infectious or inflammatory processes
All of these have the potential to masquerade as dementia. If diagnosed and treated, the cognitive symptoms can be reversed.
If these medical conditions are ruled out as the cause of changes in memory or cognition, our focus shifts to modifying the patient’s environment and/or providing the caregiver(s) with different approaches to improve quality of life. Recent Michigan Medicine research confirms that the best clinical outcomes are seen in non-pharmaceutical interventions including:
- Providing education for the caregiver
- Enhancing effective communication between the caregiver and the person with dementia
- Creating meaningful activities for the person with dementia
- Simplifying tasks and establishing structured routines
- Ensuring safety and simplifying and enhancing the environment around the patient, whether in the home or the nursing/assisted living setting
Medical management is explored after these avenues have been pursued.
Researchers within Michigan Medicine’s Program for Positive Aging have developed and tested an innovative framework that doctors and caregivers can use to make the most of what’s already known. Called DICE for Describe, Investigate, Evaluate, and Create, it tailors approaches to each person with dementia, and as symptoms change.
To learn more about Michigan Medicine’s Geriatric Psychiatry Program, visit our website.
Additional Information: Recognizing and responding to some of the most troubling dementia syndromes
Learn about Lewy Body Dementia and the U-M Rinne Lewy Body Dementia Initiative, and read a list of questions Michigan Medicine experts have compiled to help doctors recognize the condition.
Learn about Capgras Syndrome, characterized by delusions that a loved one has been swapped for an imposter.