Dementia care.
Part 2: understanding
and managing beiiaviourai chaiienges
Abstract
Management of dementia should focus on the maintenance of
function and independence for the person with the disease. Non-
pharmacological interventions to manage dementia include
reality orientation, aromatherapy and validation therapy. Non-
pharmacological ways of managing challenging behaviour are
recommended in current guidance. Drug treatments, which may
stahiUze the symptoms of Alzheimer's disease or slow down further
progression for a time, have heen availahle in the United Kingdom
since 1997 and may help some people with dementia. There are high
levels of stress, distress and psychological illness in family caregivers of
individuals with dementia, and practitioners are well placed to signpost
carers to appropriate support organizations.
Key words: Girers • Challenging behaviour • Dementia
P
art 1 of this series on dementia care provided an
outline of recent dementia care guidance and the
Mental Capacity Act 2005, in addition to giving
practitioners a brief overview of the different forms
of dementia, the assessment process, and how to differentiate
between dementia, delirium and depression.
This article explores the management of dementia (focusing
on challenging behaviour), which includes use of psychosocial
interventions and available drug treatments. Coping strategies
and tips on effective communication are provided. It also
highlights the need for all practitioners to be aware of the
contribution informal carers make in caring for people with
dementia and also to be cognisant of what support is available
for carers to ensure timely referral to such services.
Person-centred care
One of the aims of management is to promote independence
for the individual and maintenance of fiinction for as long as
Emma Ouldred
is Dementia
possible underpinned by the philosophy of person-centred
Nurse Specialist
care (National Institute for Health and Clinical Excellence
and Catherine [NICE], 2006), whereby the person with demetia is seen as an
Bryant is individual, rather than focusing on their illness and on abilities
Consultant they may have lost. Instead of treating the person as a collection
Physician, King's of symptoms and behaviours to be controlled, person-centred
College Hospital care takes into account each individual's unique qualities,
NHS Trust, abilities, interests, preferences and needs (Kitwood, 1997)
London
Accepted for Information
publication: Following a diagnosis of dementia both the patient and their
January 2008 carer are likely to need information and ongoing support
about the condition and the implications for the future.
242
Emma Ouldred, Catherine Bryant
including the course and prognosis of the condition, available
treatments, and support available from both voluntary and
statutory organizations. The provision of written information is
recommended and the Alzheimer's Society provides a variety of
information sheets about all aspects of dementia and dementia
care (www.alzheimers.org.uk).
Coordination of care and care pianning
Care for the person with dementia needs to be coordinated
across both health and social care agencies, and may involve
different specialists within the multidisciplinary team at
certain time-points. Ideally care should be coordinated by
a case manager. Care plans should address activities of daily
living (ADLs), which maximize independent activity, enhance
function, adapt and develop skills, and minimize the need for
support (NICE, 2006). Care plans should consider:
Consistent and stable staffing
Retaining a familiar environment
Minimizing relocations
Flexibihty to accommodate fluctuating abilities
Assessment and care planning advice regarding ADLs and
ADL skill training from an occupational therapist
Assessment and care planning advice about independent
toileting skills. If incontinence occurs all possible causes
should be assessed and relevant treatments tried before
concluding that it is permanent
Environmental modifications to aid independent functioning,
including assistive technology, with advice from an
occupational therapist and/or clinical psychologist
Physical exercise, with assessment and advice from a
physiotherapist when needed
Support for people to go at their own pace and participate
in activities they enjoy
The needs of carers.
Cognitive stimuiation
Current guidelines recommend that all people with mild to
moderate dementia are offered cognitive stimulation, and the
effects may add to the effects of drug treatment (NICE, 2006).
Cognitive stimulation can be defined as engagement in a range
of activities and discussions aimed at general enhancement of
cognitive and social flinctioning (Clare and Woods, 2004). It
may occur informally through recreational activities, formally
through group programmes that are designed to stimulate or
engage people with dementia, or through training exercises
designed to address specific cognitive fianctions. Cognitive
rehabilitation programmes are usually individually tailored and
target specific goals (Clare and Woods, 2004).
British Journal of Nursing, 2008,Vol 17, No 4

Pharmacological interventions
Drug treatments for Alzheimer's disease
There is currently no known cure for Alzheimer's, but
there are drug treatments available (cholinesterase inhibitors
[ChEIs]), which may stabilize or slow down the progression
of the disease. They work by helping to stop the depletion
of the chemical neurotransmitter, acetylcholine (deficiency
of acetylcholine occurs in Alzheimer's and is related to both
cognitive and non-cognitive symptoms) (Figure 1) (Francis
et al, 1999). ChEIs may help cognitive symptoms, such as
memory loss, and patients and carers might report a positive
effect on activities of daily living, behaviour and mood. They
are effective in the mild to moderate stages of disease. There
are three drugs currently available in the United Kingdom
(UK): Aricept®, Exelon® and Reminyl®. Common side-
effects include anorexia, diarrhoea and stomach cramps. Rare
side-effects include nightmares and increased confusion. Not
all individuals with Alzheimer's wOl respond to treatment - a
third will show improvement, a third will not deteriorate and
a third will have no response and continue to deteriorate
(Overshott and Burns, 2005). ChEIs should only be prescribed
and monitored by specialists and the drug stopped if it is felt
not to be of benefit to the patient.
Memantine is licensed in the UK for moderate to severe
dementia. Memantine blocks a neurotransmitter, glutamate,
which is released in excessive amounts when brain cells are
damaged by Alzheimer's {Figure i) (Danysz et al, 2000).
NICE (2006) has recently issued guidance regarding the
availability of ChEIs on NHS prescriptions. It recommends
that these drugs should only be prescribed to people with
moderate Alzheimer's. NICE does not recommend the use of
memantine except as part of well-designed clinical trials.
Treatment for vascular dementia (VaD)
Currently ChEIs are not licensed for the treatment of VaD
in the UK. However, if the clinical picture suggests a mixed
form of dementia then they may be considered. Modification
of vascular vascular risk is widely recommended for the
management of vascular disease although long-term studies
directly addressing effect on cognition are lacking (NICE,
2006). The main aim of treatment for people with VaD
is to reduce their risk of further stroke damage through
modification of cardiovascular risk factors as stated below.
However, it is important to remember that modification of
vascular risk also needs to be addressed in all people with
dementia regardless ofthe dementia sub-type.
Modification of vascular risk factors includes (Alzheimer's
Society, 2005a):
• Treatment of strokes and transient ischaemic attacks
• Blood pressure control: people with dementia and carers
should be encouraged to comply with anti-hypertensive
medication and have their blood pressure checked regularly
• Management and treatment of hypercholesterolaemia: this
may be achieved through manipulation of diet alone or in
combination with the prescription of a statin
• Modification ofalcohol intake: people with dementia should
be advised to drink in moderation, i.e. no more than two units
ofalcohol per day (one unit is the equivalent of one shot of
spirit, a small glass of wine or half a pint of beer/lager)
British Journal of Nursing, 2008, Vol 17, No 4
NEUROSCIENCE NURSING
Figure 1. The action of cholinesterase inhibitors on acetytcholine (a); and memantine effect on glutamine (b).
Cholinergic Acetylcholine
Giutamate
nerve ending reduced to recognition site NMDA receptor in
inactive form by CNS neuron
choiinesterase Giutamate
Acetylcholine
Extracellular
Choiinesterase
Cytoplasm
Postsynaptic neuron
Choiiinesterase
Biocked by
hibitor memantine
Choiinesterase
(b)
• Smoking cessation: people with dementia should be
encouraged to give up smoking. Appropriate guidance
regarding smoking cessation clinics and methods to give up
smoking should be given
• Physical exercise: people with dementia should be advised to
exercise regularly, such as 30 minutes per day. This does not
have to be intensive gym activity but could simply mean a
walk in a local park
• Diet: advise to eat a varied low salt, low fat diet should be
given. Referral to a dietician may be required.
Treatment for dementia with lewy bodies (DLB)
There is some evidence that rivastigmine may help both
cognitive and non-cognitive symptoms in DLB (NICE, 2006).
Modification of vascular risk factors is also important in this
patient group.
Ciiallenging behaviour
Challenging behaviour can be defined as any behaviour that is
unpredictable, frequent and of long duration, and is distressing
to the individual or a nuisance to others (Table 1) (Tarbuck and
Thompson, 1995). Adverse behavioural symptoms associated
with the dementia need to be assessed thoroughly and a care
plan developed with the involvement ofthe individual and their
carer. Alleviation of carer burden should also be considered.
Neuropsychiatric and behavioural problems in older people
can occur in a number of different conditions, including
dementia, delirium, depression, paranoid states, and drug and
alcohol intoxication. More than 90% of people with dementia
develop neuropsychiatric symptoms at some stage during their
illness (BaUard and Howard, 2006) (Table 2). These symptoms
can be distressing for people with dementia and their carers, and
contribute to caregiver burden. They are often the precipitant
for admission to institutional care (Yaffe et al, 2002).
Neuropsychiatric symptoms (especially depression and apathy)
are also common in VaD. In DLB, the presence of delusions,
hallucinations and depression are a core part of the disease.
Challenging behaviour is often attributed to the dementing
process. However, while changes in the brain can cause
behavioural disturbance it is also important to consider other
factors which may be contributing to distressing behaviour.
243
 Possible causes of challenging behaviour
Background factors
Factors, such as personality, leisure and occupational activities,
and a person's habitual way of responding to stress, are
important to consider; for example, a person might wander
because they were used to walking in a previous occupation
(Monsour and Robb, 1982).
Current factors
These include medical and physiological factors, such as pain,
hunger, need for the toilet, and need for exercise.
Emotional state
Consider whether behaviour has been triggered by emotion,
such as boredom (people with dementia have a short attention
span but still require stimulating activities), anger or anxiety.
Neuropsychological deficits
Changes within the brain can cause functional deficits, such
as an inability to carry out complex tasks, which can then
lead to frustration.
Inability to orientate spatially
Changes within the brain can affect perception and spatial
awareness.This may result in a patient getting in the wrong bed
or not being able to put their clothes on in the right order.
Environmental factors
Environmental factors can contribute towards challenging
behaviour especially in the hospital setting. These include:
• Ward layout
• Proximity to other people
• Lacking control over routine (e.g. bed time and meal times)
• Being in a strange environment
• Unfamiliar tasks, such as catheterization and blood pressure
measurement
• Sensory stimulation overload: the general noise and
atmosphere of a busy ward can be overwhelming to a person
with dementia who sometimes find it difficult to make sense
of their usual home environment (Kerr, 1997).
Table 1. Examples of challenging behaviour in dementia
Behaviour Example
Difficult behaviour Refusal to'cooperate with therapy
Aggressive/ Verbai or physicai aggression, destroying objects around others
disruptive or self, e.g. trying to pull out catheters, rummaging through
iockers, interfering with other people's belongings, wandering
Deficient behaviour Behaviour may be hypoactive, apathetic or withdrawn
Tabie 2. Prevaience of neuropsychiatric symptoms
in Aizheimer's disease
• Apathy (loss of drive and motivation or lack feeiing or emotion) (50-70%)
• Agitation (excessive motor activity that may manifest as restlessness, wandering
and agitation) (20-60%)
• Depression and anxiety (40%)
• Psychotic symptoms such as hallucinations and delusions (25%)
Source: Ballard and Howard (2006)
244
Communication difficulties
People with dementia might not be able to communicate their!
needs verbally due to word-finding difficulty or dysphasia. i
Behaviour, such as calling out, agitation or wandering, might
be a way of communicating need.
Sundowning |
In dementia the sleep-wake cycle is often disturbed with '
individuals becoming more agitated or active at night (in [
some cases the cycle is reversed with individuals sleeping j
during the day and awake all night). 'Sundowning' refers to j
behavioural difficulties that worsen towards the end of the
day, with symptoms including: restlesness, agitation, suspicious j
behaviour, disorientation, visual and auditory hallucinations, '
less cooperation and increased argumentative tendancies. It
can often be worse after a move or change in routine. j
Although the cause of sundowning is unknown it seems to
result from changes within the brain and may be linked to a
lack of sensory stimulation after dark (Alzheimer's Australia,
2005); there are fewer cues towards late evening and less
routine at night which may exacerbate confusion. People with
dementia tire more easily and can become more difficult to
manage. This can often be very stressful for carers.
Coping with sundowning
• Keep person with dementia active during the morning and
encourage an early afternoon nap
• Avoid physical restraint, allow person with dementia to pace
if safe to do so; an evening walk is sometimes helpful
• Avoid caffeine towards late evening, and promote sleep by
providing hot milky drinks and gentle music
• Some people find it reassuring to sleep with the radio on
or night-lights
• Preparing the environment, such as closing curtains and
encouraging the person with dementia to assist in evening
meal preparation, may promote routine and reduce anxiety
• Consider whether loud noise from television might
exacerbate confusion
• Encourage participation in activities familiar from earlier
times such as card games
• Avoid invasive procedures towards evening if possible
• Make sure physical needs are met such as nutrition,
hydration, elimination, pain
• Exclude physical illness as a possible cause of sundowning.
Management of behavioural problems in dementia is often
multifactorial and needs to be tailored for the individual
patient. People with dementia should be managed by skilled
multidisciplinary teams, and psychiatric and/or psychology
expertise may be needed. Delirium and depression must
always be looked for and treated. Physical symptoms, such as
pain or constipation, should be treated. Sensory deficits should
be corrected. Good dementia care practice means that non-
pharmacological interventions should always be tried first.
Pharmacological interventions should only be considered if
there is serious distress or risk to the patient. Case Studies 1
and 2 describe unusual behaviour in dementia and encourage
practitioners to consider various possible causes of challenging
behaviour in addition to providing advice on how to adopt
non-pharmacological ways of managing such behaviour.
British Journal of Nursing. 2008, Vol 17, No 4
 NEUROSCIENCE NURSING

Case study 1. Unusual behaviour

Mr B suffers from moderate Alzheimer's disease. He also walks very slowly and wears glasses. He attends the local memory clinic and is wife is his
main carer. Mrs B reports to the dementia nurse specialist that over the past few weeks her husband has become much more agitated and has started
to become disoriented in his own home. She is particularly distressed cis he has started to pass urine in the waste paper basket, is getting up to use the
toilet frequently at night and is occcisionally incontinent of urine.

Possible causes of behaviour Possible solutions

Urinary tract infection
Nocturnal polyuria might indicate prostatic hypertrophy
Constipation
Mistaking waste paper bin for toilet due
to perception problems
Mr B might not see the toilet due to visual impairment
Mr B might not remember where toilet is in home
Mr B sometimes does not get to the toilet in time and is
incontinent due to limited mobility, and messages from
the brain are taking longer to get through due to the
dementing process
Dipstick urine. Encourage 2 litres of fluids a day
Seek medical advice
Establish normal bowel pattern. Mr B may need a rectal examination. Encourage high fibre
diet, increase fluids, consider aperients
Consider use of a commode or urine bottle but advise Mrs B to gently show her husband
where the toilet is
Ensure glasses are worn and regular eye checks are performed
Ensure a large sign is placed on toilet door with a picture of toilet and also the written word.
Keep a light on in the corridor at night
Encourage Mr B to use the toilet on a regular basis. Try establishing a 2 hour toileting regime.
Consider placing urine bottle near Mr B. Encourage elasticated, easy wear trousers and
underwear. Refer to district nursesforcontinence assessment and provision of continence pads

Communication and dementia Music therapy

As people with dementia lose the ability to use and
understand language, communication difficulties result in
frustration for the patient and caregiver (Alzheimer's Society,
2005b). However, for staff managing a confused patient there
are simple ways to improve communication {Table 3).
As the name suggests music therapy is an innovative way of
using musical improvisation (by chent and practitioner) to
create a healing environment. It has been shown to treat the
symptoms of dementia and improve quality of life for people
with dementia and carers (Alzheimer's Society, 2003).

Psyciiosociai interventions in dementia Reminiscence therapy

Recent guidance suggests that non-pharmacological/
psychosocial interventions for the management of non-cognitive
symptoms (such as hallucinations, delusions and anxiety) and
challenging behaviour should be considered in the first instance
unless there is an immediate risk of harm to the person with
dementia or others, or if there is severe distress then medication
might have to be used as a first line measure (NICE, 2006).
A range of approaches have been used although good quality
evidence of benefit for many is lacking (Livingston et al, 2005).
Qualitative evidence suggests that it is important to avoid
compounding feelings of failure and humiliation where people
with demenda have difficulty with interventions, activities and
games (NICE, 2006).
Complementary therapy
The benefits of aromatherapy and massage have been shown to
be an effective way of alleviating agitation in severe dementia
(Alzheimer's Society, 2003; Ballard and Holmes, 2004).
Multisensory stimulation
Multisensory therapy includes visual, auditory, tactile and
olfactory stimulation offered to clients in a specially designed
room. Stimulating music, lights, aromas, and objects are
offered to people with dementia in a non-sequential and
unpatterned fashion, which does not place great intellectual
stress on the patient. Multisensory stimulation/snoezelen
therapy reduced apathy compared with activity therapy or no
therapy in people with moderate to severe dementia (Verkaik
et al, 2005).
This involves the discussion of past activities, events and
experiences with another person or group of people, usually
with the aid of prompts, such as photographs, household and
other familiar items from the past and music. Reminiscence
groups typically involve group meetings in which participants
are encouraged to talk about past events. Life review
usually involves individual sessions, in which the person is
guided chronologically through life experiences and may
produce a life storybook. Reminiscence is interactive and
informative. Knowing a little about a person's past, hobbies
and experiences helps carers to understand an individual
better (Livingstone et al, 2005). Although evidence is lacking
for this intervention, it is widely used and not harmful to the
person with dementia.
Table 3. Communication advice
• Break down tcisks into manageable chunks
• Keep environmental noise to a minimum, e.g turn TV down
• Avoid hostile body language
• Remain pleasant, calm and supportive
• Maintain eye contact with your patient
• Use short sentences
• Speak slowly and wait for response
• Ask only one question at a time
• Keep the pitch of your voice low but ensure patient can hear you
• Point, touch, show, initiate a movement for the patient
• Talk to the main carer. How do they communicate with your patient? Do they
have any special advice?

British Journal of Nursing, 2008,Vol 17, No 4 245


Case study 2. The wandering patient
Mr N is a 73 year-old gentleman who has severe vascular dementia. He lives at
home with his family and is admitted to the local hospital for an endoscopy to
investigate anaemia. He has jDrofound word-finding difficulty.
Diagnosis
• Diverticular disease
• Osteoarthritis
• Hypertension
• Hypercholesterolaemia
• Previous exposure to asbestos
Has given up smoking but used to smoke a packet a week. He used to be a postman.
Current medication
Simvastatin 10 mg once daily (OD)
Aspirin 75 mg od
Bendrofiumethiazide 2.5 mg od
Quetiapine (atypical antipsychotic) 25 mg per night (nocte)
Lorazepam (benzodiazepine) 0.5 mg when required (prn)
Beiiaviourai probiems
• Mr N wanders around the ward during the day but especially at night
• He is disinhibited and walks around with his trousers unbuttoned
• He interferes with other patients and their belongings
• He tries to pick up imaginary items from the fioor
This upsets other patients and staff, and increases his risk of falls. However,
this behaviour is not new and his fcimily admit they lock him in at home.
Reasons for exiiibiting sucii beiiaviour
' Change of environment: Mr N is used to his own home and may be frightened
by hospital admission. Ask his family to bring in fcimiliar items for him such as
photographs
• Looking for somebody/something: Mr N feels insecure and needs reassurance
' Lacking stimulation: Mr N may be bored. Ask his family what activities he enjoys
doing at home
' Depressed: consider performing a Cornell Assessment of Depression in Dementia
Scale
' Sleeping too much in the day: encourage participation in activities and avoid naps
' Over-sedated: ask the medical team to review his medication especially quetiapine
and lorazepam
In pain: remember Mr N has other medical problems, such as osteoarthritis. and
may not be able to conceptualize pain and may be unable to verbalize his feelings
due to word-finding difficulty. Observe for non-verbal signs of pain such as posture
' Responding to hostility and negative body language: staff and other patients may
unwittingly exacerbate the situation by being aggressive towards Mr N. Remember
other patients need reassurance
' Continuing a habit: Mr N was a postman and was used to spending hours at a time
on his fieet. His wandering might be a result of pre-learned behaviour
• Consider environment. Is it safe for him to wander around a certain area of the ward?
Validation therapy
This is the process of communication with disorientated
elderly people by acknowledging and supporting their feeUngs
in whatever time or location is real to them, even though this
may not correspond to our'here and now' reality (Jones, 1985).
Rather than correcting factual errors in conversation, one seeks
to find out the real meaning behind communication.
Reality orientation
Reality orientation (RO) is aimed at reducing confusion and
inappropriate behaviours in people with dementia. RO can be
divided into a 24-hour or informal format and a classroom or
246
group format. The informal format depends on environmental
cues and memory aids, such as clocks, calendars, newspapers'
and incidental conversations that reinforce orientating content.
The classroom format involves small groups with similar levels
of cognitive function meeting several times a week to focus
on orientating tasks. The classic task is completing the reality
orientation board, which summarizes information such as
the day, date, place, weather, etc. In a systematic review RO
was shown to improve cognitive function and behaviour in
dementia (Spector et al, 1998).
Cognidve behavioural therapy (CBT)
CBT works by changing people s attitudes behaviour. Therapies
focus on thoughts, images and beliefs, and how this relates to
behaviour. Examples include progressive relaxation techniques,
which reduce agitation and anxiety (Prasher, 2005).
Environmental modification
Kerr (1997) suggests that environments might require
modification to make them calm, familiar and safe. Examples
of environmental modification include: wall colour, signage, the
structure of a building and flooring.
Psychological interventions with caregivers
Research evidence suggests that specific techniques
(psychoeducation) to teach caregivers how to change their
interactions with people with dementia may alleviate the
neuropsychiatric symptoms of dementia (such as agitation).
There is also some evidence to suggest that family counselling
can be helpful in reducing institutionalization of people with
dementia (Livingston et al, 2005).
Carers
There are over 4 million carers in the UK. One million
people provide care for more than 50 hours per week (Audit
Commission, 2004). Carers provide the vast majority of health
and community care. Their works saves the nation an estimated
/;87 billion per year (Carers UK, 2007).
There are high levels of stress, distress and psychological
illness in family caregivers of individuals with dementia
(Mahoney et al, 2004). Many studies have shown that the
incidence of depression in caregivers is high, ranging from
18-47% (Rosenthal et al, 1993; Teri and Traux, 1994), and
caregivers who are depressed experience higher degrees
of burden (Lawton et al, 1991). The degree of behavioural
problems in people with dementia appears to contribute to
caregiver burden (Baunigarten et al, 1994).
Support for carers
Over the past decade the needs of informal carers have been
recognized through legislation and government guidance.
NICE (2006) has recently set out comprehensive guidance
regarding the assessment, interventions and practical support
that should be available for carers.
NICE guidance on carer support
Assessment
Health and social care managers should ensure that the rights
of carers to an assessment of needs - as set out in the Carers and
British Journal of Nursing, 2008, Vol 17, No 4

Disabled Children Act 2000 and Carers (Equal Opportunities)
Act 2004 — are upheld. Carers' assessments should seek to
identify any psychological distress and the psychosocial impact
on the carer, including after the person with dementia has
entered residential care.
Interventions
Care plans for carers should include tailored interventions,
such as:
• Individual or group psychoeducation
• Peer-support groups tailored to the needs ofthe individual,
e.g. the stage of dementia of the person being cared for
• Telephone and internet information and support
• Training courses about dementia, services and benefits, and
dementia care problem-solving
• Consider involving the person with dementia and other
family members, as well as the primary carer
• Ensure support, such as transport or short-break services, is
provided to enable carer participation in interventions
• Offer psychological therapy, including cognitive behavioural
therapy, with a speciahst practitioner to carers who
experience psychological distress and negative psychological
impact.
Practical support
• Health and social care managers should ensure that carers
of people with dementia have access to:
- A range of respite or short-break services
- Services should meet the needs of both the carer (in
terms of location, flexibility, and timeliness) and the
person with dementia
- Services should include, for example, day care, day- and
night-sitting, adult placement and short-term and/or
overnight residential care
- Transport to these services should be offered
• Respite/short-break care should include therapeutic
activities tailored to the person with dementia provided in
an environment that meets their needs (the person's own
home wherever possible).
Conclusion
This article highlights the importance of coordinated care
and a person-centred approach to dementia care. It outlines
reasons why a person with dementia might exhibit behaviour
that challenges and provides useful coping strategies.
Non-pharmacological interventions in the management
of dementia can be therapeutic although more research is
needed to provide a greater evidence base.
Informal carers have a difficult task to perform and are
often isolated. It is hoped that practitioners will understand
the needs of carers better and also feel more confident in
directing carers to support organizations.
Part 3 moves onto the advanced stages of dementia. It
highlights the need for dementia to be recognized as a
terminal condition, which deserves equal access to palliative
care services as other more recognized conditions, such as
cancer. The article is a useful point of reference for nurses
working in the acute hospital setting and the community
environment. IBS
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NEUROSCIENCE NURSING
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KEY POINTS
I Management of dementia should focus on the maintenance of function
and independence for the person with the disease.
i Modification of vascuiar risk factors is important in aii forms of dementia.
i Choiinesterase inhibitors are avaiiabie for symptomatic reiief of cognitive
symptoms in Aizheimer's disease.
i Neuropsychoiogicai and behavioural probiems are very common in people
with dementia and a variety of non-pharmacologicai interventions are available.
I Carer burden can be improved by a number of interventions, including
provision of information, education and training.
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