Management

The cause of the dementia should be corrected if possible. Acetylcholinesterase inhibitors are licensed for use in AD; see details below.

For the majority of cases, specific treatment produces limited benefit. The aim of management is therefore to keep patients functioning at their optimum level by maintenance of good physical health and provision of a suitable environment. It is usually best for patients to remain in their own homes with help from community services (see Chapters 20 and 25); indeed, the vast majority of patients with dementia do reside in the community. Much of the care necessary is provided by relatives and friends. The burden on them can be lessened by arranging respite care every so often, and by offering prompt emergency help in the event of an intercurrent illness or a social crisis.

Admission to hospital or nursing home may worsen confusion and distress, although it may be inevitable in the later stages. Long-term inpatient hospital care for dementia is now almost extinct in the NHS. It is now in England mainly provided through private nursing and residential homes, for which the patient has to pay until almost all his money is gone. This includes his home, which otherwise he might have wished to pass on to his children. In other parts of the UK, this care is provided free by the state.

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