Multi-Infarct Dementia

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Multi-Infarct Dementia Treatment

There is no known definitive treatment for MID. Treatment is based on control of symptoms and the correction of the precipitating risk factors (high blood pressure and high cholesterol, especially). Other treatments may be advised based on the individual condition.

INITIAL DIAGNOSIS AND TREATMENT:
The person should be in a pleasant, comfortable, non-threatening, physically safe environment for diagnosis and initial treatment. Hospitalization may be required for a short time. The underlying causes should be identified and treated as appropriate.

Discontinuing or changing medications that worsen or even induce confusion or that are not essential to the care of the person may improve cognitive function. Medications that may cause confusion include anticholinergics (including antidepressants with anticholinergic properties, such as amitriptyline or imipramine), analgesics, cimetidine, central nervous system depressants, lidocaine, and other medications.

Disorders that contribute to confusion should be treated as appropriate. These may include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often greatly improves the mental functioning.

Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others. These are usually given in very low doses, with adjustment as required. Such medications may include antipsychotics (especially the newer atypical agents, olanzapine and quetiapine), beta-blockers, and serotonin-affecting drugs such as trazodone (which may lower the blood pressure), buspirone or fluoxetine.

It is important to note that the cholinergic medications currently recommended for Alzheimer's disease (namely donepezil [aricept] and rivastigmine [exelon]) are not beneficial in the treatment of vascular dementias. There is no data about the newest agent in this family of drugs (galantamine) although it has a similar mechanism of action and therefore would not be expected to improve symptoms due to multiple infarcts. Even when used to treat properly-diagnosed Alzheimer's disease, these medications only moderately slow, but do not prevent progression.

Sensory function should be evaluated and augmented as needed by hearing aids, glasses or cataract surgery.

LONG-TERM TREATMENT:
Provision of a safe environment, control of aggressive or agitated behavior and the ability to meet physiologic needs may require monitoring and assistance in the home or in an institutionalized setting. This may include in-home care, boarding homes, adult day care or convalescent homes. Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services and other community resources may be helpful in caring for the person with MID. In some communities, there may be access to support groups.

In any care setting, there should be familiar objects and people. Lights that are left on at night may reduce disorientation. The schedule of activities should be simple.

Behavior modification may be helpful for some persons in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.

Legal advice may be appropriate early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with MID.