Social Structures
Author: Sowmya Shrivastava, 3rd year BSc Psychology Student, Maynooth University, Research Intern for Mac MacLachlan at the ALL Institute
There is a growing realization that hospital employees and services must comprehend the complexities of caring for and treating dementia patients. The World Health Organisation (WHO) estimates that dementia rates will double every 20 years, reaching up to 115·4 million people with a diagnosis in 2050. A number of underlying neuropathological symptoms can lead to the diagnosis, which can create problems when trying to differentiate dementia from psychiatric disorders as the disease is found to often mimic them in presentation. Due to this, there is a broad research area in matters concerning the treatments and interventions for patients with dementia. Doctors and researchers have found that the disease modifying antibody drug Lecanemab slowed the decline in memory and mental agility by 27% in patients with mild Alzheimer’s disease but what about the other 73%? What steps can be taken to aid the other, larger part of people living with this degenerative disease?
A unimodal approach has been the most obvious route researchers have taken in order to find a cure for dementia; meaning that only one type of treatment route is used for treating the patient. However there is a downside to this one sided view. By conducting a research review on studies carried out who either took a pharmacological stand or a psychosocial step towards treatments for patients, it was found that both have delivered inadequate results in terms of validity and reliability. The data within research statistically shows that by solely applying a single approach to treating patients, i.e., only psychosocial interventions without administering any drug treatment, the rate of dementia development is slowed, but only at a miniscule level.
Hence, a more multimodal form of treatment for dementia patients would be a more effective approach. These can consist of assistive technologies such as those found in the SHAPES project. This involves developing accessible assistive technology to help those who are aging and have physical and/or cognitive disabilities such as dementia. The project takes into consideration the various types of dementia that exist and the different stages at which each individual may be. This approach takes drug treatments into consideration allowing for more than one type of intervention to be applied. Popular psychosocial interventions include cognitive stimulation therapy (CST), cognitive behavioural therapy (CBT) and reminiscence therapy for patients with dementia.
Another approach which has become prominent as of late has been the public patient involvement (PPI) movement. PPI involves patients in the design and delivery of services created for them, many of whom are diagnosed with different types of dementia at different stages. The opinion and outlook of the patients’ caretakers on the different behavioural changes displayed after the patient goes through various therapy sessions holds a strong importance in future directions for different psychotherapies recommended. It can aid with increasing diverse opinions in the system and adjust the research systems in terms of making it more accessible and friendly through the lens of lived experience.
To aid the diagnoses of Lewy Body Dementia (LBD) as a preclinical marker, colour vision impairment was found to have a statistically high presence in patients. The precise biological nature of the relation between colour discrimination deficits and the presence of visual hallucinations in this disorder for patients has not been thoroughly examined. However, one study demonstrated that a significant association was found. Further study in the pathological occurrences and biological factors for the reason this happens would serve as a beneficial area of research as a diagnosis could be given earlier to patients in their early stages of LBD.
There has been a gap associated with the treatment of dementia related psychosis (DRP) symptoms often which can occur as hallucinations or other debilitating symptoms for those diagnosed with dementia. Atypical anti-psychotics have shown non-significant results in improving this condition. However newer research is proposing pharmacological agents such as pimavanserin which holds potential for future treatment of DRP. Further research on this drug and discovery of others such as Lecanemab can help those experiencing DRP and could aid patients who experience depression and anxiety when diagnosed with dementia too.
Through discussion of the many other treatments available to patients it would be imprudent not to adopt a multimodal approach when treating and also when trying to diagnose an individual with dementia. Disciplinary dominance should not be overlooked, and health care workers should be urged to broaden their outlook and areas of discipline within which their research is based. If the multimodal formation is adopted on an international scale larger numbers in data would be available to confirm whether it is really an effective approach to treating dementia patients. However the discussed trends so far seem to be pointing in a positive direction and we hope to see some good data produced in the coming years.