Progressive dementia: strategies to manage new problem behaviors

The primary care physician plays a key role in the diagnosis and treatment of progressive dementia and in coordinating supportive care with the patient's caregivers. When a patient exhibits a new symptom such as wandering or verbal abuse, your initial workup should eliminate acute medical illness, psychiatric disorders, and drug reactions that may present as behavioral symptoms. In the home, the main focus of care is to provide a safe and secure environment, using preventive measures to minimize the risk of injuries. When caregivers become exhausted from dealing with nocturnal wakenings, a short course of sleep medication for the dementia patient is often necessary. To improve communication, avoid stressful and confusing situations that compound the patient's difficulty in understanding messages or expressing thoughts.