Dementia and Psychotherapy
Dr Jonathan Haverkampf
Dementia in most cases is the result of an underlying degenerative biological process. There is no cure for dementia.  So what can be done with psychotherapy?
First, let us take a look at the available medication. Cholinesterase inhibitors such as donepezil are often used and may be beneficial in mild to moderate dementia by improving cognitive functioning and the patient’s ability to carry out day to day tasks.   The overall benefit, however, may be minor.  
Treatment of behavioral problems with antipsychotics is common but not usually recommended due to the little benefit and the potential side effects form this class of drugs, possibly including an increased risk of death.  
Exercise programs have been shown to have a positive effect. 
It should also be mentioned that there are at least four conditions that can lead to symptoms of dementia, but are usually reversible. These can be tested for:
- vitamin B12 deficiency
- Lyme disease
The first two should be checked for in any case if someone presents with memory loss. The last two should be investigated if there is an indication for a heightened risk.
There is some evidence that mental exercise can help increase cognitive functioning in patients with dementia , but it is unlikely that this will stop the progression in a significant way. Cognitive and behavioral interventions may be appropriate.
Educating and providing emotional support to the caregiver is important. This is frequently overlooked. But an empathic and understanding environment reduces the fear and anxiety in the patient and the stress and risk towards burnout in the caregiver.
Psychiatric nurses can make a distinctive contribution to people’s mental health.  Cognitive reframing seems to have some benefit.  There is unclear evidence for validation therapy. 
Appropriate and meaningful communication often lies at the heart of improving the results for someone suffering from dementia. Since dementia impairs normal communication due to changes in receptive and expressive language, as well as the ability to plan and solve problems, agitated behavior is often a result of fear and anxiousness from too demanding or complex communication. Memory and communication lie at the heart of treating dementia. Music therapy is used, but the evidence is unclear,  reminiscence therapy may be of some help .
Actively searching for a potential cause, such as pain, physical illness, or overstimulation can also be helpful in reducing agitation. 
There seems to be a change in personality when people suffer from dementia. It can also lead to an increase in fear. It seems the individual is becoming disconnected from the inner and the outer worlds, which also may be responsible for the fears and observed changes. The neurodegeneration affects first and foremost the communication in the neural network. If the patient notices the cognitive degeneration this causes a sense of helplessness and substantial fears and even anger. At some point there is a disconnection from what makes up an important part of the self, the value and interests, which give humans direction in life and let us see happiness in our future.
In working with people with dementia it is important that they can hold on to the sense of meaning, values and interests as long as possible. The argument that it can no longer be acted upon and creates more suffering misses the important point that this core of who we are conveys an important sense of stability. In order to maintain it one has to consider the communication networks the patient is placed in.
It is a general observation that keeping regular empathic, understanding and open contact with the patient reduces fears and reduces suffering. The reason is that it is primarily the disconnectedness which causes these negative emotions and the fears. Humans are born to communicate and it is through communication that we feel alive and stay connected with the concepts in ourselves that remain stable and point us in a direction that makes us happy. And it should be an objective of therapy to keep this form of happiness as long as possible.
© Dr Christian Jonathan Haverkampf. All rights reserved.
This paper is solely a basis for academic discussion and no medical advice is given. Always consult a professional if you believe you might suffer from a physical or mental health condition.
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