Posted: January 27th, 2023

Neuropsychiatric Disturbances in Dementia Patients: A Case Study of United Kingdom

The Role of Nurses in Improving the Cognitive Functioning and Neuropsychiatric Disturbances in Dementia Patients: A Case Study of United Kingdom

Dementia is a progressive neurodegenerative disorder that affects millions of people worldwide. It is characterized by cognitive impairment, memory loss, and behavioural and psychological symptoms, also known as neuropsychiatric symptoms (NPS). NPS include agitation, aggression, depression, anxiety, apathy, psychosis, and sleep disturbances. NPS are common in dementia patients and can cause distress, reduced quality of life, increased caregiver burden, and earlier institutionalization. Therefore, managing NPS is a crucial aspect of dementia care.

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Nurses play a vital role in the assessment, diagnosis, treatment, and support of dementia patients and their families. They are often the first point of contact for patients with NPS and have the opportunity to intervene early and effectively. Nurses can use various strategies to improve the cognitive functioning and reduce the NPS in dementia patients, such as:

- Providing person-centred care that respects the individual preferences, values, and needs of the patient
- Educating the patient and the family about dementia and NPS and providing them with information and resources
- Assessing the patient's cognitive status, medical history, medication use, and environmental factors that may trigger or worsen NPS
- Implementing non-pharmacological interventions such as psychological therapies (e.g., cognitive stimulation, reminiscence, validation), psychosocial interventions (e.g., social interaction, music therapy, aromatherapy), and environmental modifications (e.g., reducing noise, enhancing lighting, creating familiar surroundings)
- Collaborating with other health professionals and multidisciplinary teams to provide holistic and integrated care
- Monitoring the patient's response to interventions and adjusting them as needed
- Evaluating the outcomes of interventions and documenting them in the patient's record
- Advocating for the patient's rights and dignity and ensuring their safety and comfort

A case study of a dementia patient with NPS in the United Kingdom can illustrate how nurses can apply these strategies in practice. Mrs. Smith is a 75-year-old woman who lives alone in her apartment. She was diagnosed with Alzheimer's disease two years ago and has been experiencing progressive cognitive decline and NPS such as agitation, depression, and paranoia. She often calls her daughter, who lives nearby, to complain that someone is stealing her belongings or trying to harm her. She also refuses to take her medications or accept any help from home care workers. Her daughter is worried about her mother's well-being and safety and contacts the local memory clinic for assistance.

A nurse from the memory clinic visits Mrs. Smith at her home to assess her situation. The nurse introduces herself to Mrs. Smith and explains the purpose of her visit. She asks Mrs. Smith about her medical history, medication use, daily activities, mood, sleep patterns, social support, and any concerns or difficulties she has. She also observes Mrs. Smith's cognitive functioning using standardized tools such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). She notes that Mrs. Smith has mild to moderate cognitive impairment (MMSE score of 18/30; MoCA score of 12/30) and exhibits signs of agitation (e.g., pacing, restlessness), depression (e.g., low mood, tearfulness), and paranoia (e.g., accusing others of stealing or harming her).

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The nurse then explores the possible causes and triggers of Mrs. Smith's NPS. She finds out that Mrs. Smith has been experiencing chronic pain due to arthritis, which may contribute to her agitation and depression. She also notices that Mrs. Smith's apartment is cluttered, dark, noisy, and unfamiliar to her due to recent renovations. She suspects that these environmental factors may exacerbate Mrs. Smith's confusion, anxiety, and paranoia.

Based on her assessment findings, the nurse develops a care plan for Mrs. Smith in collaboration with her daughter and other health professionals from the memory clinic. The care plan includes:

- Educating Mrs. Smith and her daughter about Alzheimer's disease and NPS and providing them with written materials and online resources
- Prescribing analgesics for Mrs. Smith's pain management
- Reviewing Mrs. Smith's medications for any potential interactions or side effects that may affect her cognition or mood
- Recommending non-pharmacological interventions such as cognitive stimulation (e.g., puzzles, games), reminiscence therapy (e.g., looking at photos), music therapy (e.g., listening to soothing songs), aromatherapy (e.g., lavender oil), and environmental modifications (e.g., decluttering,
enhancing lighting, adding familiar objects)
- Referring Mrs. Smith to a psychologist for cognitive behavioural therapy (CBT) to help her cope with her depression and paranoia
- Arranging for a home care worker to visit Mrs. Smith regularly and assist her with personal care, household chores, and medication adherence
- Encouraging Mrs. Smith to join a local dementia support group and engage in social activities with her friends and neighbours
- Providing emotional support and respite care for Mrs. Smith's daughter and linking her to a caregiver support network

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The nurse implements the care plan and follows up with Mrs. Smith and her daughter every two weeks. She monitors Mrs. Smith's cognitive functioning and NPS using standardized scales such as the Neuropsychiatric Inventory (NPI) and the Cornell Scale for Depression in Dementia (CSDD). She also evaluates the effectiveness of the interventions and makes adjustments as needed. She documents the progress and outcomes of the care plan in Mrs. Smith's record and communicates them to the memory clinic team.

After three months of intervention, Mrs. Smith shows improvement in her cognitive functioning and NPS. Her MMSE score increases to 20/30; her MoCA score increases to 14/30; her NPI score decreases from 36 to 18; her CSDD score decreases from 14 to 8. She reports less pain, agitation, depression, and paranoia and more satisfaction, enjoyment, and confidence in her life. She also develops a trusting relationship with the nurse, the home care worker, and the psychologist and accepts their help and guidance. Her daughter expresses relief and gratitude for the nurse's support and intervention.

This case study demonstrates how nurses can use evidence-based strategies to improve the cognitive functioning and reduce the NPS in dementia patients. By providing person-centred, holistic, and integrated care, nurses can enhance the quality of life, well-being, and safety of dementia patients and their families.

References:

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- Sabates J, Chiu W-H, Loi S, et al. The Associations Between Neuropsychiatric Symptoms and Cognition in People with Dementia: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2023; https://doi.org/10.1007/s11065-023-09608-0
- Watt JA, Thompson W, Marple R, et al. Managing neuropsychiatric symptoms in patients with dementia. BMJ 2022;376:e069187. https://doi.org/10.1136/bmj-2021-069187
- Lyketsos CG, Steinberg M, Tschanz JT, et al. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry 2000;157(5):708–714. https://doi.org/10.1176/appi.ajp.157.5.708

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