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Treatment

   Psychotherapy

  • Individual and family
  • Orientation:  Cognitive behavioral psychotherapy
  • Cognitive remediation/accommodation for neurological conditions

 

Many neurological disorders have concurrent psychological disorders.  For example, conditions that result in loss of oxygen to the brain are often accompanied by depression.  This can include sudden onset loss of oxygen to the brain due to a stroke or to a tonic-clonic seizure.   Conditions that result in a gradual loss of oxygen to the brain (such as untreated sleep apnea and emphysema) are also often accompanied by depression.  Depression can occur even when there is no change in one’s environment that would affect his or her daily activities.  Depression has a biological basis.  Those areas of the brain that are at high risk for stroke and for loss of oxygen are areas of the brain that have long been known to be involved with mood. The frontal lobes and their connections to the rest of the brain are involved with mood.  This was known before frontal lobotomies were performed to treat depression.  

Regardless of the causes of the depression, treatment has been demonstrated to be most affective with a combination of psychotherapy and medication.  Another important component for the treatment of people who have a decline in cognitive abilities is the development of compensatory strategies.  Establishing a person's cognitive strengths and weaknesses through neuropsychological evaluation can help him or her determine ways to compensate for deficits.  Some people have significantly compromised cognition as a result of an underlying neurological disorder such as a significant traumatic brain injury or to dementia.  In these cases, it is particularly important to involve their families in the treatment process.  Education regarding a neurological and/or psychiatric condition is power.  Part of any treatment plan should include education.

Many types of dementia result in hallmark changes in mood.  For example, Lewy body dementia (LBD) is characterized by a combination of hallucinations and delusions that start early in the course of the dementia syndrome.  A delusion is a false belief.  For example, thinking that your spouse is having an affair or that people are trying to steal from you (when they are not) could be caused by dementia.  This belief system is as real to the person who is experiencing the delusion as it is not real to all others around him or her. 

Attempting to convince someone who has a delusion that his or her belief is not real is as difficult as it is for the person who is having the delusion to convince others that it is real.  Medications can often get rid of the aforementioned psychosis (delusions and/or hallucinations).  Hallucinations and delusions are experienced by someone with Alzheimer’s disease in the late stages of the dementia process.  Depression and/or agitation are more common than hallucinations in persons with Alzheimer’s disease.  Some medications used to slow declining cognition in dementia patients suffering from Alzheimer’s or Lewy body disease have also successfully treated some of the neuropsychiatric symptoms that can accompany these dementias. 

Treatments plans may include:

a) establishing cognitive strengths and weaknesses

b) formulating an accurate diagnosis

c) education

d) modifying one’s environment to cut cognitive demands

e) medication for mood

f) medication to slow a progressive decline in cognition, and

g) brain exercises

 

Research suggests that other lifestyle modifications can slow or prevent the onset of dementia.  Generally, if something is good for your heart, it tends to be good for your brain as well.  In addition,  it is essential for your healthcare providers work together as a team to maximize the benefit one might have as a result of the aforementioned treatments and interventions.