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The head-injured person who has become demented benefits from emotional support and education. This may include any of the following:

• Behavior modification
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• Cognitive rehabilitation
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• Medication for specific symptoms
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• Family or network intervention
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• Social services

One goal of these interventions is to help the head-injured person adapt to his or her injury mentally and emotionally. Another is to help the person master skills and behaviors that will help him or her reach personal goals.

• These interventions also help family members learn ways that they can help the head-injured person and themselves cope with the challenges a head injury poses.
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• These interventions can be especially important in establishing realistic expectations for outcome and pace of improvement.

Behavior modification

Behavior modification has been shown to be very helpful in rehabilitation of brain-injured persons. These techniques may be used to discourage impulsive, aggressive, or socially inappropriate behavior. They also help counteract the apathy and withdrawal common in head-injured persons.

• Behavior modification rewards desired behaviors and discourages undesirable behaviors by withdrawing rewards. The goals and rewards are, of course, tailored to each individual. The family usually becomes involved to help reinforce the desired behaviors.
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• Persons who have insomnia or other sleep disturbances are taught “sleep hygiene.” This instills daytime and bedtime habits that promote restful sleep. Sleeping pills are generally avoided in persons with head injury, who are more sensitive to the side effects of these drugs.

Cognitive rehabilitation

In general, cognitive rehabilitation is based on the results of neuropsychological testing. This testing clarifies problems and strengths in persons with dementia. The goals of cognitive rehabilitation are as follows:

• Encouraging recovery in functions that can be improved
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• Compensating for areas of permanent disability
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• Teaching alternative means of achieving goals

For example, gradually increasing the time spent reading helps a person both improve concentration and develop confidence in his or her ability to concentrate. Keeping lists allows a person to compensate for decreased memory.

Medication

The use of medication to treat dementia symptoms in head-injured persons is discussed in the next section.

Family or network intervention

Head injuries often cause substantial family distress.

• Changes of personality in head-injured persons, especially apathy, irritability, and aggression, can be burdensome to family members, especially the main caregivers.
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• It is important that family members understand that undesirable behaviors are due to the injury and that the head-injured person is unable to control these behaviors.

Even when family members understand that the person is unable to control his or her behavior, the person’s slowness, inappropriateness, and erratic responsiveness can be exasperating or even frightening.

• Family members become isolated from usual support, especially when the person’s impairments are severe, prolonged, or permanent.
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• Counseling for family members, especially caregivers, is highly recommended by mental health professionals.
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• Family caregivers can speak directly to the injured person’s health care provider to vent feelings and voice concerns. In many cases, the health care provider can refer the caregivers to professionals who can help solve problems and to family support groups. These interventions improve morale and help family members cope.

Social services

A trained social worker can help the head-injured person with dementia apply for disability benefits, locate specialized rehabilitation programs, attend to medical problems, and participate in treatment.

Dementia symptoms such as poor reasoning, impulsiveness, and poor judgment may render the person unable to make medical decisions or to handle his or her own affairs. Social services can help in establishing a guardian, conservator, or other protective legal arrangement.

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