Dementia in Head Injury (cont.)
Julia Frank, MD
Nestor Galvez-Jimenez, MD
Francisco Talavera, PharmD, PhD
Helmi L Lutsep, MD
IN THIS ARTICLE
The head-injured person who has become demented benefits from emotional support and education. This may include any of the following:
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.
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.
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:
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.
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.
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.
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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Traumatic brain injury can lead to deficits in 5 general areas: (1) short-term memory impairment, (2) slowed processing speed, (3) impaired executive function, (4) disrupted abilities of attention and concentration (which likely contributes to the deficits noted in the first 3 categories), and (5) emotional dysregulation.
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