Hello everyone! Today, we want to talk to you a little bit about pharmacological and non-pharmacological approaches to Promote Better Care. Following the diagnosis of dementia and basic care principles, caregivers start to ask "How can I provide better care?" Currently, although there is no effective treatment method that will completely eliminate harmful effects of dementia, there are many medicines and other treatments that help control the condition and ease some of the symptoms. We will talk about. What are the main drugs used to treat Alzheimer's disease? Are dementia medications effective? To be brief, we can say that prescribed drugs in patients with Alzheimer's disease may help the symptomatic progression of their disease positively. Alzheimer's drugs don't cure the disease but those can slow the progression of the disease. The inhibitors donepezil, galantamine and rivastigmine are used in the management of Alzheimer's disease and these exhibit similar effects. Memantine is also used to treat Alzheimer's disease. The action of memantine is different from that of donepezil, rivastigmine and galantamine. Moreover, antipsychotic medications are often used to treat behavioral and psychological symptoms of dementia. What should we do if we experience side effects from medication? Let's talk about it if you want. Alzheimer drugs may have side effects. In such a case, doctors will evaluate the side effects for each patient on a patient basis. If you experience side effects or drug-related problems you can report your doctor right away. In addition to the drugs linked to Alzheimer's disease, some other drugs like sleeping pillscan commonly be used. For example, drugs for sleep disorders can be used when they have sleep problems, or psychiatric medications can be used when psychiatric symptoms are encountered. Of course, the decision to use drugs that are not directly aimed at the disease will be made by our physician. Do Alzheimer's patients need vitamin supplements? If the patient doesn't have a vitamin deficiency, no need to take extra vitamins. Vitamin supplements may have side effects. In case of a vitamin deficiency, the doctor will prescribe a supplement to deplete a certain vitamin or mineral you need. Are herbal medicines effective? There is limited scientific evidence to establish the safety and efficacy of most herbal products and herbal supplements. They may even interact with prescribed medications in some cases. This may lead to unwanted, undesirable effects. If you want to use such a product, you should inform the doctor and get consent for it. What medications should dementia patients avoid? Alzheimer's drugs are used chronically. If differentdrugs for other health-related issues is to be used in addition to Alzheimer's drugs, you should inform the doctor about this. You should do so in case of prescription modification as there may be an interaction between the drugs. If the patient has complaints or s/he responds to the same drug differently, you should see the doctor immediately. What are the proper ways of using drugs? Let's talk about them. A medicines list can be a useful way to keep all the information about your medicines together. What does the list include? You can use a medicines list to record: all the medicines you use, dose of medicine, when and how to use each medicine. The list will help get better results from the medicines you use and help to prevent side effect and interactions. What do you do when a patient doesn't want to take medicine? It is important for patients to understand their medications. Explain medications clearly. Someone with dementia may believe that you're giving drugs to poison them as they may be more suspicious and anxious. Make sure the patient takes the medicine. After all, how would you deal with a situation where a person is refusing to take their medication? Upon consultation with the doctor or pharmacist, and when possible, crush the pills that are crushable and mix with a food. Be careful about the food as a drug-food interaction may occur when your food and medicine interfere with one another. Food can prevent medicine from working the way it should. Here are the considerations when taking medication: You should not stop taking your medications without consulting your doctor. You must follow the doctor's instructions and orders. Medications used to control Alzheimer's are drugs that are used for chronic conditions. People with Alzheimer's disease may also take other medicines to treat other medical conditions. If that is the case, you must report the doctor about other medicines. It should not be forgotten that drug interactions can reduce the patient's response to treatment, and may have serious side effect risks of severe complications like hospitalization and even death. Considering that Alzheimer's disease, dementia and age-related diseases, both age-related physiological changes and the higher number of prescribed drugs make these patients more susceptible to drug interactions. If the patient has complaints or s/he responds to the same drug differently, you should see the doctor immediately. In case of prescription modifications as there may be an interaction between the drugs. If there is any change in treatment plan, the patient has complaints or s/he responds to the new drug differently, please inform the doctor. What can we do if, despite all your efforts, your patient still has difficulty using the drug or if the patient refuses to use the drug? If your patient continues to refuse to take their medication, different forms of drugs may be preferred. Of course, you should consult your doctor about this. Non pharmacological interventions are person-centered treatments aiming to help individuals stay independent in everyday life for as long as possible rather than forcing them or focusing on their deficiencies. These non-drug interventions are expected to improve people's cognitive performance, increase their independence, support wellbeing and improve quality of life. These non-drug interventions can improve mental health by decreasing and preventing conditions such as anxiety. Interventions are also important for non-professional caregivers to get support and help reduce the burden of care. They are better able to cope with situations that are often stressful and upsetting. Help groups, trainings, relaxation techniques and psychotherapy that can help overcome current difficulties increase the quality of life of family members. When the patient feels good, caregivers and family members are also positively affected by this situation. When conflicts stemming from being together in the same home are coped with, caregivers' stress level can reduce and enhance their quality of life. How should we choose non-drug treatments? Which one is better for someone living with Alzheimer? Non-drug treatment methods include a wide variety of approaches ranging from psychotherapeutic treatments in the early stages to sensory stimulation in the later stages of the disease. While some of the non-drug treatments are administered by specialists, some can be used by family members or caregivers and integrated into daily life. All therapeutic interventions are individualized and must be modified according to changing circumstances over the course of the disease. Non-drug treatment methods will achieve their goal when personal skills, preferences, needs, motivation and life story are taken into account. In the meantime, cognitive overload (but also over-underloading) should be avoided as much as possible. The interventions should promote existing skills of the patient and provide with the opportunity for subjective success experience. While choosing which one is better, it should be taken into account the fact that dementia affects many areas. Therefore a single method cannot be effective, it is important to cooperate. What are non-pharmacological interventions? First of all, I would like to talk about psychotherapeutic approaches. Psychotherapeutic approaches commonly used in dementia are psychotherapy, psychoeducation, help groups, and relaxation exercises. Psychotherapy can support people with dementia in the early stages of the disease to cope with diagnosis. Psychotherapy may also be effective for family members due to the emotional and physical strain of caregiving. Psychoeducation enables recipients to receive educational information on the disease itself, key facts and information on signs, symptoms and causes in the context of a supportive psychotherapeutic environment. This information helps the patient and family members to understand the diagnosis better, classify the symptoms, and cope with the disease. psychoeducation can be individual, family, or group based. Self- help groups, often initiated and accompanied by staff of counseling centres, are mostly for family members. Groups of people come together to address their common problems. Sharing and social support through the group are also effective in reducing the impact of dementia on their lives. Relaxation exercises applied to individuals with dementia are very effective. Jacobson progressive muscle relaxation techniques are suitable for individuals with dementia. Because it can be learned easily with professional guidance and can be practiced individually (supported by family members or care staff) at home. Now I would like to talk about other non-pharmacological interventions. Reminiscence therapy is often used to treat people with Alzheimer's and other forms of dementia. Reminiscence therapy (RT) involves remembering of past activities, events and experiences with another person or group of people. RT aims to stimulate mental activity and improve well‐being. Reminiscence therapy is carried out usually with the aid of prompts such as household and other familiar items, old clothes, photographs, music from the past. Reminiscence therapy involves sharing personal life experiences, memories and stories from past. Memories in remote memory can be consciously recalled. It often helps memory as people with Alzheimer's have difficulty with their more recent memory while they have a better memory for the distant past than for recent events. It also may be suitable for people with severe dementia. Reality orientation is another therapeutic approach. Details about time, place, and names are sprinkled into conversations while the goal is to seamlessly slip in details that can help orient the person to the present reality. Using reality orientation techniques with people living with dementia has been shown to slow cognitive decline and may even improve cognitive functioning. Reality orientation may be better suited for people with mild to moderate cognitive impairment. Occupational therapy is concerned with promoting health and wellbeing through occupation to to enable people to participate in the occupations of everyday life. Occupational therapists focus on maximizing engagement in activities, creating safe environments, improving the adult's competency and sense of emotional well-being, simplifying tasks, and maintaining existing abilities for as long as possible. An occupational therapist can help loved ones with Alzheimer's adapt to an environment, maximize engagement in daily activities, promote safety, and enhance their quality of life. Logopedia: Many patients are experiencing communication challenges due to Dementia. It's common for speech-related issues to progress with the onset of dementia. As dementia progresses, swallowing difficulties become more common. A logopedia therapist may help with tips. Family and caregivers are provided with information coping with disabilities. Physical activity and exercise: Taking regular physical exercise is an important part of a healthy lifestyle and can help to maintain wellbeing. Physical exercise affects brain plasticity, influencing cognition and wellbeing. Physical activity creates valuable opportunities to socialise with others, and can help improve and maintain a person's independence. This is beneficial to both people with dementia and their carers. Accessing a structured exercise program with trained staff and using family, friends and volunteers can help to ensure this. Art therapy is possible in many forms, primarily drawing, painting and object design. Art and music therapy is offered professionally, but family members and/or caregivers can support creativity and emotional expression. Creative expressions enable them to interact actively and increase their self-confidence. Ambient therapy modifies the social and organizational environment of the spaces in which people with dementia live, such as the architecture and furnishings. The aim here is to adapt this environment to suit the deteriorating abilities of the human being. The patient's home is modified and designed so that s/he can adapt as much as possible and move safely. Validation therapy imparting respect to the person, their feelings and their beliefs is the basis of this method. Validation therapy is a method of therapeutic communication which can be used to define the types of actions or behaviors one should use when communicating with a person who has dementia. Validation therapy is based on the concept of communicating and accepting an AD patient's reality rather than attempting to correct it. Cognitive training (also called brain training) is a program of regular activities purported to maintain or improve one's cognitive abilities to think, remember, pay attention. Cognitive training is a treatment for people with mild to moderate dementia. Cultural differences and level of education factors should be taken into account for cognitive training. Recognition activities, matching socks games, seasonal fruits and vegetables sorting activities, telling the time, sequencing the actions, playing memory card games, practicing crossword puzzles, completing jigsaw puzzles, drama activities, making jokes, Playing checkers and bingo, playing card matching games, some types of video games such as action, puzzle, and strategy games, creating a writing trays, playing with baby dolls and stuffed toys are some of the brain exercises that may help boost memory. So , which non-drug treatment methods can we use in the last stage of dementia? Validation therapy is a unique form of therapy that involves listening to elderly seniors with dementia, connecting with them through empathy, and providing dignified care in the last stages of their lives. Validation therapy revolves around communicating respect and helping seniors feel understood and acknowledged instead of dismissed. Validation therapy can help calm agitation in seniors with dementia and discover how they are really feeling. Especially in later stages, patients can perceive themselves and their environment in a very limited way. With the help of sensory treatment methods such as basal stimulation, snoezelen, aromatherapy, massage and targeted touches, all senses (touch, hearing, sight, taste, smell) can be addressed and they can be relaxed. The last issue I would like to mention is the cost of non-pharmacological treatment methods. Some of the non-pharmacological treatment methods can be prescribed by the doctor and covered by social security institutions. Usually physiotherapy, ergotherapy, logopedia and behavior therapy etc. Treatment methods are provided free of charge by the social security institution. Some associations, local governments and health institutions can provide these services without charge. We hope that the chapter has been useful to you, and also hoping that these tips can help you cope and get the support you need. If you are interested in obtaining more information, you can consult our project website at: http://demcare.hcilab.es/ . Until the next episode!