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There is no specific, known treatment for MID. The goal is to control symptoms and correct risk factors such as high blood pressure and high cholesterol. Other treatments may be recommended.
INITIAL DIAGNOSIS AND TREATMENT
The person should be in a pleasant, comfortable, non-threatening, physically safe environment for diagnosis and initial treatment. Hospitalization may be required for a short time. The health care provider will try to identify the cause and treat it.
Stopping or changing medications that worsen or cause confusion may improve cognitive function. Medications that may cause confusion include anticholinergics (including antidepressants with anticholinergic properties such as amitriptyline or imipramine), pain relievers, cimetidine, central nervous system depressants, and lidocaine.
Disorders may contribute to confusion. These may include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. Correction of coexisting medical and psychiatric disorders often greatly improves the mental functioning.
Medications may be required to control aggressive or agitated behaviors or behaviors that are dangerous to the person or to others. The medicines are usually given in very low doses and adjusted as needed. Such medications may include antipsychotics (especially the newer atypical agents, olanzapine and quetiapine), beta-blockers, and serotonin-affecting drugs such as trazodone (which may lower the blood pressure), buspirone, or fluoxetine. Medications used to treat Alzheimer's disease have not been shown to work for MID.
Hearing aids, glasses, or cataract surgery may be needed if the person has sensory problems.
LONG-TERM TREATMENT
The person may need regular monitoring. This may include in-home care, boarding homes, adult day care, or convalescent homes. Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services and other community resources may be helpful in caring for the person with MID.
In any care setting, there should be familiar objects and people. Leaving lights on at night may reduce disorientation. The schedule of activities should be simple.
Behavior modification may help some persons control unacceptable or dangerous behaviors. This therapy consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.
Legal advice may be appropriate early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with MID.
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