Dementia
1 January 2012
Dementia (taken from Latin, from de- "without" + ment, the root of mens "mind") is an umbrella term used to describe symptoms which occur when the brain is affected by certain diseases or conditions (the most common of which is Alzheimer’s disease). The early symptoms can range in their severity, as can the effects on the sufferer, but are generally characterized by a decline in cognitive faculties and occurrence of behavioural abnormalities which interfere with an individual's daily life1. The affected areas of cognition are commonly memory, language, attention and problem solving2.
Risk factors
The primary risk factors of Dementia are age, family history, and genetics1. However, there are other risk factors that you can influence. Maintaining a healthy heart and avoiding high blood pressure, heart disease, stroke, diabetes, and high cholesterol can decrease the risk of Alzheimer’s and other forms of dementia 2. Recent evidence has also indicated that those with a low BMI may be more susceptible 3, although further research is required to establish whether this is a causal factor or simply a side effect.
Who is affected?
Dementia usually affects elderly individuals but may occur in individuals younger than 65 years as seen in early-onset Alzheimer’s1. It is seen more often in patients whose parents or grandparents developed Alzheimer’s disease at a young age and is generally associated with three specific gene mutations 4.
How common is it?
100 years after the first description, Alzheimer's disease is one of the most disabling and burdensome health conditions worldwide. The condition is on the increase, with the number of people affected predicted to double every 20 years to 81.1 million by 20405.
Early symptoms
The most well-known and often most obvious symptom of dementia is memory loss. By this I do not mean simply forgetting someone’s name, not remembering to post a letter or the name of an object. A person with dementia will also often forget the context in which the object’s name is used or their relationship to the person who’s name they have forgotten. They may also struggle to remember recent events, but easily recall things that have happened in the past. This can be upsetting for relatives but such memory loss may only be temporary; even those with the most advanced cases may have moments of lucidity.
Those with dementia can forget simple steps of a daily routine, such as getting dressed or preparing a meal. They may struggle to follow conversations, often repeating themselves or losing the thread of what is being said. In addition, their judgment may be affected so they make decisions which seem nonsensical or socially inappropriate to others. As the person becomes aware of their actions and their memory loss, it is common for them to become confused, depressed and even aggressive.
Diagnosis
Confirming a diagnosis of dementia can be difficult, as many of the “common” symptoms can be caused by other factors. For example, a deficiency of vitamin B12 can cause depression, fatigue and memory loss in some cases. Memory problems can also be the result of infections such as urine infection or chest infection or the liver, kidney or thyroid not working as they should and a poor sleep pattern, poor diet, constipation, urine retention and dehydration can lead to confusion in some cases. A measurement of thyroid hormones to rule out disorders of this nature may be taken and a urine sample may be required.
There are also overlaps with other conditions; depression affects 20–30% of people who have dementia and about 20% have anxiety6. Each of these needs therefore to be assessed and treated independent of the underlying dementia7. Once these problems have been ruled out, if a person’s memory is still bad and they or their doctor feels it could be attributed to dementia, their GP will need to carry out an assessment.
The doctor will ask a series of questions to assess how the brain is functioning, to see whether the person has correct orientation to place and time and to assess their memory and visio spatial abilities. A CT scan will be performed to gather information about the physical state and structure of the brain and to make a formal dementia diagnosis and establish the type of dementia. It is also common for some short questionnaire-based tests to be performed to establish the level of any mental impairment.
Treatment
It is important to get the type of dementia correct when diagnosing, as certain drugs can exacerbate symptoms if prescribed incorrectly or unnecessarily. Common types of drugs used in the treatment of dementia symptoms are anti-psychotics, anti-convulsant and anti-depression drugs. Antipsychotics can increase the risk of death in dementia-associated psychosis8, meaning that any use of antipsychotic medication for dementia-associated psychosis should only be considered after weighing up the risks and benefits or after other treatments have failed. Antidepressants can effectively treat the cognitive and behavioural symptoms of depression in patients with Alzheimer's disease9 but evidence for their use in other forms of dementia is weak10.
There are also a number of psychological treatments thought to help those with dementia, including Cognitive Stimulation and Reality Orientation therapy. This can include stimulating activities to improve memory and language ability and a display of information within the person’s own home or care home showing the current day, date and location. A carefully constructed care plan for those requiring support is essential - as is communication between doctors, relatives, care staff and the person with dementia - in order to lessen the feelings of frustration and confusion.
What to do if you suspect you or somebody in your family may be affected
People often worry when they feel their memory is not as sharp as it was or begin struggling to recall and process information that would not have posed a problem previously. Memory problems can be wide ranging; both young and old people can experience cognitive difficulties and the causes can be just as broad. It is therefore very important to have a proper assessment carried out if you are concerned that your memory is not functioning quite as it should, rather than rely on self-diagnosis.
Although it is understandable to feel anxious about the cause of memory problems, it is incredibly worthwhile to make an appointment to see your GP as soon as possible if you are concerned. Not only is this the first step to identifying (and thus potentially rectifying) any problems, but they may also be able to put your mind at ease. A clear awareness of the cause can also help you to work on specific ways to manage better in day to day life. The sooner the condition is identified, the sooner you can receive the right treatment and support.
Through my work I understand that people often feel extremely worried about the results of cognitive assessments and will become very anxious when trying to answer questions for fear of being labelled with a particular condition. It is important to remind yourself or your family member that any problems that are identified as a result of the assessment will enable a GP to help sufferers live a better life despite their cognitive difficulties. It is also important to remember that although there is currently no cure for dementia, with treatment and support many people who have the condition are able to lead active fulfilling lives.
People I have assessed will often fear that as a result of a particular diagnosis I will take them out of their own home and they will lose their independence. In contrast, health professionals will simply look at what can be done to assist people to continue to manage in their own homes. Advice such as simple memory tips (such as using a whiteboard and marker to jot down important things to remember or a timer/alarm to notify when food has cooked in the oven) can help sufferers to feel less alone and lead a more independent life. Health professionals are also able to inform those with dementia of other sources of support is available to them, from memory aides to financial help such as pension credit and attendance allowance.
A relationship with a dementia sufferer – Practical help and support
Some of the moods and physical characteristics dementia sufferers display can be difficult for a loved one to experience and witnessing the deterioration of a parent or partner can be very distressing. However, it is important to remember that a dementia sufferer is not responsible for or necessarily aware of their behaviour.
When a person has dementia the approach is very important; it is best not be confrontational and to deflect rather than conflict. If they are confused and making inaccurate statements (i.e. referring to family members who are now deceased as if they were still alive) it is important not to bring them back to reality with a bump. Instead of correcting them, discuss the matter with them and then try to move on to a different subject to comfort them. It is likely that they are seeking reassurance if they are asking for someone who has provided comfort in their lives in the past.
Living with dementia will fundamentally change your relationship with the person, but this does not have to be in a negative way – accepting that there will now be differences to their needs and behaviour can lead to a deeper understanding of one another. With this in mind, it is essential that friends and relatives take advantage of all support available to help them understand what it’s like to live with the condition. In the more advanced stages, a great deal of patience may be required but dementia patients are still individuals with unique needs and should be treated as such by everyone they come into contact with.
Conclusion
Learning you have dementia is never easy, nor is witnessing the decline of someone you love. However, with more research being done into the illnesses falling within the dementia category and our understanding of the symptoms becoming greater, many patients live full and happy lives maintaining much of their lifestyle and many of their relationships.
Further support and information
The Alzheimers Society provides many valuable resources and information about Dementia care.
Website: http://alzheimers.org.uk/
Helpline: 0845 300 0336
About the authors
Lucy Murison has worked with Dementia suffers for the last 4 years. She holds the Alzheimers Society certificate having trained in their “Yesterday, Today, Tomorrow” dementia qualification and has also trained in “Older People, Relationships & Sexuality”, “Mental Health Issues”, and “Challenging Behaviour”. Having worked for major healthcare providers within the UK, she has experience both on the ground floor level as a carer in specialist Dementia Care homes, as well as the provision and management of care services, person-centred living assistance and creating and coordinating activities and therapy sessions for dementia residents based on research. Running support groups for relatives and friends of dementia patients, she has a unique insight into what it is like living with dementia on a daily basis. She is currently studying for the Registered Managers Award for UK Care Homes specialising in Care of the Elderly and Enduring Mental Health.
Stuart Maddock works as a Primary Care Dementia Practitioner, offering advice and information to people who have memory problems. The role of his team is to work alongside the national dementia strategy to speed up diagnosis, increase information and understanding about dementia and to improve the lives of those who are living with dementia. Prior to this job Stuart worked as a community nurse with the Dementia Intensive Support Team, problem solving to prevent unnecessary admissions to hospital and allow people to return home sooner by ruling out physical health problems augmenting symptoms, improving knowledge and understanding of dementia to both service users and carers. He has also worked on a long stay dementia unit for people who have complex care needs and require a higher level of care through challenging time or to create a care package to enable them to be cared for in the community.
References:
- Fadil, H., Borazanci, A., Haddou, E. A. B.,Yahyaoui, M., Korniychuk, E., Jaffe, S. L., Minagar, A. (2009). Early Onset Dementia. International Review of Neurobiology. 84: 245–262. Retrieved from: http://www.sciencedirect.com/science/article/pii/S0074774209004139
- NHS (2011). Worried someone close to you is losing their memory? Retirved from: http://www.nhs.uk/dementia/Documents/Dementia__campaign_leaflet.pdf
- Vidoni, E., Townley, R., Honea, R., Burns, J., (2011). Alzheimer disease biomarkers are associated with body mass index. Neurology. 77, 21 1913-1920. Retrieved from: http://www.neurology.org/content/77/21/1913.short
- Tsuang, D., & Bird, T., (2001). Genetics of dementia. Med Clin North Am. 86 (3), 591-614. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/12171060
- Ferri, CP., Prince, M., Brayne, C., Brodaty, H., Fratiglioni, L., Ganguli, M., Hall, K., Hasegawa, K., Hendrie, H., Huang, Y., Jorm, A., Mathers, C., Menezes, PR., Rimmer, E., Scazufca, M., (2005). Global prevalence of dementia: a Delphi consensus study. Lancet 366 (9503): 2112–7. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850264/?tool=pmcentrez
- Calleo, J., Stanley, M., (2008). Anxiety disorders in later life differentiated diagnosis and treatment strategies. Psychiatric Times 25 (8). Retrieved from: https://member.cmpmedica.com/index.php?referrer=http://member.cmpmedica.com/cga.php?assetID=425&referrer=http://www.psychiatrictimes.com/display/article/10168/11669
- Shub, D., Kunik, Mark., (2009). Psychiatric comorbidity in persons with dementia: assessment and treatment strategies. Psychiatric Times 26 (4). Retrieved from: http://www.psychiatrictimes.com/alzheimer/content/article/10168/1403050
- Bowcott, O (2010). Chemical restraints killing dementia patients. The Guardian. Retrieved from: http://www.guardian.co.uk/society/2009/nov/12/anti-psychotic-drugs-kill-dementia-patients
- Thompson, S., Herrmann, N, Rapoport, MJ., Lanctôt, KL., (2007). Efficacy and safety of antidepressants for treatment of depression in Alzheimers disease: a meta analysis. Canadian Journal of Psychiatry 52 (4): 248–55. Retrieved from: http://publications.cpa-apc.org/media.php?mid=586&xwm=true
- Bains, J., Birks, J., Dening, T., (2002). The efficacy of antidepressants in the treatment of depression in dementia. Cochrane Database of Systematic Reviews (4). Retrieved from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003944/abstract;jsessionid=BE08E3EF61AE7E76A7D6FD2FC670705E.d01t03?systemMessage=Wiley+Online+Library+will+be+disrupted+3+Dec+from+10-12+GMT+for+monthly+maintenance
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