Dementia as Conditions Resulting From a Disease

Understanding Dementia

Dementia is not a disease but a group of conditions resulting from a disease such as Alzheimer’s and Vascular dementia or a group of symptoms which may result from age, brain injury, confusion, difficulty in performing day to day or familiar tasks, changes in personality, mood and behaviour. Dementia is a condition in which there’s a gradual loss of brain function, it is a decline in cognitive/intellectual functioning. Dementia causes permanent and progressive damage to the brain.

Each part of the brain functions differently and therefore when a region is affected individuals can lose significant functions. The brain controls every aspect of our behaviour, from the smallest movement to the most sophisticated thought. The largest part of the brain is called the cerebral cortex, which is divided into different regions, known as lobes; these control the different functions such as:

• Frontal Lobe – Planning and organising actions, learning tasks, initiating and stopping regular behaviour, abstract thought, logic, language and personality.

• Parietal Lobe – Remembering sequences of actions, body sense(e.g. sensing where one limb is in relation to the rest of the body), sentence construction, calculation, interpreting visual information received from the occipital lobe and locating objects.
• Occipital Lobe – Processing information about colour, shape and movement received from the eyes.
• Temporal Lobe -Learning new information, recording and storage of verbal memory (such as names), and visual memory (such as faces) and attention.

Every type of dementia involves progressive physical damage to the brain. The main areas affected in most dementias are the temporal, parietal and
frontal lobes.

Some doctors and researchers split dementia into two categories – the cortical dementias and the subcortical dementias – based on which part of the brain is affected.

Cortical dementias arise from a disorder affecting the cerebral cortex, the outer layers of the brain that play a critical role in cognitive processes such as memory and language. Alzheimer’s and Creutzfeldt-Jakob disease are two forms of cortical dementia. Cortical dementia patients typically show severe memory impairment and aphasia, the inability to recall words and understand common language. Subcortical dementias result from dysfunction in the parts of the brain that are beneath the cortex.

Usually, the memory loss and language difficulties that are characteristic of cortical dementias are not present. Rather, people with subcortical dementias, such as Huntington’s disease, Parkinson’s disease and AIDS dementia complex, tend to show changes in their personality and attention span and their thinking slows down.

There are cases, such as with multi-infarct dementia, where both parts of the brain tend to be affected.

There are many causes of dementia, including neurological disorders such as Alzheimer’s disease, blood flow related (vascular) disorders such as multi-infarct disease, inherited disorders such as Huntington’s disease and infections such as HIV. The most common of dementia include: Degenerative neurological diseases, such as Alzheimer’s, dementia with Lewy bodies, Parkinson’s and Huntington’s Vascular disorders, such as multiple-infarct dementia, which is caused by multiple strokes in the brain Infections that affect the central nervous system, such as HIV dementia complex and Creutzfeldt-Jakob disease Chronic drug use.

Depression

The first signs of dementia are short term memory loss. Symptoms of dementia are dependent upon the areas of brain that are affected and the key symptoms are include:

• Loss of memory: Forgetting some recent incidents and inability to recall information.
• Disorientation: People forget their familiar surroundings, neighbourhood, wondering how they got there and do not know how to get back home.
• Communicating: People suffering from dementia forget simple words and substitute some irrelevant words in their speech, making it difficult to understand for the listener.
• Abstract thinking: People suffering from dementia have trouble carrying out simple calculations such as adding numbers, multiplying, dividing and subtracting.
• Poor or reduced judgement: People suffering with dementia have poor judgement and do not know how to react to emergencies.
• Performance of familiar tasks: People face difficulty in performing daily activities such as preparing a meal off coffee/tea, operating an oven, playing a game, making a telephone etc.
• Mood or behavioural changes: People suffering from dementia exhibit rapid changes in moods such as a happy/joyous mood to tears or anger for no apparent reason. Dementia patients can also experience depression.
• Misplacing articles: People with dementia tend to misplace articles in unusual places.
• Loss of initiative: People suffering from Alzheimer’s disease because passive, e.g. watching TV for longer duration, sleeping for longer hours and not performing normal activities.
• Changes in personality: Dramatic changes in personality of people suffering from dementia can also be seen.

There are some things we can do that might decrease our risk of developing dementia, but there are also certain things that could increase our chances of developing dementia. These are known as risk factors which are:

• Growing old – As a person grows older so does the likelihood of dementia.
• Having a close relative with dementia – Makes your own chance of developing it slightly higher than someone who does not have a relative with dementia.

The risk is minor. In some rare cases, dementia is actually caused by an inherited genetic defect.

1. High blood pressure – Increases the risk of developing both Vascular Dementia and Alzheimer’s disease.
2. Down’s syndrome – People who have Down’s syndrome are at particular risk of developing dementia as they grow older. High blood cholesterol level – Increases the risk of developing both Vascular Dementia and Alzheimer’s disease.
3. Suffering severe of repeated head injuries – People who have had severe or repeated head injuries, especially those that have lost consciousness, have an increased risk of developing dementia as they grow older.
4. Drinking large amounts of alcohol regularly – Alcohol related dementia and Korsakoff’s syndrome can result from excessive consumption of alcohol (more than 3-5 units per day) over a long period of time.

Furthermore,

• Heavy drinking can increase the risk of Vascular Dementia.
• Smoking – Significantly increases the risk of both Alzheimer’s disease and Vascular Dementia.
• Eating large amounts of saturated fat – Can cause narrowing of the arteries and increase the risk of Vascular Dementia.
• Obesity – Increases a person’s risk of developing dementia later in life. Obesity also increases the risk of diabetes, which is also associated with increased risk of dementia.

Medical Model of Dementia

The dominant model of dementia care is the medical one, which seeks to respond to the disease of the brain that results in neurological deterioration and cognitive impairments (Cheston & Bender, 1999; Kitwood, 1997). Down92002) contends that the medical view sees dementia as a condition about which nothing can be done and that this attitude dominated the thinking of health care professionals until the early 1990’s.

Social Model of Dementia

The social model of care includes understanding the experiences of living with dementia and relationship-building and individualised care. Studies show that it is possible people with dementia can speak for themselves (Sabat 2002). Down’s (2002) suggests we have begun to listen to individuals with dementia. This change has been called the ‘new culture of dementia care’ (Kitwood 1997). Dementia, which has formerly been defined as a disease, is now viewed as a disability.

Dementia, which has formerly been defined as a disease, is now being viewed as a disability. Viewing dementia as a disability allows us to view the person with dementia as an individual, coping with her of his own impairment and entitled to an adequate quality of life and comfort. This way we can
see the person as an individual.

Depression is often difficult to distinguish from dementia. Depression will usually onset over a period of days, weeks or months. Moods may be low in the morning but improve during the day. Individuals may speak, think and move slowly and they may become irritable or agitated and recent memory maybe impaired. Depression and dementia can coexist. Symptoms of depression in the elderly may include:

1. No energy
2. Difficulty sleeping
3. No appetite
4. Diminished functioning
5. Problems with memory and concentration

Part of the normal ageing process means changes will occur to normal cognitive abilities. This may mean we cannot think as quickly or remember this as we used to. This may be mistaken for dementia. These changes should be gradual and not interfere significantly with our daily activities. If these changes are more dramatic and are affecting daily activities this could possibly indicate dementia.

If you’re diagnosed with dementia it will have a big impact on your life. You and your family may worry about how long you can care for yourself, especially if you live alone. People with dementia can remain independent for some time but will need support from family and friends. When a person with dementia finds that their mental abilities are declining, they often feel vulnerable and in need of reassurance and support. The people closest to them, including their carer’s, friends and family, need to do everything they can to help the person to retain their sense of identity and feelings of self-worth.

Positive relationships and communication help to enable positive feelings. We can support people to experience a sense of well-being by helping to boost their self-esteem and confidence by providing activities which can give a sense of purpose. People with dementia do not lose their identity. It is usually the attitude of those around them that can deny them their identity.

It is important to talk in terms of living with dementia rather than suffering from it. The starting point for positive intervention and support is an understanding of the lived experience of the person with dementia, recognition of the person’s strengths and abilities and an understanding that the person with dementia is still a unique individual with his or her own preferences, needs and life story.

Different techniques that can be used to facilitate positive interactions with an individual who has dementia include:

• Memory books
• Recreational activity
• Problem solving activity
• Music therapy
• Use of pictures
• Use of non-verbal communication

By doing these techniques it provides stimulation, reduces disengagement, reduces challenging behaviour, enriches the life of the individual, helps the individual to feel valued and helps the individual feel understood.

You can adapt your interactions to facilitate the communication needs of individual with dementia by:

• Gestures
• Sign language
• Memory books
• Use of non-verbal communication
• Reminiscence therapy
• Pictorial approach
• Tactile approaches

You can gather information about an individual who suffers from dementia from:

• Family and friends
• GP
• Managers
• Colleagues
• Care worker
• Social worker
• Nurse
• Dementia care advisor
• Psychiatrist