Understanding Dementia: Causes, Symptoms, and Impact

  • 14 Pages
  • Published On: 19-12-2023
Introduction

Dementia is a term that is used to describe several symptoms of cognitive decline including the impairment in thinking, communication, and memory (Livingston et al., 2017). The condition is more prevalent in the elderly with Alzheimer’s disease being the main cause of dementia which accounts for between 60 and 80 percent of entire dementia cases. The number of people estimated to be suffering from dementia is about 47.5 million worldwide (Livingston et al., 2017). Some of the symptoms that are associated with the conditions are mood change, disorientation, and memory loss. Also, the patient could be having problems in the change of personality where they become fearful, suspicious, and maybe irritable (Livingston et al., 2017). To add, disorientation and problems in communication are also symptoms that are associated with dementia, and the person may experience difficulty in completing tasks that are familiar to them.

Dementia stages

As stated by Vermunt, et al., (2019), dementia can be categorized in several stages depending on its severity. Mild cognitive impairment is the first stage which is associated with general forgetfulness. It is common to many people but it may progress to more severe dementia in others. Mild dementia is the second stage where the person experiences occasional cognitive impairments that affect their daily activities. The individual may experience hardship in planning as well as in carrying out activities, losing the directions, personality changes, confusion, and memory loss. Moderate dementia is the third stage where the patient may require help in performing certain tasks and they are more challenged by daily life. At this stage, the person may need help to perform the basic activities including getting dressed, and sometimes even combing their hair. Also, some get sleep disturbances. Severe dementia is the final stage where the symptoms worsen considerably and the patients may need full-time care (Arvanitakis, Shah, and Bennett, 2019). It is associated with the loss of communication and bladder control and the patient may also be unable to do simple tasks like sitting (Arvanitakis, Shah, and Bennett, 2019).

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Types and causes of dementia

There are several types of dementias. Alzheimer’s disease is one type that is characterized by protein abnormalities that cause tangles and plagues in the brain (Wan, et al., 2020). The size of the patient’s brain shrinks and it has progressively fewer nerve cells and connections. Parkinson’s is another condition that can lead to dementia. It is characterized by the presence of Lewy bodies. Neurodegenerative disease, as well as the death of brain cells, are some of the factors that cause dementia. However, the relationship between the deaths of brain cells to dementia is not clear. Research on whether it is dementia that causes the death of brain cells or is it is the death of brain cells that causes dementia is still ongoing (Wan, et al., 2020).

Needs

The needs for handling dementia may divide into the patients’ needs and the needs of the caregivers (Rabins, Lyketsos and Steele, 2006). The needs of the patient include the need for accurate diagnosis. The diagnosis given must be the accurate one so that the accurate treatment is given. Misdiagnosis may lead to worsening of the condition due to wrong treatment. Personal safety is another need of the patient since the condition can make the patient insecure especially since it affects the brain (Rabins, Lyketsos and Steele, 2006). The needs and the wants of the patients also have to be provided. These patients have so many needs and want that ought to be taken care of so that they may live a better life. Therefore, those needs and wants must be met.

On the other hand, the caregivers have their needs so that they can take care of the patients effectively. First, they must be educated on the prognosis as well as on the treatment (Rabins, Lyketsos and Steele, 2006). This will go a long way in ensuring that they are well conversant with the condition. Also, the caregiver must be guided on decision-making. An expert need to support the caregivers such that they advise them accordingly especially when they need to make decisions. Additionally, the caregivers need to be given emotional support. Taking care of those living with dementia can be emotionally draining, therefore, there is a need to offer them emotional support. To add, the care gives as well as the family needs to have time for themselves. Sometimes they need to be away and have to reflect on themselves and also to reflect on their lives. They too need to be referred to the community resources that may offer them support (Rabins, Lyketsos and Steele, 2006). Sometimes they may want to aces some of the community resources but they may be unable to. Therefore, referring them to the community resources would be of great importance.

Case study

From the study, Josephine is in her 70's which is the age that most people develop dementia since dementia is associated with age. Therefore, at that age, she was at risk of developing dementia. Also, she had become forgetful in the recent past and she could sometimes not remember routes that were well known to her when she was driving. These are some of the signs of the first stages of dementia where people tend to forget, but they can perform most of the tasks including driving without the need of any help. Her self-worth and independence are affected by this. Even though a diagnosis of dementia is not a reason to stop driving, Josephine might need a helper who will be driving her around because she has become forgetful. 33 percent of the people living with dementia can still drive but it is crucial to know if they can still do it safely.

Additionally, Josephine may not be in a position to deal with the challenges that she may encounter on the road including obstacles and diversions. She therefore needs a caring support program that will help her with the groceries and shopping. The relevant authorities like the age UK can be of help when it comes to this support. Josephine's memory has also been affected by dementia and she can no longer remember to take her diabetes medication and she attributes the forgetfulness to old age when questioned by her husband. I would advise that she gets an alarm to remind her so that she may not rely on Andy always.

There has been an increase in the number of people that are suffering from dementia. The world health organization has therefore requested the governments to declare dementia a public health priority (Arvanitakis, Shah, and Bennett, 2019). Most of the people who are living with dementia are home-dwelling hence the need for making their homes more comfortable for their living. Due to the deterioration in her dementia, the 1930 house she is living in might need some modifications to suit her needs. Hence, there is a need for the assessment by the local council who will look at the lighting. The lighting needs to be improved to minimize falls and to avoid confusion. To add, there is a need for signs and clear labels written in big letters to facilitate her movement. With time, Josephine might be required to move into the care homes as her condition deteriorates since she may need more attention.

Depending on Andy’s health and the dementia advancement, there might be the need for a carer to oversee her medication. The emotional struggle that Josephine is going through and the reluctance to meet with her friends might be a sign of low moods and that Josephine recognizes herself. To supper her overcome this, she may need to create new friends and also join social groups to help her cope and improve her quality of life. Most of the people living with dementia risk being discriminated against and isolated in society. Therefore, there is a need for increasing their wellbeing and the quality of their lives through encouraging confident relationships and social contact. Also, there is a need of taking care of their psychosocial needs where the person's hygiene, medication, and nutrition are looked into.

Pillars to dementia care

The treatment goals are determined by the caregiver's needs as well as those of the patient. Therefore, it is personalized to suit the needs. To add, there are several pillars to dementia care. The first is to support the people who take care of the patients (Rabins, Lyketsos, and Steele, 2006). This would ensure that the care given is up to standard with the requirements. The second is to support the patient. Those patients suffering from dementia need a lot of care and hence should be supported as much as possible so that they can lead a better life. Next is to treat the symptoms that are associate with dementia. Several symptoms are associated with dementia which includes behavioural, functional as well as cognitive. The final goal is to treat dementia (Rabins, Lyketsos, and Steele, 2006). Although there is no known cure for the condition, there are several interventions that help to slow down the rate of dementia. Curing dementia would make the patient as well as the caregivers feel relieved and live a normal life.

Principles of dementia care

To add, several principles guide dementia care. First, the persons living with dementia are individuals and their care should be personalized (Rabins, Lyketsos, and Steele, 2006). It is important to take each person as an individual and personalize their care and treatment so that the health care services delivered to those people are of high quality. The second principle is that those individuals have a similar need with those who do not have the condition. This principle warns against discriminating against those living with dementia since they are also people like the rest who do not have the condition.

Additionally, the principle that Individuals living with dementia are valued the same as other adults is key (Rabins, Lyketsos, and Steele, 2006). The principle tries to equalize everyone such that no person is expected to be treated differently from the other since they are all values the same. Fourth is the principle that individuals with dementia can be happy and can also lead a healthy life. The principle is important in ensuring that the people with dementia are well taken care of so that they can live a healthy and happy life. The fifth principle is that that slight changes can have a great impact. Finally, there is always something that can be done to help manage the condition. The principle encourages people not to give up on their condition and it is also a principle that acts as a message for hope.

Aetiology

The risk factors of dementia can be grouped into genotypic, environmental, and genetic. Age is one of the risk factors of dementia. The risk of dementia increases with an increase in age (Keret et al., 2020). To add, several environmental factors predispose one to dementia. One of them being smoking. From the case, smoking Andy could have predisposed Josephine to contract dementia. Diabetes is another condition that may lead to atherosclerosis which is one of the factors that cause dementia.

Pathophysiology

Subcortical dementia is characterized by difficulty in performing complex intellectual tasks like solving problems and strategizing, slow cognition, mood disturbances, and visual-spatial abnormalities (Jacobson and Garcia-Pittman, 2018). The condition has been identified in vascular, infectious, and inflammatory conditions and is also common in degenerative extrapyramidal disorders. The neurochemical, metabolic, and histologic research shows that the condition is a result of the dysfunction of the subcortical frontal connection, subcortical structures, or the subcortical neurotransmitter systems. Additionally, the condition anatomically and neuropsychologically differs from Alzheimer's dementia since it affects the cerebral cortex.

Prevention and treatment

Apart from age, other factors can cause dementia. Some of the causes of dementia include diabetes, high cholesterol levels, atherosclerosis, smoking, and alcohol abuse Dyer et al., 2018. Therefore, to prevent dementia, it is important to avoid those factors that predispose a person to the condition. Degenerative dementia has no known cure since the death of brain cells is irreversible. However, the symptoms can be managed and by providing treatment. The interventions to the management of dementia can be divided into nonpharmacological and pharmacological. Pharmacological interventions are those that involve the use of drugs.

Pharmacological interventions

Drugs have been used in the management of the symptoms since there is no known cure. The drugs are referred to as anti-dementia drugs and they are meant to slow down the progression of the disease (Dyer et al., 2018). The choice of the drug varies depending on the dementia subtype. With Alzheimer's, the acetylcholine in the brain becomes depleted hence the drugs that are meant to manage it relate to the presence or the absence of acetylcholine in the brain. Therefore, the treatment of Alzheimer's dementia involves the use of acetylcholine inhibitors which are meant to increase the acetylcholine levels in the brain. The most common acetylcholine inhibitors are galantamine, rivastigmine, and donepezil. To add, memantine has also been used in the management of the condition since it blocks glutamate which is excessively produced in the brain.

Nonpharmacological interventions

These are the interventions that do not involve the use of drugs. In dementia care, non-pharmacological interventions are crucial. Social support groups, as well as cognitive therapy, have been crucial in the management of dementia.

Validation therapy

With the validation therapy, there is an attempt by the medical caregiver to communicate with the individual suffering from dementia by empathizing with the meanings behind the behaviour, speech, and also with their feelings (Zucchella et al., 2018). The therapy is meant to acknowledge their feelings hence making them as happy as possible. However, validation therapy is not recommended when the person is having delusions which would lead to distress.

Cognitive stimulation therapy

This is a non-pharmacological intervention that is used for people whose dementia symptoms are mild to moderate. A therapeutic session is offered where dementia care, a skilled interpersonal communicator, and a trained practitioner also participate. The sessions contain themed activities that are meant to stimulate and engage the patient. This therapy uses the principle of respect and individual centeredness which strengthens relationships and maximizes potential (Theleritis et al., 2018).

Physical exercise

Research has shown that physical exercise benefits people living with dementia especially those who were living an active life (Dyer et al., 2018). Encouraging the patients to have physical exercises based on their safety needs, preferences, interests, and abilities would be a form of non-pharmacological intervention. Physical exercise has been found to reduce behavioural disturbances and depressive symptoms.

Multisensory stimulation

It is mostly used to help people living with dementia who are agitated or restless. Snoezelen rooms are used and multi-sensory stimulation including quiet music, soft furnishings, contrasting textures, colour, water, light, and fibre optics are used to enhance communication and also to relax the person (Theleritis et al., 2018).

Reminiscence therapy

As stated by Ijaopo (2017), people suffering from dementia may have impaired short-term memory while their long-term memory is no affected. Reminiscence therapy enables the person to remember their memories and relive their most memorable moments. It is a therapy that is used by both the person living with dementia and their families. It also allows the person to reflect on their pasts.

Rules and regulations

Under the UK disability regulation, dementia has been categorized as a disability. The 2010 equality act says that disability is a mental or physical impairment that has a long-term and substantial adverse impact on an individual’s ability to perform their everyday activities (Mason, and Minerva, 2020). From the definition, is evident that dementia falls in this category especially at the stage where the symptoms are severe. Therefore, the people living with dementia are entitled to protection against any discrimination. The service provides as well as employers need to have slight adjustments to accommodate them. The mental capacity legislation is another act that is meant to protect the rights of people living with dementia. The legislation allows those people to make their own decisions if they are in a position to. The act covers Wales2 and England and is meant to protect the rights of those living with dementia. It also protects one from the risk-averse cultures in social care and health and also from overprotection that undermines their self-determination and decision making.

1998 human rights act

To add, the 1998 human rights act gives the people living with dementia the light to life (Matthews, 2019). This right gives them the right to seek treatment and to be treated so that their lives are protected. Also, the act prohibits degradation or inhuman punishment or treatment. Therefore, those people living with dementia are protected from any inhuman treatment that would be based on their disability. Also, they are entitled to the right to security and liberty. They, therefore, need to be protected and be secure to protect them. Also, the 1998 human rights act gives a person the right to a family and private life. Hence the privacy of those living with dementia has been protected.

Convention on the rights of people living with disability

The rights of the people living with disabilities have also been protected by the international treaty that was passed in 2006 by the United Nations. The treaty warns against discrimination and it promotes equality and the enjoyment of life by the people living with dementia (Arstein-Kerslake and Flynn, 2017). The treaty calls upon the public to take care and understand those living with disabilities. It aims to eradicate society's perception and treatment of non-disabled and disabled people. The convention on the rights of the people living with disability has been ratified by the UK therefore, the government policies and the national laws should comply.

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Additionally, the treaty gives the persons living with dementia the right to seek justice. To add, they are given the right to health where they are entitled to good health and they also have the right to access health services. The treaty also gives them the right to access services including sport, recreational, culture, participation in civic life, adequate living standards, and work. This ensures that they are protected against any form of discrimination.

References

Arstein-Kerslake, A. and Flynn, E., 2017. The right to legal agency: Domination, disability and the protections of Article 12 of the Convention on the Rights of Persons with Disabilities. Int'l JL Context, 13, p.22.

Arvanitakis, Z., Shah, R.C. and Bennett, D.A., 2019. Diagnosis and management of dementia. Jama, 322(16), pp.1589-1599.

Dyer, S.M., Harrison, S.L., Laver, K., Whitehead, C. and Crotty, M., 2018. An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioural and psychological symptoms of dementia. International psychogeriatrics, 30(3), pp.295-309.

Ijaopo, E.O., 2017. Dementia-related agitation: a review of non-pharmacological interventions and analysis of risks and benefits of pharmacotherapy. Translational psychiatry, 7(10), pp. e1250-e1250.

Jacobson, J.C. and Garcia-Pittman, E.C., 2018. Case of A Patient with Bipolar Disorder and Delayed Subcortical Dementia Onset Following Acute Lithium Toxicity. The American Journal of Geriatric Psychiatry, 26(3), p.S97.

Keret, O., Hoang, T.D., Xia, F., Rosen, H.J. and Yaffe, K., 2020. Association of late-onset unprovoked seizures of unknown aetiology with the risk of developing dementia in older veterans. JAMA neurology, 77(6), pp.710-715.

Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S.G., Huntley, J., Ames, D., Ballard, C., Banerjee, S., Burns, A., Cohen-Mansfield, J. and Cooper, C., 2017. Dementia prevention, intervention, and care. The Lancet, 390(10113), pp.2673-2734.

Mason, A. and Minerva, F., 2020. Should the Equality Act 2010 Be Extended to Prohibit Appearance Discrimination? Political Studies, p.0032321720966480.

Matthews, P., 2019. Changing the Conversation: From Suffering with Dementia Through Dementia as a Disability Rights Issue, to a Deeper Theological Perspective. Journal of Disability & Religion, 23(2), pp.149-165.

Rabins, P. V., Lyketsos, C. G., & Steele, C. D. (2006). Practical dementia care. Oxford, Oxford Univ. Press.

Rabins, P.V., Lyketsos, C.G. and Steele, C.D., 2006. Practical dementia care. OUP USA.

Theleritis, C., Siarkos, K., Politis, A.A., Katirtzoglou, E. and Politis, A., 2018. A systematic review of non-pharmacological treatments for apathy in dementia. International journal of geriatric psychiatry, 33(2), pp. e177-e192.

Vermunt, L., Sikkes, S.A., Van Den Hout, A., Handels, R., Bos, I., Van Der Flier, W.M., Kern, S., Ousset, P.J., Maruff, P., Skoog, I. and Verhey, F.R., 2019. Duration of preclinical, prodromal, and dementia stages of Alzheimer's disease in relation to age, sex, and APOE genotype. Alzheimer's & Dementia, 15(7), pp.888-898.

Wan, Y.W., Al-Ouran, R., Mangleburg, C.G., Perumal, T.M., Lee, T.V., Allison, K., Swarup, V., Funk, C.C., Gaiteri, C., Allen, M. and Wang, M., 2020. Meta-analysis of the Alzheimer's disease human brain transcriptome and functional dissection in mouse models. Cell reports, 32(2), p.107908.

Zucchella, C., Sinforiani, E., Tamburin, S., Federico, A., Mantovani, E., Bernini, S., Casale, R. and Bartolo, M., 2018. The multidisciplinary approach to Alzheimer's disease and dementia. A narrative review of non-pharmacological treatment. Frontiers in neurology, 9, p.1058.


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