What Is Dementia?
Dementia is not a disease, but rather an umbrella term for a variety of symptoms that may accompany or indicate certain diseases or conditions. Today over 60 different conditions are known to cause dementia symptoms. Symptoms may include impaired memory and confusion, difficulty in performing day-to-day or familiar tasks, and changes in personality, mood, and behaviour. When caused by disease or injury, dementia is usually irreversible; however, the symptoms may be reversible when caused by treatable conditions, such as: dehydration, constipation, infection, vitamin deficiencies and imbalances, pain, medication poisoning, brain tumours or depression.
What is the difference between dementia and Alzheimers disease?
Dementia is not a disease, but a broad term to cover a group of symptoms; the most common being memory loss.
The most common cause of dementia is Alzheimers disease, a degenerative disease accounting for between 50 70% of all cases. To date, there is no medical cure or preventative for Alzheimers. Medical treatments available today can only prolong a stage of dementia for a certain period of time with varying success depending on the product and the individual. It is important to be aware that despite the amazing assessment tools available today, it is still not possible to truly diagnose Alzheimers until an autopsy has taken place. Also, in many situations there is no direct link between the persons neurological changes and the degree of dementia symptoms he or she may experience.
Below are some examples of curable or reversible conditions:
Dehydration can cause confusion and increased memory loss both symptoms of dementia.
Constipation
Infection. e.g. pneumonia, urinary tract infection or even the smallest infection can cause dementia symptoms.
Vitamin imbalance. Imbalance or lack of brain vitamins such as C, E, B6, B12 and folate (folic acid) can also cause dementia symptoms. High homocysteine levels are associated with an increased risk for cardiovascular disease, stroke and also Alzheimer’s disease and other dementias. Adequate intake of vitamin B and folate can help reduce homocysteine levels.
Pain can cause dementia symptoms.
Medication poisoning. This can occur easily in older people because their bodies are less able to excrete surplus medication, which can build up in the system and create side effects, such as: bewilderment, confusion and amnesia; all symptoms of dementia.
Brain tumours (that can be removed) benign as well as malignant.
Depression can also cause symptoms similar to dementia, such as decreased memory and concentration loss; often leading to misdiagnosis.
Once any of the above existing conditions have been cured, the dementia symptoms are likely to disappear or return to the level they were at before the condition appeared.
Medical research has not yet been able to find any treatment or preventatives for the following conditions:
Alzheimers disease (the most common cause of dementia) is a result of damage and changes to nerve cells within the brain. These abnormalities are referred to as amyloid plaques and neurofibrillary tangles which can ultimately destroy nerve cells.
Vascular dementia or multi-infarct dementia (the second most common cause of dementia) and more commonly known as stroke, is a result of the blood supply to the brain being cut off due to clotting or blood vessels bursting in the brain, (aneurism) destroying surrounding tissue and triggering strokes.
Lewy Bodies dementia (the third most common cause of dementia) is a result of a build-up of Lewy bodies accumulated bits of alpha-synuclein protein inside the areas of the brain that control particular aspects of memory and motor control. The dementia symptoms are characterised by pronounced fluctuations in mood with periods of confusion, followed by greater lucidity, and disturbed visual experiences.
Excessive alcohol intake or Korsakov Syndrome is associated with prolonged alcohol use characterised by personality changes and short term memory loss.
Fronto Temporal Lobar Degeneration (FLTD) including Picks disease is caused by a degeneration occurring in one or both of the frontal and temporal lobes of the brain resulting in significant behaviour and personality changes.
Other less common causes of dementia include Huntingdons and Parkinsons diseases.
Early signs of dementia
The first signs and changes in a person with dementia may be scarcely noticeable as most often they come on gradually. (Except in cases like multi-infarct dementia, which takes a more step-like decline.) The person or family may initially only notice memory lapses, such as difficulty in remembering dates or finding the right word. The person may use impaired judgement resulting in financial or ill-considered decisions. Behaviour and personality changes may occur too, such as becoming more assertive/more withdrawn, less flexible; showing a loss of interest in things that have mattered previously, becoming absent minded or repeating the same story or question.
Each person will be affected in his or her own unique way, and also dependant on the type or cause of his or her dementia. It is important to avoid foretelling the future or embracing all the pessimistic possibilities you may hear or read of because such negative predictions may well result in a self-fulfilling prophecy.
The fact that some brain cells die or that there has been a deterioration of brain cells resulting in the onset of dementia does not mean the path ahead has to be all downhill. Some research studies show that there is no correlation between the severity of brain damage and the extent to which a person is generally affected by the dementia process.
Research into the brain also shows that even though some brain cells may die, the brain has the capability to repair itself, creating new networks and pathways to link information stored in cells that are still functioning. There is much excitement in the scientific world about the possibility of nerve regrowth in the brains of people with dementia.
We know through experience that people with dementia have a fabulous ability to develop new strategies and behaviours to compensate for what they have lost. Positive responses to and interpretations of these changes, strategies and behaviours can be a matter of attitude, both in the person and those of their supportive partners or carers.
Often, after a dementia diagnosis, focus fixes only on the persons symptoms and behaviour rather than on his or her needs. With this daunting diagnosis, it can seem that there is not much that can be done and it can be very hard to maintain a positive attitude. However, if we shift our focus and energy to the persons strengths and remaining abilities, it will help us to keep a positive attitude and influence both the way we care and how the person we support will feel and respond to us.
The first step is to switch our thinking from dementia as resulting from an irreversible, degenerative disease of the brain without a cure. (A very negative picture); To: dementia resulting from a disability of certain parts of the brain. We need to remember that the rest of the person is still alive, feeling, sensitive and responsive. There are many possibilities to work with to help the individual improve, blossom and grow. By focusing on all that the person can still do, we can help ensure meaningful, positive and fulfilling lives for those we support.
When we open up to possibilities instead of the forecast probabilities, a whole new dimension can develop in relationships between either you and the person who supports you or you and the person you support.
Symptoms and Stages of Dementia
Dementia symptoms are often grouped in stages here we refer to 4 different stages. These stages should only serve as guides though as each person responds differently to their particular symptoms, and stages can fluctuate and overlap. A person may show symptoms common to the early stage one minute and those common to middle or late stage the next. These variations can be very much dependent on whether the person is experiencing an underlying physical condition or the lack of genuine respect and appreciation.
Though a person may appear muddled one particular day or in the morning or afternoon this doesnt mean that the person is locked at that point or has moved on to the next stage. It only means that this is where he or she is at that particular moment and this may change and the person may revert to being quite clear again.
The definitions we use here for the 4 stages are expressed from the point of view of social psychology; and are different from those of the medical model, which focuses mainly on the deterioration occurring in the brain. (Note: Research has shown that there is little correlation between the severity of brain damage and how it actually affects a person with dementia.)
We can all be forgetful at times. Who hasnt gone to another room and arrived to wonder what they were doing there? Who hasnt forgotten what day it is momentarily, especially when on holidays? Who hasnt misplaced their car keys on occasions? The difference for the person with dementia is that he or she may find the keys but not know what to do with them.
In the first stage, people with dementia begin to experience that something is not right The old memory is playing up. They may feel embarrassed or frightened when they recognize changes in their memory or thinking. Family and friends begin to question and comment on the changes and forgetfulness. The person is likely to fight to keep up the façade of normality and being in control. They might do things, such as making up a little story to fill the memory gap of someone or something they cant remember. Professionals label this gap filling as confabulation. However, this story telling or gap filling does not mean that the person is telling a lie. It is actually a creative, self-defence mechanism that helps the person to keep up the façade. It will help supportive partners and carers to understand if they can imagine it in this way too.
The person may express anger or annoyance to direct questions requiring memory or thinking skills. A seemingly simple question, such as: Where were you born? may elicit a snappy, Thats none of your business!
Also, the person might blame others for his or her memory lapses.
Lydia cannot find her glasses. She asks her husband, Eric, Have you seen my glasses? Eric recalls seeing them earlier in the bedroom, and says, Have a look on the bedside table. I think you put them there. Lydia is not going to admit that she might have put the glasses there herself and forgotten; so she says, Well, you must have put them there, because I didnt.
This type of response is easy to take as an accusation, but it is not. It is simply the person fighting to hold on to a small piece of control and to keep up the façade.
Sometimes the person in this first stage can drive family and friends wild wanting to check and recheck everything. Paul may ask, Is it today that my son is coming? What is the time? Is today Monday? He checks again and again, until patience frays and frustration builds. It is important to remember that Paul is not doing this to annoy you; he is simply trying to reassure himself that he is in control.
People in this early stage seem to use every opportunity to exercise the control they feel they are losing.
When Mary says, Mum, we are going out at 3 oclock, and they have not left by 10 past 3, Mum may pull her up. You said we were leaving at 3, and its 10 past 3!
Mum is not trying to challenge Mary; she is simply trying to show that she remembers that they had a different arrangement.
In this first stage, people with dementia generally use much the same language as most people do. They might forget a word, a phrase or a memory and then create a little story to fill the memory gap. Sometimes they may also appear vague in the way they communicate.
Instead of Stan saying, Please give me the cup, he forgets the word cup and (while pointing at it) might say, Please give me that one.
He might use vague phrases such as, Something has happened, or, Something is not right.
These are just two examples of the wonderful way people with dementia compensate for missing memories.
Or they may try to get us to create multiple-choice questions so they only have to answer one of them, and, in that way, we jog their memory too. For example you might ask Stan, Where have you been? his response might be, Oh, you know where.
Note: It is far easier for people with dementia to recognise situations that are described to them rather than to remember something out-of-the-blue.
In the second stage, people with dementia are far more relaxed and inclined to give in and let go. They may start to withdraw and appear to become preoccupied with the past, thinking back to happy times, restoring old memories and sometimes living in that time and reality. Their way of communicating may change too. Sentence construction may not be as clear. They might start a sentence, and it make perfect sense; but then it becomes muddled in the middle and ends as gobbledegook, which is hard to understand.
If they cant remember a word, they might create one. Often the words will be familiar, only now put together in an innovative way creating a poetic new word or phrase. Here is a great personal example of how this can occur.
One day we were out driving. Suddenly, Mum pointed out of the window and said, Look at that beautiful water nest. I looked across at the dam in the paddock and thought, What is she talking about? Then I realised. Mum couldnt remember the word for dam, so, instead, shed said, water nest. A far more beautiful word picture than dam!
Another time, she said, I cant find my rain stick. I did have to wonder for a moment about this rain stick? Of course, Mum meant her umbrella.
Once we work out the intended meaning, it can seem so obvious.
People who have dementia develop their own wonderful language. Each person is unique and so will develop an individual style of language that those closest to them will learn to understand. A close family member may even get to a point where he or she doesnt even think of it as different.
In the second stage, the person may start to mix up relationships and generations, such as Emily believing her son to be her deceased husband, or Ray believing his niece is his sister.
The person may start to address you by a different name. Just because you are addressed in this way for a short time does not mean it will last forever. It may only be that the person is preoccupied, for the moment, in thinking about Mum or Dad. So, when you appear, you may temporarily become Mum or Dad.
In this stage, the person may still be able to do many things, but might become sidetracked when starting on something new.
Evelyn pulls out a drawer to put something away. Once the drawer is open, she is inspired by what she sees inside and forgets what she came to do. Instead, she begins to empty the contents.
John may begin to set the table using the correct movements; but once he spreads out the tablecloth, he forgets what he is doing. Suddenly, re-inspired, he begins to fold the cloth up again and puts it away.
Some of these actions can be frustrating, but they are easier to understand when we know that the person is not deliberately trying to frustrate or irritate; it is simply that he or she sets out to do the one thing, and then gets distracted.
In the third stage, people with dementia start to withdraw even further into the past and become so preoccupied with their memories that they live almost entirely in that time and reality.
They may also start to wander. When this happens, it is important to know that there is usually a valid reason. Either the person is looking for something or someone, or is trying to prevent boredom.
The person may also start expressing needs, wants and feelings increasingly through body language using gestures and actions. For example: Some may sit picking minute fluff-balls off clothing, wringing their hands, or appear to be kneading dough or mending clothes. These are ways of going back into the past and recreating a time when they felt needed, useful and special. Often these positive experiences are missing for them in this reality. These movements do have purpose, even if they might seem strange to us.
Language, at this stage, may consist mainly of one-syllable words, such as Yes and No, interspersed with only a key word. This key word might be a noun or a verb, but is always something that has particular meaning and that we can take note of to help us understand what is being talked about.
We can maintain communication with people who have dementia in all stages.
The person may become incontinent in the third stage, but, remember, this may not necessarily happen.
In the fourth stage, people with dementia may completely shut out the outside world. They might sit in a chair or lie in bed staring straight into thin air, or they might have their eyes closed. They may not respond when someone walks into the room or speaks to them.
Today, we know that the person at this stage still hears and experiences through touch, and it is extremely important that we continue to talk with them and still make physical contact.
Written by Jane Verity
Source : http://www.dementiacareaustralia.com/index.php?option=com_content&task=view&id=117&Itemid=58
May 13th 1007
Warm Regards,
Sailesh Mishra
Email – sailesh2000_2000@yahoo.co.uk