Dementia

Dementia is a slow, progressive decline in mental function including memory, thinking, judgment, and the ability to learn.

Causes Of Dementia

Commonly, dementia occurs as a brain disorder with no other cause (called a primary brain disorder), but it can be caused by many disorders. Most commonly, dementia is Alzheimer’s disease, a primary brain disorder. It accounts for 50 to 70% of cases. Other common types include vascular dementia, Lewy body dementia, and frontotemporal dementia (such as Pick’s disease). People may have more than one of these dementias (a disorder called mixed dementia).

A subdural hematoma (an accumulation of blood between the outer and middle layers of tissue that cover the brain) results when one or more blood vessels breaks, usually because of a head injury. Such injuries can be slight and may not be recognized.

Many disorders can worsen the symptoms of dementia. They include diabetes, chronic bronchitis, emphysema, infections, a chronic kidney disorder, liver disorders, and heart failure.

Many drugs may temporarily cause or worsen symptoms of dementia. Some of these drugs can be purchased without a prescription (over the counter). Sleep aids (which are sedatives), cold remedies, antianxiety drugs, and some antidepressants are common examples. Drinking alcohol, even in moderate amounts, may also worsen dementia, and most experts recommend that people with dementia stop drinking alcohol.

Symptoms Of Dementia

In people with dementia, mental function typically deteriorates over a period of 2 to 10 years. However, dementia progresses at different rates depending on the cause. In people with vascular dementia, symptoms tend to worsen in steps, worsening suddenly with each new stroke, with some improvement in between. In people with Alzheimer’s disease or Lewy body dementia, symptoms tend to worsen more steadily. The rate of progression also varies from person to person. Looking back at how fast it worsened during the previous year often gives an indication about the coming year. Symptoms  may worsen when people with dementia are moved to a nursing home or other institution because people with dementia have difficulty learning and remembering new rules and routines. Problems, such as pain, shortness of breath, retention of urine, and  constipation, may cause delirium with rapidly worsening confusion in people who have dementia. If these problems are corrected, people usually return to the level of functioning they had before the problem.

Symptoms of most dementia are similar. Generally, dementia causes the following: memory loss, problem using language, changes in personality, disorientation, problems doing usual daily tasks, disruptive or inappropriate behavior.

Diagnosis Of Dementia

Forgetfulness is usually the first sign noticed by family members or doctors. Doctors and other health care practitioners can usually diagnose dementia by asking the person and family members a series of questions, such as the following:

  • What is the person’s age? Has any family member had dementia or other types of mental dysfunction (family history)?
  • When did symptoms start? How quickly did symptoms worsen?
  • How has the person changed (for example, has the person given up hobbies and activities)? What drugs is the person taking (because certain drugs can cause symptoms dementia)?
  • Has the person been depressed or sad, especially if the person is older?

The person is also given a mental status test, consisting of simple questions and tasks, such as naming objects, recalling short lists, writing sentences, and copying shapes, more detailed testing (called neuropsychologic testing) is sometimes needed to clarify the degree of impairment or to determine whether the person is experiencing true mental decline. This testing covers all the main areas of mental function, including mood, and usually takes 1 to 3 hours.

Treatment Of Dementia

For most dementias, no treatment can restore mental function. However, treating disorders that are worsening the dementia sometimes slow mental decline. For people who have dementia and depression, antidepressants (such as sertraline and paroxetine and counseling may help, at least temporarily. Abstaining from alcohol can result in long-term improvement. Drugs that may be making the dementia worse, such as sedatives and drugs that affect brain function, are stopped if possible. Pain and any other disorders or health problems (such as a urinary tract infection or constipation), whether they are related to the dementia or not, are treated. Such treatment may help maintain function in people with dementia.

Creating a safe and supportive environment can be remarkably helpful and certain drugs can help for a while. The person with dementia, family members, other caregivers, and the health care practitioners involved should discuss and decide on the best strategy for the person.

Safety Measures: Safety is a concern. A visiting nurse or an occupational or physical therapist can evaluate homes for safety and recommend useful changes. For Example, when the light is dim, people with dementia are even more likely to misinterpret what they see, so lighting should be relatively bright. Leaving a night-light on or installing motion sensor lights may also help. Such changes can help prevent accidents (particularly falls) and help people function better.

Supportive Measures: People who have mild to intermediate dementia usually function best in familiar surroundings and can usually remain at home.

Generally, the environment should be bright, cheerful, safe, and stable and include some stimulation, such as radio or television. The environment should be designed to help with orientation. For example, windows enable people to know generally what time of day it is. Structure and routine help people with dementia stay oriented and give them a sense of security and stability. Any change in surroundings, routines, or caregivers should be explained to people clearly and simply. Before every procedure or interaction, they should be told what is going to happen. Such as a bath or a meal. Taking time to explain can help prevent a fight.

Following a daily routine for tasks such as bathing, eating, and sleeping helps people with dementia remember. Following a regular routine at bedtime may help them sleep better.

Other activities scheduled on a regular basis can help people feel independent and needed by focusing their attention on pleasurable or usual tasks.

Such activities can also help relieve depression. Activities related to interests people had before dementia are good choices. Activities should also be enjoyable and provide some stimulation but not too many choices or challenges. Physical activity relieves stress and frustration and thus can help prevent sleep problems and disruptive behavior, such as agitation and wandering. It also helps improve balance (and thus may help prevent falls) and helps keep the heart and lungs health. Continued mental activity, including hobbies, interest in current events, and reading, helps keep people alert and interested in life.  Activities should be broken down in small parts or simplified as the dementia worsens.

Excessive stimulation should be avoided, but people should not be socially isolated. Frequent visits by staff members and familiar people encourage people to remain social. Some improvement may occur if daily routines are simplified, if expectations for people with dementia are realistic, and if they are enabled to maintain some sense of dignity and self-esteem.

Extra help may be needed. Family members can get a list of valuable services from health care practitioners, social or human services (listed in the telephone book), or the Internet (through Eldercare Locator). Services may include housekeeping, respite care, meals brought to the home, and daycare programs and activities designed for people with dementia. Around the clock-care can be arranged that is expensive.

Because dementia is usually progressive, planning for the future is essential. Long before a person with dementia needs to be moved to a more supportive and structured environment, family members should plan for this move and evaluate the options for long-term care. Such planning usually involves the efforts of a doctor, a social worker, nurses, and a lawyer, but most of the responsibility falls on family members. Decisions about moving a person with dementia to a more supportive environment involve balancing the desire to keep the person safe with the desire to maintain the person’s sense of independence as long as possible. Such decisions depend on many factors.

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