Dementia is not a single specific condition that impacts the lives of a definite number of people in an absolute way.
There is no way to calculate your exact risk of developing this disease. Instead, dementia is an umbrella term for “a decline in mental ability severe enough to interfere with daily life” (“What Is Dementia,” n.d.). It is difficult to deal with dementia and care for those who have it.
Just to understand what it really means is a challenge that an enormous percentage of people today have to face. Even with the amount of research, documentation, and information available, there is still a huge disconnect between the general population and this wealth of knowledge. There is not a single foolproof way to recognize dementia, as the symptoms have a large amount of variation.
However there are five cornerstone symptoms that are flags for dementia: “memory, communication and language ability for focus and pay attention, reasoning and judgment, visual perception” (“What Is Dementia,” n.d.). Of these five, two must show signs of significant impairment to raise the diagnosis of dementia. Individuals living with this disease have the most difficulty with short-term tasks, as well as with visuospatial tasks. While it is true that most individuals have the occasional issue with remembering where they may have left their phone or keys, dementia is a much more serious and persistent issue. In a majority of cases, dementia is progressive and memory deteriorates more quickly the longer the symptoms are present (“What Is Dementia,” n.
d.). The way signals are communicated in the brain is a complex system with vast numbers of moving parts such as hormones, chemicals, and electricity.
Every neuron in the body communicates through electricity. The way that nerve cells communicate with each other, however, is through synapses. Synapses are tiny gaps between neurons where the different neurotransmitters are transferred from one neuron to the next. These chemicals are what regulate, initiate, and determine the type and amount of electricity that will be conveyed to the next neuron (“Brain Synapses and Neurotransmitters” n.d.). Dementia disrupts both the electric charges and the travel of neurotransmitters, making communication between brain cells increasingly difficult (“Brain Synapses and Neurotransmitters” n.d.
). These damages that cause disconnect make recalling extremely difficult because memories are stored in specific patterns in the brain (“Brain Synapses and Neurotransmitters” n.d.). When a piece of the memory puzzle is absent or damaged, memory recall can become frustrating for the individual struggling to remember.
As with any person, this level of frustration with a seemingly simple task, ‘remember’, can cause changes in the individual’s thought patters, behaviors, and feelings (“What Is Dementia,” n.d.). It is important to note that the damages that dementia creates to the actual brain cells are irreversible and will worsen, there is treatment that may improve conditions caused by secondary diagnoses like depression (“What Is Dementia,” n.d.). While Alzheimer’s disease is not the only form of dementia, it is the most common, accounting for around 60 to 80 percent of cases of dementia (“What Is Alzheimer’s” n.d.
). Because this more specific form of dementia makes up such a large portion of cases, it is the most well researched subcategory of dementia. While Alzheimer’s is not a normal part of aging, the most widely believed risk factor is aging (“What Is Alzheimer’s” n.d.
). In fact, “the majority of people with Alzheimer’s are 65 and older” (“What Is Alzheimer’s” n.d.). There are also about 200,000 Americans who have developed younger-onset Alzheimer’s disease who are under the age of 65 (“What Is Alzheimer’s” n.d.). This form of dementia worsens over time, survival ranges from between four and 20 years (“What Is Alzheimer’s” n.
d.). It is between stokes and diabetes as the sixth leading cause of death in the US.
While more high profile dementias, like Alzheimer’s, aren’t reversible, there are some other forms of dementia that are. Dementias like delirium and Wernicke-Korsakoff Syndrome are. There are dementias are more commonly caused by infections, alcoholism, vitamin deficiencies, other diseases, and some tumors, that are reversible (“What Causes Dementia?” n.
d.). There are also infections dementias that are caused other diseases, AIDS, and syphilis that are reversible as well (“What Causes Dementia?” n.d.). Dementia is also usually present with conditions s like Parkinson’s disease, Creutzfeldt-Jakob disease, and Huntington’s disease (“What Causes Dementia?” n.d.
). There are many causes of dementia, but there are also many stages that dementia can be broken into. The first stage is at a functioning level that is considered normal. This means that there is no sign of significant memory issues or cognitive impairment (“The Seven Stages of Dementia” n.
d.). The first three of the seven total stages are commonly called the “pre-dementia” stages (“The Seven Stages of Dementia” n.d.). The next stage is memory impairment related to age.
This stage is characterized by the occasional lapse of memory (“The Seven Stages of Dementia” n.d.). This usually manifests as forgetting where something was left, or names of close friends and family (“The Seven Stages of Dementia” n.d.
). While mild memory decline is normal with increasing age, it is unfortunately also one of the earliest signs of irreversible, or degenerative, dementia (“The Seven Stages of Dementia” n.d.). The next stage can be recognized by mild cognitive impairment. This stage is more distinguishable as a precursor to dementia. Red flags like: poor sense of direction, not being able to recall names of loved ones, poor work performance, inability to retain information, losing important things, and difficulty concentrating (“The Seven Stages of Dementia” n.d.
). Individuals in the third stage typically develop anxiety as their day-to-day routines are increasingly disrupted (“The Seven Stages of Dementia” n.d.). The fourth stage, which is the first outside of the “pre-dementia” phase, is considered to be mild dementia. Those in the fourth stage usually experience social withdrawal, and their personality begin to change (“The Seven Stages of Dementia” n.d.).
Denial of the disease is usually exhibited in stage four as a self-defense mechanism (“The Seven Stages of Dementia” n.d.). Decreasing knowledge of recent events, issues with personal history memories, inability to manage finances, disorientation, and inability to recognize familiar people are all behaviors that are indicative of this stage (“The Seven Stages of Dementia” n.
d.). Individuals in the fourth stage of dementia will disguise their symptoms or prevent anxiety by avoiding difficult situations (“The Seven Stages of Dementia” n.d.). Stages 5 and 6 are interim stages of dementia. Beginning at stage 5, dementia patients begin to need help carrying out their lives (“The Seven Stages of Dementia” n.d.
). The biggest red flag for this stage is forgetting important details, like family members, or home address (“The Seven Stages of Dementia” n.d.). Disorientation is increasingly common in this stage, as well as trouble with decision-making (“The Seven Stages of Dementia” n.d.).
While these patients do need assistance with daily tasks, more basic functioning tasks, like using the bathroom and eating, are still accessible skills (“The Seven Stages of Dementia” n.d.). These basic functions will begin to slip away as stage 6, moderately severe dementia, sets in. The names of children begin to elude these individuals, they are unaware of their surroundings most of the time, and they are missing details of their personal past (“The Seven Stages of Dementia” n.d.).
Delusional behavior, aggression, obsession, anxiety, lack of willpower, and genera agitation are also factors in stage 6. These individuals may have issues with sleep, they will start to wander, and sometimes, hallucinations will become an issue as well (“The Seven Stages of Dementia” n.d.).
Stage seven is the final stage of dementia and patients in this stage need assistance with every part of life. Language and motor skills have gone by this point, and caregivers will need to assist the individual with all parts of basic functioning. It seems in this stage, that the brain loses its connection with the rest of the body (“The Seven Stages of Dementia” n.d.). Walking and eating, as well as continence will prove to be serious obstacles in the last stage of dementia. Caring for individuals with this disease can be exhausting and straining both emotionally and physically. As the stages of dementia progress, so does the need for full time support.
The task presented in helping these patients is a job for a team of caregivers; the weight of solo responsibility can be overwhelming to caregivers or family members. An individual with dementia experiences changes that can impact their personalities and coping skills which can result in extra strain on caregivers while communicating with the individual (“Caregiver’s Guide,” n.d.).
Communication is the basis of all human contact so it is essential to be able to communicate with the person being taken care of in order to administer the best level of care possible. Most of the issues with communication can be solved by small changes in the communication style of the caregiver; positive body language, clear speech, small steps, reassurance, and redirection go a long way when interacting with a dementia patient (“Caregiver’s Guide,” n.d.). There are a variety of problem behaviors associated with dementia, it is important to remember a few things: every behavior stems from a cause, behaviors have triggers, and the solutions to a behavior may not work every time (“Caregiver’s Guide,” n.d.). A few of the issues that come with dementia are things like wandering, incontinence, agitation, perseveration, paranoia, as well as dressing, hallucinating, sexual inappropriateness, shadowing, and a lack of cooperation (“Caregiver’s Guide,” n.
d.). Caring for individuals with dementia means being able to understand them. These individuals are losing their ability to communicate with and relate to the world around them.
Even though they are not able to communicate, navigate, or self-regulate, they still have inner monologues as they did before dementia set in. In many cases these individuals are extremely frustrated in their inability to say what they mean, remember familiar faces, or even bring forward important detail about their own lives. It is important to avoid embarrassing those with dementia because they are not able to regulate themselves through such a strong emotion. Giving them a chance to simple tasks on their own boosts confidence and strengthens the bond between patient and caregiver because it creates a sense of trust and assistance instead of dominance. Treatment for dementia begins with a diagnosis.
Since there are so many types of dementia, getting an accurate diagnosis can be challenging. After reviewing medical history, a physical examination, and interviews with those near to the patient, a series of tests may be run to understand the problem (“Dementia” 2017). Some of these tests are more subjective, like a cognitive and neuropsychological test, or a neurological evaluation.
Others are more objective, such as brain scans, and laboratory tests (“Dementia” 2017). Although many types of dementia are incurable, there are ways to manage the symptoms. Some of these methods are mediations are cholinesterase inhibitors, memantine, and medications to treat depression, inability to sleep regularly, or agitation (“Dementia” 2017). Other treatments such as occupational therapy and environmental and task modification have also been proven to be successful (“Dementia” 2017).
These treatments may temporarily slow dementia and improve quality of life (“What Is Alzheimer’s Disease” n.d.).
Treatment for any disease begins with prevention. Factors like age and genetics are unchangeable factors, but there are risk factors where control is possible. Since the brain demands a lush supply of oxygen and therefore blood, cardiovascular issues increase the risk for dementia (“What Is Dementia” n.d.). It is important to remember that issues with blood vessels anywhere in the body can have a serious impact on those in the brain (“What Is Dementia” n.d.
). The same steps taken to prevent heart issues are serious advantages in the prevention of dementia. Maintaining a healthy weight and cholesterol level through diet and exercise in very important as well (“What Is Dementia” n.d.). Physical exercise increases blood to the brain, therefore increasing oxygen traveling to the brain, which can help in the prevention of dementia (“What Is Dementia” n.d.).
Dementia can be a very intimidating obstacle to face for both those experiencing the disease, and those in the caregiver position. Research can be the key to finding the proper balance of treatment for these individuals; medication for the symptoms and memory exercises are two methods of treatment that can work wonders together. An incredibly important aspect of this disease is to remember that these individuals are still functioning in their own minds; they simply lack the neuronal connections that enable communication. This, as almost all aspects of dementia, requires patience. No mater which side of the disease you are on, a good support system is essential. It is impossible for the individuals who live with this disease to lead a life with good quality on their own, especially as dementia progresses. Caregivers will feel this overwhelming pressure, and need a good support system themselves.
Communication is key both between caregivers and between the caregiver and the patient. A good quality of life for these patients is the ultimate goal. It is complicated and difficult to navigate the unsteady waters of dementia, but with a proper understanding, and a good set of intellectual tools, it is possible.