Dementia Care 4222-237

Dementia is the term used to describe the symptoms that occur when the brain is affected (damaged) by certain diseases and conditions (e.g. a stroke), including Alzheimer’s disease. As this is a progressive disease, symptoms can be slowed down, but not cured and will always, gradually get worse. Regardless of the cause of the dementia, as it is the brain cells that are dying, some of the person’s abilities and functions of day to day life will progressively become more difficult.

There are five areas of the brain that can be affected by dementia:
1. The Frontal Lobe, affecting behaviour (personal & social), interpretation (not able to problem solve or focus on single tasks), movement and feeling and the inability to express themselves clearly.
2. The Parietal Lobe, affecting language, the inability to name specific items , read or write , special awareness, knocking into things, issues with hand eye coordination and recognition of anything familiar (words/faces).
3. The Temporal Lobe, which affects memory, usually short term loss of events/people, speech and identifying items and hearing.
4. The Occipital Lobe affecting sight, making reading and writing more difficult, struggling to identify colours and occasionally experiencing hallucinations.
5. The Cerebellum which affects balance, posture and movement. This is turn makes it difficult to walk, reach and grab things, possibly experiencing slurred speech too.
It can be extremely difficult for Dementia to be diagnosed correctly, as there are several similar symptoms found within depression, delirium and old age. Someone with depression could be suffering with memory problems, problematic sleeping patterns, and loss of interest in social activities, all of which are common within Alzheimer’s disease. Similarly, being in a confused state, disruptive thoughts and behaviour, sudden changes in perception and mood could be classed as delirium not just dementia. When looking at age related memory impairments, some of the natural changes that can occur include forgetfulness/short term memory loss or difficulties learning new skills, again, potentially nothing related to dementia.
Within Health and Social Care there are models which provide the framework for which health and social care needs and ideas for care and support can be developed and implemented. Two of the most important of these models are “Medical” and “Social”.
Medical – In which dementia is seen as a clinical syndrome that is an impairment of the mind of which nothing can be done to help the person suffering with the condition. It focusses specifically on the disease and the treatment of the disease rather than the person and sees the impairment as the problem. This model seeks to create dependency on others, restrict a person’s choice, disempower, devalue and reinforce stereotypes.
Social – Is the direct opposite of the medical model and is totally focussed on the individual with the disease and tries to ensure that the sufferer’s skills, capabilities and achievements are retained. It tries to understand the emotions and behaviours of the person with dementia through learning about their history and background. This can then ensure that the care and support they receive, is appropriate to their needs.
Dementia should be seen as a disability, as in accordance with the Equality Act 2010 a person has a disability if:
They have a physical or mental impairment.
The impairment has a substantial and long term adverse effect on their ability to perform normal day to day activities.
Dementia in its entirety is disabling due to the damage to the person’s brain, preventing them from being able to carry out daily tasks that they were once capable of, including communicating, personal care and maintaining relationships.
The four most common types of dementia and their signs and symptoms are:
Alzheimer’s disease – the most common form, destroys brain cells and nerves which disrupt the transmitters carrying messages to the brain, making it difficult to maintain the ability to speak, think, remember and make decisions. In the early stages, the person may be slightly forgetful with words or objects, but will get progressively worse, forgetting faces/names of familiar people/items, become more confused, experience mood swings, have continence issues and have difficulty eating and drinking. They will be completely dependent on others.
Vascular Dementia - where brain cells become damaged following insufficient blood supply usually triggered from a series of mini strokes within the brain cells, which affect the person’s speech, coordination, language and memory. This form of dementia progresses in stages, with periods of lucidity followed by a rapid decline with certain functions. Most common problem areas are concentration and communication. Memory loss generally occurs a lot a further on, so the likelihood of frustration and depression is more common as the person is more aware of their declining health.
Dementia with Lewy bodies – this is similar to Alzheimer’s in as much as it is caused by degeneration and death of the nerve cells in the brain, but the reason for this is due to protein deposits in the nerve cells which then obstruct the chemical messages sent to the brain. This will affect the person’s attention/concentration, language, memory and the ability to reason and judge distances. This is also a progressive form and commonly could be spotted through noticing a person experiencing muscle stiffness or shuffling when walking, trembling of the limbs or issues with spatial awareness, sudden inability to plan activities in advance, potentially even hallucinating.
Fronto-temporal Dementia - caused by damage to the frontal lobe possibly also the temporal areas of the brain, sometimes associated with motor neurone disease or possibly a genetic hereditary condition. This affects a person’s behaviour, language and emotional responses. Their memory usually stays intact in the initial stages which can be distressing for them. As this predominantly affects behaviour and personality, initial signs could include sudden changes in either of these areas, for example having been shy and quiet for years suddenly being overly confident and loud, possibly even rude in their behaviour. Loss of inhabitations especially in public places, the need to suddenly undress in public. Sudden signs of compulsive rituals with daily tasks, possibly becoming easily distracted or aggressive.
It has been identified that there may be certain factors that can put people at a risk of developing any of form of dementia. These are:
Age – As possible as it is to develop dementia at any age, the risk is higher in those aged 65 – 80.
Gender – Women are at higher risk of developing Alzheimer’s due to the lack of oestrogen in the body following the menopause, even if they have been on HRT. However men are at a higher risk of developing vascular dementia as they are more likely to have suffered with high blood pressure and heart disease.
Genetics - the risk is increased if any family members have suffered with the disease.
Medical History – certain medical conditions can increase the risk, such as multiple sclerosis, HIV, high blood pressure, high cholesterol and diabetes.
Environmental and Lifestyle Factors – A poor diet, lack of exercise and smoking are all high risk factors due to their links with heart disease and lack of oxygen to the brain cells. Certain sports can also be high risk, boxing for example, due to the continuous blows to the brain, which slowly damage the cells.
There are currently over 800,000 people in the UK who suffer with dementia in one form or another, of these approx. 62% suffer with Alzheimer’s disease, approx. 17% suffer with vascular dementia, approx. 10% have a mixed form, approx. 4% have dementia with Lewy-bodies, approx. 2% suffer with fronto-temporal dementia, 2% with Parkinson’s dementia and 3% from rarer causes.
Even though people living with varying types of dementia show similar signs and symptoms, they will all experience dementia in different ways due to having different personalities, states of health, life experiences and varying degrees of neurological impairment.
Alzheimer’s is a gradually progressive form, with the first signs including forgetfulness of recent events, repetition, confusion eventually leading to the inability of being able to perform the simplest of everyday tasks. This can result in a loss of interest and lack of initiative to try to do things for themselves which can cause irritability and depression.
Vascular dementia is progressive in a step like manner with bouts of worsening being followed by periods of stabilisation. Due to only certain parts of the brain being affected the individual is more likely to aware of their declining health making them more prone to depression.
Fronto-temporal dementia suffers are not so forgetful as those with Alzheimer’s as their memory tends to be less affected, the changes are seen more in their personality and behaviour.
Lewy body suffers have their brain’s function interrupted in such a way that it affects their memory, concentration and speech and so can also be misdiagnosed as Parkinson’s disease due to the tremors, difficulties with speech and slowness of movement that accompany it.
Age within dementia can cause serious difficulties within families, as more than 17,000 sufferers in the UK currently are under the age of 65, whereas this is commonly seen as only a disease experienced within the older generation. With a younger sufferer, depression is more likely as their needs are different; they are more likely to have a younger, reliant family, a mortgage/other financial commitments and have been working when diagnosed. The family may also have problems getting a confirmed diagnosis due to not being aware of the symptoms or where to go to for help and support.
Sufferers who already have a disability may also struggle to get diagnosed due difficulties in communicating the change in their abilities; they are also more likely to develop dementia at an earlier age. Sometimes their physical health can be greatly affected by the symptoms of dementia, for example if suffering with a visual impairment; they can become more disorientated in unfamiliar situation which could then affect their balance, coordination and mobility.
In general, people with little knowledge of an illness, such as dementia, can be very negative towards those suffering with it, which can have an extremely detrimental effect on those with the illness. The most common harmful attitudes/actions are:
To disempower – to not allow the person to carry out a task they are capable of or to make them feel worthless or incompetent.
To patronise – to treat them in an insensitive manner; speak to them a low grade term as if they are a small child.
To ignore – to not meet their evident needs or to speak to others that are present as if that person is not there.
To mock – to tease or humiliate at their expense, due to actions beyond their control.
To be intimidating – to be overpowering causing fear and anxiety.
To treat as if an object – not speak to or move the person as if they are human, just an inanimate object.
To Outpace – to rush the person when performing tasks or making decisions resulting in them feeling pressured to do/say things when not ready/able to do so.
Therefore the more knowledge provided to all, the better understood and helped a person with dementia can be.