Dementia disease analysis

Dementia refers to a wide variety of symptoms associated with impairment in memory and other mental skills, which interferes with everyday life tasks (Miesen, 2016). It is most common in adults over the age of 65, though it can begin as early as thirty, forty, or fifty. While the symptoms of dementia vary significantly, Hickey and Bourgeois show that severe impairment of at least two essential mental functions is required for the disorder to be diagnosed (2011). Memory, communication and language, reasoning and judgement, visual perception, and the ability to focus and pay attention are examples of essential mental activities. To understand the types of dementia, causes of the disease must come in handy. According to Miesen (2016), there are four reversible causes which include: Lyme disease, vitamin B12 deficiency, hypothyroidism and neurosyphilis. These diseases should be ruled out in all cases of dementia since they are treatable. Among the irreversible types, vascular dementia accounts for around twenty percent of all dementia cases and is caused by damage to blood vessels supplying the brain. The most common type of dementia, however, is Alzheimer’s disease and it accounts for fifty to seventy percent of all cases. The cause of Alzheimer’s disease is not known, but on autopsy, brains of people with the disease have plaques and tangles (Lu & Bludau, 2011). It has also been seen that some genetic factors are risk factors for Alzheimer’s disease.

Other types of dementia include Lewy body dementia, where Lewy bodies are found in the brains of patients, frontotemporal dementia, where there is degeneration of nerve cells in the temporal and frontal lobes, mixed dementia, characterized by a combination of Alzheimer’s, Lewy body dementia, and vascular dementia, progressive supranuclear palsy, and corticobasal degeneration which is very rare (Brooker & Lillyman, 2013). All these are progressive dementias which are irreversible. Nall (2017) adds Creutzfeldt-Jakob disease, Wernicke-Korsakoff syndrome, Huntington’s disease and normal pressure hydrocephalus as other causes of dementia. She also stresses that people with multiple sclerosis and late stage HIV can develop dementia.

Signs and Symptoms

Early signs of dementia may include difficulty concentrating, memory loss, difficulty finding the right words, confusion, mood changes, apathy and difficulty following a conversation. These symptoms however worsen gradually, labelled as mild cognitive impairment, as they are not severe enough for a dementia diagnosis (Pace et al., 2011). Symptoms specific to Alzheimer’s disease include short term memory loss, difficulty finding words, visual-spatial difficulties, troubles with judgement, reasoning and insight (Lu & Bludau, 2011). The most common early symptoms include: forgetfulness to take medication, word-finding difficulties, repetition and getting lost in previously familiar environments.

With vascular dementia, however, the symptoms are dependent on the location of the brain stroke, and whether the vessels affected are large or small. In dementia with Lewy bodies, the main symptoms are very vivid visual hallucinations and parkinsonism, while in frontotemporal dementia, there are drastic changes in personality and language difficulties, but memory problems are not a main problem (Miesen, 2016). A very common sign in frontotemporal dementia is apathy, and social inappropriacy.

Diagnosis of Dementia

There does not exist a single confirmatory test for dementia. Diagnosis is based on a combination of thorough medical history, laboratory tests, physical examination, and behavioral changes associated with each dementia type (Hickey & Bourgeois, 2011). Nevertheless, the symptoms, behavioral and brain changes in different types of dementia usually overlap deeming it hard to identify the dementia. Also, as mentioned above, at least two of the core mental functions must be affected to consider a diagnosis.

Patricia Scully’s Case

In Patricia’s case, the type of dementia is progressive with signs and symptoms consistent with Alzheimer’s. She started struggling finding simple words like cup, had difficulty remembering the name of a country, Zimbabwe, and faltering over prayers that she knew very well. In addition, she had difficulty concentrating. Jennifer Davies says that on many occasions when she called her mother, it was difficult to have a conversion on the phone when her other siblings were talking to her. She also had short term memory loss. An example is when Jennifer and her mom were talking about Jennifer’s husband and the mother couldn’t remember who he was. She had had just seen Rob the previous week, yet she couldn’t remember him, or that her daughter was already married.

Her dementia then progressed and worsened. She started fixating on her physical appearance. Her wrinkles and later, her breasts. According to Lu and Bludau (2011), Alzheimer’s patients can get fixated on certain actions or thoughts, which are usually harmless, both psychologically and physically like in Patricia’s case. However, when these obsessions start causing distress or harm, intervention is necessary. Patricia’s fixation to her breasts made her socially inappropriate, another symptom of Alzheimer’s, when she started showing her breasts out in public to demonstrate to others what she meant.

Care Approaches

Person centered care, developed by Professor Thomas Kitwood, is recommended to decrease aggression and agitation (Smith, 2016). The health care revolves around the patient’s needs. Therefore, it is important to take dementia patients to facilities that provide this specialized care, like Patricia’s family did. The health care worker should always make note of factors that cause distress to the patient, and always use positive language without being condescending. Short simple sentences are also encouraged to encourage orientation. The patient should be treated with dignity, and their opinions always considered (Hickey & Bourgeois, 2011). In later stages of dementia, nutritional supplements should be considered to ensure they do not lose weight.

Impact, Challenges and Coping Strategies

Dementia takes an emotional and psychological toll on the immediate care givers and community in general. Grief surrounds the family, because of loss of the person they knew. Progressive dementia, for instance, only worsens with time and the feelings of grief and loss do not get better. Most families may not afford the specialized care facilities and are left with no choice but to take time off their busy schedules and care for their loved ones. If it is a parent, like in Jennifer’s case, worry, sadness and stress become part of one’s life.

Dementia also has a greater impact on society since it affects up to twenty percent of people over eighty. Alzheimer’s in specific, is responsible for eighty percent of all dementia cases in people over seventy-five years. With increasing number of the elderly, the possible impact of the disease on health sector and society is massive. According to Smith (2016), an estimated ten caregivers for dementia patients are women who give up-to fifty hours weekly to the role of taking care of these patients. this means that their contribution to the economy and society is crippled by this disease.

Caregivers also need coping strategies to deal with dementia patients. Smith (2016) divides this into two: emotion focused techniques and problem focused techniques. Emotion focused, deals with coping with feelings of anger, frustration, guilt, and shame among others. Problem focused techniques emphasize on source of problem causing distress to the caregiver. This may include trying to come up with a strategy to deal with the situation or alienating one self from the source of the stress.

References

Brooker, D., & Lillyman, S. (2013). Dementia care. New York: Routledge.

Hickey, E., & Bourgeois, M. S. (2011). Dementia: From diagnosis to management - a functional approach. Abingdon: Taylor & Francis.

Lu, L. C., & Bludau, J. H. (2011). Alzheimer's disease. Santa-Barbara, CA: ABC-CLIO.

Miesen, B. (2016). Dementia in close-up. New York: Routledge.

Nall, R. (2017). Types of dementia. Retrieved from https://www.healthline.com/health/types-dementia#frontotemporal

Pace, V., Treloar, A., & Scott, S. (2011). Dementia: From advanced disease to bereavement. Oxford: OUP.

Smith, G. (2016). Dementia care: A practical approach. Boca Raton, FL: CRC Press.