WHAT IS DEMENTIA?
Dementia is a chronic neurological disease that affects individuals 65 or older. The disease is brought on by damage of the nerve cells which can occur in different parts of the brain. The severity of the disease depends on what portion of the brain is damaged and how much damage occurs which worsens over time. Because of this, doctors and researchers have classified different stages of dementia, though the diagnosis of certain stages is difficult. To diagnose someone with the disease, at least two core mental functions must be impaired at a level that affects daily living. Several of these mental functions includes memory, language skills, ability to focus and be attentive, problem solving and reasoning, and visual perception (Dementia, 2019). A number of tests must be performed before diagnosis and can include cognitive and neuropsychological tests, a neurological evaluation, brain scans, laboratory tests, and psychiatric evaluation.
SYMPTOMS OF DEMENTIA
Individuals suffering from the disease experience changes that affect cognitive, neurological, behavioral, and psychological function. In terms of cognitive changes, individuals with dementia suffer from memory loss, difficulty communicating, reasoning or problem solving, handling complex tasks, planning, organizing, problems with coordination and motor functions, and confusion and disorientation. Psychological and behavioral changes often go hand in hand because behavior is directly correlated by the psyche. Loss of psychological function may result in personality changes, depression, anxiety, inappropriate behavior, paranoia, agitation, and hallucinations. (Causes, n.d.)
STAGES OF DEMENTIA
As dementia progresses, the severity of the symptoms increases. There are two models for the stages of dementia – a 3-stage model which most physicians refer to and a 7-stage model that is more in depth and useful for Alzheimer’s Disease. In the 3-stage model, the stages include Mild or Early Stages, the Moderate or Middle Stage, and the Severe or Late Stage. In the Early Stage, an individual with the disease may experience forgetfulness, losing or misplacing things, and may struggle to find their words. These symptoms may be experienced in any elderly person but more frequent occurrences in which an individual’s daily life is affected signals the early stages of the disease. As dementia progresses, people experience increased confusion, worsening judgement, and greater memory loss. They may become disoriented, forget personal information and may begin to wander (Grossman, 2017). As the disease worsens, more care is required. In the Late Stage, physical and cognitive functioning decline rapidly. Though a person may be able to speak, they are unable to fluently communicate. It becomes more difficult to eat or swallow, to control bladder and bowel movement, and to walk.
The 7-Stage model focuses on cognitive decline. Stages 1-3 are known as pre-dementia stages. These stages are hard to diagnose because the symptoms that occur are commonly associated with aging in general. In Stage 1, there is no impairment nor memory loss. In other words, this is the normal functioning stage. A person does not display significant problems with memory or cognitive loss. In the second stage, occasional memory lapses are normal. This could include forgetting where an object has been placed or forgetting significant names. Stage 3 is characterized as mild cognitive impairment when signs with cognitive problems become clearer. Some of these signs include difficulty retaining information, getting lost or forgetting where someone is going, losing important objects, and problems concentrating. As these symptoms arise more frequently, the onset of anxiety typically occurs and can interfere with a person’s day to day life. In the fourth stage of dementia, changes in personality and mood become noticeable, often leaving individuals socially withdrawn. This stage is often where people are in denial of their symptoms which may include lowered knowledge of current events, difficulty remembering personal history, disorientation, and difficulty recognizing faces (Reisberg n.d.). During Stage 5, people begin to require assistance with tasks of daily living. This is often when a person is placed in a community where they can receive help or will require an in-home caregiver, though a person can typically handle tasks such as using the restroom or eating on their own. Stage 6 describes moderately severe dementia where an individual starts forgetting names, places, and other important information and will require full-time care. They may experience delusional behavior, wandering, aggression and anxiety. The final stage, Stage 7 is severe dementia when a person loses motor skills, loss of speech, the inability to eat or use the restroom. (Reisberg n.d.).
TYPES OF DEMENTIA
There are a number of different types of dementia including Alzheimer’s Disease, Parkinson’s Disease, Huntington’s Disease, Vascular Dementia, Lewy Body Dementia, Frontotemporal Dementia, and so on. The most common type of dementia is Alzheimer’s disease which is an irreversible and progressive disorder in which brain cells are damaged. This often induces memory loss and negatively impacts cognitive abilities (Causes, n.d.). There are two types: early onset which occurs between ages 30 and 60 and the more common type, late onset which occurs in people over the age of 60. Alzheimer’s typically leads to more severe forms of dementia and have similar symptoms. These may include memory loss, difficulty planning or problem solving, decreased vision, losing track of time, misplacing objects, difficulty speaking or writing, and changes in personality and mood. Age, genetics, environment, and lifestyle are all factors that contribute to Alzheimer’s (Dementia, 2019).
The second most common type of dementia, Vascular Dementia, results in decreased cognitive skills caused by a blockage or reduced blood flow to the brain. When the brain is deprived of oxygen and nutrients cognitive function is compromised. Vascular Dementia is most frequently associated with a stroke, though high blood pressure and diabetes are both contributing factors (Causes, n.d.). Similar symptoms may include confusion, difficulty concentrating or speaking, vision impairment, lowered ability to problem solve or complete tasks, loss of bowel or bladder control, and hallucinations.
Lewy Body Dementia, a brain disorder, is another common form of dementia and results in irreversible cognitive decline and mobility problems, similar to Parkinson’s Disease. Lewy bodies are an “alpha-synuclein protein that develops in areas of the brain involved in thinking and motor control” (Dementia, 2019). The buildup of these can affect memory, thinking skills, movement, mood and behavior. Symptoms include slow movements, shaking, difficulty balancing, fainting, problems concentrating, hallucinations, fluctuating mood, memory loss and confusion. Age and genetics are the leading risk factors for this disease.
TREATMENT
There is no cure for dementia, though preventative measures can decrease the risk of developing the disease and lower the severity of the progression of the disease. Factors that contribute to dementia that may be avoided include drug or alcohol abuse, cardiovascular diseases, smoking, decreased mental health like depression, head trauma, and high estrogen in women. (Dementia, 2019) A healthy, active, and social lifestyle that promotes cognitive stimulation lowers the risk of developing the disease.
There are certain medications that help manage the symptoms of dementia when the condition cannot be treated or slowed. Several classes of medications include cholinesterase inhibitors which decrease disorientation, confusion and memory problems as well as glutamate inhibitors which prevents cell damage caused by glutamate overproduction. The other class is medications for managing mental health, mood, and behavioral issues like antidepressants, antipsychotics, and mood-stabilizing medications (Dementia, 2019).
Therapy in many forms helps slow the progression of the disease and lessen the severity of its symptoms. Therapy is most used to improve mood and stimulate cognitive function. One type of therapy is cognitive stimulation therapy which helps individuals in the early stages of dementia. This involves training memory, language ability and skills with problem solving which can often help an individual avoid medication. Behavioral therapy is typically performed by family, loved ones, or caregivers of those suffering with dementia. This specifically targets triggers of unwanted behaviors such as wandering or aggression. This form of therapy is twice as effective as an antipsychotic (Causes, n.d.). While there is no cure for dementia, preventative measures, medications, and therapy can reduce the progression and severity of the disease.
References
Causes Of Dementia. (n.d.). Retrieved February 19, 2019, from https://www.dementia.org/causes
Dementia. (2019, January 24). Retrieved February 19, 2019, from https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013
Grossman, M. (2017, June 26). Stages of Dementia: The 3-Stage and the 7-Stage Models. Retrieved February 19, 2019, from https://www.kindlycare.com/stages-of-dementia/
Reisberg, B., Ferris, S.H., de Leon, M.J., and Crook, T. The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 1982, 139: 1136-1139.