Dementia

Question

Dementia Capstone Project

Background

When people experience memory loss or dementia, their relationships, perceptions, and priorities undergo shifts. The first step to treating dementia is to understand the cognitive decline causes, the essence of memory loss, and ways to identify the dementia types. Awareness of dementia, its symptoms, and causes enables people to improve the outcome and preserve the sense of control.

Dementia is a group of symptoms caused by brain disease that is either chronic or progressive. It is a collection of symptoms caused by disorders that affect the human brain. Dementia incidence is a global concern as the disease prevalence is almost 36 million individuals. In 2010, the occurrence of dementia cases reached 3.5 million. The sharpest increase in dementia occurs in underdeveloped and developing countries. It is believed that the number will be doubled every 20 years, and, by 2030, the predicted prevalence of dementia will be 65 million individuals. Treatment for dementia patients is one of the greatest concern factors and the treatment for dementia care does not necessarily help the patients.

The disease is characterized by symptoms and signs that affect language, judgment, comprehension, calculation, learning capacity, behavior, and personality. All symptoms indicate progressive brain malfunction. People with dementia have impaired intellectual functioning that prevents them from having normal relationships and leading an active lifestyle. Such people are unable to solve problems and control their emotions. In addition, they tend to experience behavioral problems and personality changes, hallucinations as well as delusions (“Types of Dementia” n. pag.).

Several conditions cause dementia or dementia-related symptoms. They include metabolism-related problems, reactions to medications, infections, poisoning, endocrine abnormalities, deficiencies caused by poor nutrition, and heart-related problems.

Signs and Symptoms

When a person has difficulties in remembering names and recent events, is depressed and apathetic, it means that he/she may experience early clinical symptoms. Later symptoms of dementia include confusion, disorientation, problems related to the expression of thoughts or/and walking, behavior changes, and others. Other symptoms of dementia include faulty reasoning, problems related to balance, gait, tremor, neglect of personal safety, trouble eating or swallowing, wandering or restlessness, agitation, etc.

These symptoms are not the signs of the normal process of aging. They are severe enough to negatively influence independence, relationships, and daily living. The progression and outcome of the disease vary and are closely related to the type of dementia. Dementia is diagnosed with the help of a series of clinical examinations, clinical imaging, and diagnostic testing.

When people have the first stages of dementia, they experience subtle signs and symptoms. In most cases, the disease signs become evident only when one examines the behavior of a person during a certain period. The first dementia stage is called mild cognitive impairment (MCI). Unfortunately, 70% of people with MCI will progress to dementia changing the brain. When the symptoms are severe and affect patients’ daily function, they are considered dementia (“Understanding Dementia” n. pag.).

In the early stages of dementia, people have symptoms that began to be noticeable for others. During the early dementia stages, people are aware of the issues and they find the loss of memory and cognition functions frustrating as they are unable to do routine and simple tasks. The symptoms begin to negatively influence people’s daily activities and may be identified depending on the dementia type. At this stage, a person may experience difficulties doing domestic chores. The patient can take care of himself/herself, but some usual things are often forgotten.

Early disease symptoms include memory difficulty but can also have problems with organizational skills. The matter becomes problematic when the person is not able to handle finances independently. Dementia evaluation takes into account the way a person was able to function five years earlier. Memory difficulty is the main symptom of Alzheimer’s dementia.

In the middle stage of dementia, the symptoms worsen and the patient is unable to function. Consequently, such a person cannot be left alone as he/she is unable to do simple tasks and chores, and needs assistance for hygiene and personal care.

In the late stages of the disease, the patients have hallucinations, tend to wander, and are unable to control their bowels. They lose the ability to swallow and eat and need assistance in doing the simplest tasks. In addition, such patients lose their appetite and do not want to go out of bed. In some cases, people in the stages of the disease do not recognize friends, family members, and experience significant problems related to sleep.

Most types of diseases are slow and do not progress for a long period. In many cases, the process in the brain is happening for a long time until the person starts to show the signs. Moreover, a person may have two different types of dementia at the same time. Nearly 10% of all people with dementia have a mixed type of disease combining Alzheimer’s disease and vascular dementia. 20-30% of people with dementia experience depression and almost 20% suffer from anxiety. Aggression and psychosis are the symptoms that accompany the disease. However, each of the symptoms should be treated independently and with great care.

Thus, memory loss is one of the main symptoms of dementia patients. However, loss of memory does not necessarily indicate the fact that a person has dementia as it is diagnosed only in the case of two or more impaired brain functions without any signs of consciousness loss.

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Diagnosis

The first step to the disease diagnosis is the assessment of symptoms with the help of physical examination, a person’s medical history as well as evaluation of abilities related to memory and thinking. Other dementia causes are ruled out through laboratory tests and brain scans. The next step of diagnosis is to determine the cause of the disease. There are many types and causes of the disease and the symptoms are only slightly different. Due to the similarity of symptoms, difficulties are diagnosing the type of disease by symptoms alone.

Brain scanning techniques and brain biopsy aid to make proper diagnoses. People who are getting older do not show improved outcomes through general cognitive impairment screening through early diagnosis or cognitive testing. However, screening exams are considered to be effective in people over 65 who have complaints because of memory issues.

As a rule, a diagnosis is supported in case disease symptoms are present for at least half a year. Dementia may be easily confused with a short cognitive dysfunction called delirium. The diseases have similar symptoms. However, dementia is characterized by a long, slow onset, slow mental functioning decline, and long duration. Delirium has a sudden onset, short duration, and is related to a somatic disturbance. Sometimes, it is difficult to differentiate the symptoms of mental illnesses that include psychosis and depression as they belong to both dementia and delirium. However, some people have barriers to early diagnosis including memory problems because of a normal aging process, dementia attached stigma, and fear about the future.

Evaluation of dementia includes a depression screening. In many cases, people who have memory complaints suffer from depression, rather than dementia. Hence, it is usually called pseudodementia. Nowadays many people who have memory complaints have MCI (the earliest dementia stage).

Cognitive Testing

There exist some brief tests that provide reliability to dementia screening including the abbreviated mental test score, the modified mini-mental state examination, and others. One more widely used screening approach for dementia is filling out a questionnaire about his/her everyday cognitive functioning. Such questionnaires give additional information to brief cognitive tests. The Informant Questionnaire on Cognitive Decline in the Elderly is considered to be the best one.

The Alzheimer’s Disease Caregiver Questionnaire is another widely used tool that helps get 90% accuracy for Alzheimer’s disease and can be completed online or in the office. However, the general Practitioner Assessment of Cognition combines an informant interview and a patient assessment as it was designed for the primary care setting use. Tests of attention, memory, executive function, and language skills are also essential as they assist with diagnosing the disease.

Laboratory Tests

Dementia treatment is ruled out by traditional blood tests that include folic acid, calcium, C-reactive protein, electrolytes, full blood count, liver enzymes, and others. Abnormalities suggest a deficiency in vitamins, infection, and other problems that result in disorientation and confusion in the elderly. In addition, testing for dementia-inducing drugs is also indicated.

Imaging

A magnetic resonance imaging or CT scan is performed to detect metabolic changes associated with the disease. The imaging suggests a potentially reversible disease cause and helps reveal information about the different types of the disease including vascular dementia and infarction. The modalities of functional neuroimaging of PET and SPECT assist in assessing long-standing cognitive dysfunction showing the possibility to diagnose the disease as a cognitive and clinical exam testing (Geddes, Gelder, and Mayou 25).

Forms of Dementia

There are many kinds of dementia including Alzheimer’s disease, Lewy Body dementia, frontotemporal dementia, vascular dementia, Huntington’s disease, Creutzfeldt-Jakob disease, Frontotemporal dementia, and others. Each of the forms has slight differences in the manifestation and consequences that depend on the affected part of the brain (“Types of Dementia” n. pag.).

Alzheimer’s Disease

Alzheimer’s disease is the most common dementia form that leads to the loss of memory and other mental disabilities including confusion, disturbances, misplacing things, and unexpected mood change. If the symptoms of dementia are caused by Alzheimer’s disease, medications help delay the onset of other debilitating symptoms. Early diagnosis is the first step in disease treatment and management.

Vascular Dementia

Vascular dementia is the second most frequent cause of dementia. It is characterized by a decline in cognitive functioning and memory is associated with blood circulation in the brain. This form of dementia results from a series of small strokes related to the blood supply of the brain. There are certain ways to reduce and even prevent the disease severity.

Lewy Body Dementia

Lewy body dementia is another common form of dementia. It is the second most common neurodegenerative form of dementia in old age. The disease usually occurs either as a standalone or a secondary being a part of Parkinson’s disease. The symptoms include sleep disturbances, mental decline, high blood pressure, depression, hallucinations, problems related to planning, problem-solving, and attention, body temperature increase, and others (Hummings, 2002).

Frontotemporal Dementia

In this form of dementia, the profile of the cognitive dysfunction usually demonstrates deficits in the tasks of the frontal system consisting of problem-solving tasks, planning, attention, and verbal fluency. Some of the most typical behaviors include hyperreality, preservative behavior, insight loss, early social disinhibition, and emotional blunting.

There are three main types of frontotemporal dementia. The first one is the behavioral variant of frontotemporal dementia. It is the most common and has major symptoms in the personality and behavior area. The second type is temporal variant dementia and is characterized by the loss of the word meaning and difficulties naming things. The third type of frontotemporal dementia is progressive non-fluent aphasia and is related to the problems of speech production and troubles finding the right words.

Progressive Supranuclear Palsy

It is the dementia form that is related to eye movement problems. The first symptoms are difficulties moving the eyes up and down. Further symptoms are difficulties related to proper movement and balance. Muscles become rigid and people may even fall backward. What is more, there is increased irritability, depression, apathy, and social withdrawal. In addition, a person may experience behavioral problems, perseveration as well as difficulty swallowing and talking. This dementia form is often misdiagnosed as Parkinson’s disease because both of them have the signs of movement-related problems.

Corticobasal Degeneration

This is the form of dementia that is subdivided into different types of neurological problems that tend to get worse over time. It affects the brain in different places and at different rates. One of the main symptoms is an alien limb. It means that the person’s limb moves without the control of the brain. Other disease symptoms include jerky limb movements, difficulty with speech accompanied by the inability to move the mouth muscles, limb numbness, and others. In addition, the person ignores the opposite side of the body and may not feel the pain on one side of the body. The individual may experience muscle contractions that result in strange movements that are continuously repeated.

Huntington’s Disease

The disease is characterized by a progressive brain disorder caused by a single chromosome 4 defective gene. Huntington’s disease patients have abnormal involuntary movements, irritability, a severe decline in reasoning skills and thinking, depression, and mood changes. It is explained by the fact that the gene defect causes abnormalities in a brain protein. Then, it leads to worsening symptoms.

Treatment and Care

For many people dealing with the disease is a real challenge. However, to ease it people should follow certain strategies. It is necessary to care about the emotional state getting proper care. People with dementia may join the support group, turn to close family members, talk to counselors, therapists, or clergymen. People with dementia should avoid potential financial, medical, and legal confusion by creating a consistent plan and communicating their wishes. In addition, treatment should be discussed and documented together with end-of-life preferences.

It is essential to watch for treatable changes. Sleep disturbances, the interaction of different medications, and depression can make the symptoms worse leading to limited independence. Treating them requires changes related to lifestyle and medication. In addition, people with dementia should be placed in a dementia-friendly environment. Independence, accessibility, safety, and happiness should be taken into account. It is advised to evoke memories through pictures and familiar objects, organize a caregiving network, remove tripping hazards, and others. Hence, flexibility and planning keep dementia patients one step ahead of changing their needs. Proper understanding and support provide people who suffer from dementia with enjoyment and connection.

Risk and Prevention

The risk of dementia development is considerably increased when a person is diagnosed with a decline in intellectual abilities and mild cognitive impairment that does not seriously affect a person’s daily life.

Physical fitness, proper diet, and cardiovascular factors may reduce or prevent dementia. Regular physical exercises tend to lower the risk of some dementia types directly benefiting brain cells providing them with increase oxygen flow. Proper diet is believed to have the best impact on the brain and have an effect on heart health. Our brain is nourished by the blood vessel networks. Any risk factor that damages blood vessels can also damage the brain depriving brain cells of oxygen and vital food.

Blood vessels undergo changes in the brain that are directly linked to vascular dementia. These changes may result in more severe impairments and faster decline. The brain may be protected in the same way as the heart (“Types of Dementia” n. pag.). In addition, it is possible to prevent the disease from keeping the brain functioning optimally. It can be done with the help of regular exercise, a healthy diet, regular and restful sleep, minimization of stress as well as the elimination of smoking and drinking.

Dementia Causes

Understanding disease causes is the first step to its prevention and successful treatment. Genetics is one of the factors that cause dementia to offset. However, a combination of hereditary, environmental, and lifestyle factors add to the disease causes.

Dementia may be caused by medical conditions that negatively influence brain cells. As a result, they are attacked leading to Parkinson’s disease, Alzheimer’s disease, or Huntington’s disease. Strokes also cause the disease as they disrupt oxygen flow and vital nutrients to the brain. Additional strokes may be prevented by the proper treatment of heart disease, reduction of high blood pressure, and elimination of smoking habits. Dehydration, lack of proper nutrition, and the use of such substances as alcohol and drugs may also cause dementia

In some cases, the symptoms of dementia are eliminated with the help of metabolic disorders, insulin resistance, and vitamin deficiencies. Some dementia patients have experienced single traumas or repeated brain injuries. Their cognitive skills and memory have been impaired because of the location of the brain injury (“Understanding Dementia” n. pag.). Finally, illnesses that affect the central nervous system and infections may also cause the disease.

Conclusion

Dementia is a growing condition that is regularly affecting a large number of people. Dementia is closely associated with the pain of losing someone from the friend and family circles. Dementia occurrence is constantly raising making people more aware of the changes which may take place in their lives in case of the disease. The increased rate of dementia prevalence results in the increased demand for health care and families who care about their ill relatives. Numerous attempts have been made to determine the best and most effective treatment for dementia patients. To cope with the disease, different factors have been identified to facilitate dementia patients giving them the independence to go outdoors and perform many tasks.

Dementia is a progressive disease that causes troubling disruptive behavior such as wandering, pacing, and shouting. These symptoms are common for dementia patients who are usually classed as easily irritating, trouble-making, resistant, explosive people. It is usually hard to care for dementia patients and they require caregivers’ energy, time, and physical vitality. The disease progresses slowly that is why caregivers and family members can provide care for many years experiencing high-stress levels. Most patients need constant reassurance and support to cope with the changes.

Dementia interferes with people’s daily functioning and includes several symptoms that affect the ability to think and to move. The existence of different dementia types and symptoms that are associated with numerous diseases make it difficult to detect dementia. However, early detection and proper treatment help dementia patients be independent and prevent severe outcomes. As dementia and its symptoms may be the cause of a variety of conditions, obtaining an accurate diagnosis is critical for disease management and treatment. The sooner the person addresses the problem, the better chances he/she has.