How we change what others think, feel, believe and do
Dementia may be defined as:
‘a clinical syndrome characterised by loss of function in
multiple cognitive abilities…occurring in clear consciousness’
Dementia can be seen less as a single condition and more as an umbrella term for a variety of processes affecting the brain, including those that affect:
Common forms of dementia include Alzheimer's disease, vascular dementia, fronto-temporal dementia, and Lewy body dementia.
Memory and problem-solving ability are commonly affected, though in different ways in each dementia form. Personality change may also appear.
Source memory, where a person remembers where and when they experienced or heard something, often fades.
Fixing new memories become difficult, for example recalling the name of a person recently met. Memory tasks that require effort may also just be too difficult.
Confusion may arise in various circumstances and simple tasks may not be understood. Loss of attention can easily result in distraction from tasks.
Dementia may also be progressive, worsening over a long period of time. It may be recognized early by spotting 'signatures' or patterns of impairment.
Early symptoms include difficulty with meaningful writing and naming objects, along with inner confusion and depressive symptoms.
It affects mostly older people. 5% of people over 65 are affected in some way whilst 20% of those over 80 are affected.
Diagnosis can be problematic. A common instrument for diagnosis is the Mini-Mental State Examination (MMSE) in which a range of cognitive tests are given. A problem with this is that MMSE also correlates with socio-economic status and educational level. CAMDEX is another alternative, as is Clinical Dementia Rating (CDR).
Asking them to nod their head, or showing them a card with a written instruction to close their eyes, results in confused inaction.
Asking questions like 'what season is it now?' may get a confused response. Attention and concentration can be assessed by giving a simple task such as asking them to count backwards from 20 to 7.
Diagnosis can be difficult when considering the effects of normal aging and factors such as differing educational levels. Even a seemingly-simple task for one 'normal' person may be approached very differently by another person.
If you can delay the onset of a late-life degenerative disease, there can be a significant impact as the person may die naturally before the disease reaches its more traumatic stages.
Drugs that hold off or slow down progress are thus more than just a stop-gap, as are any dietary controls or cognitive or physical exercises that help with delaying onset and progression.
When a person realizes they have Alzheimer's, then they may well go through the Kübler-Ross grief cycle, including periods of denial, anger and searching for a cure.
Seeing yourself become incapable can be very depressing and up to 40% of Alzheimer's sufferers are further debilitated by this condition.
With careful disclosure, counselling and support, some of these reactions may be mitigated.
There are a number of ways that sufferers can be taught to cope with the difficulties that the different forms of dementia cause, for example with loss of semantic memory, new information can be taught.
One of the most important things a Dementia sufferer needs is care. Whilst they may be largely functional, there are other aspects that they find difficult. They may also become confused and frightened as what was once easy becomes bafflingly difficult.
Support for the care-giver can also be important. It can be very exhausting looking after a person who can have fits of extreme emotions in between bouts of depression and confusion.
The 'Person-centered model' puts the human at the core of treatment and seeks to give them control and choice in improving their quality of life. Rather than being 'nannied' or 'nursed' they are given support in retaining independence.
Learning and re-learning
Just helping the person learn and re-learn can be helpful, for example with spaced retrieval, where the information is recalled after increasing intervals.
Other methods can be used to provide the forgetful person with the information they need, for example with memory boards, calendars and and other aide memoires.
By providing structure and regularity the person may be helped in learning routines by which it is easier to know what to do next and help them cope.
This can be a good solution, although it can cause feelings of guilt in all parties. It also comes with its own problems such as sustaining a sense of individual identity within an institution. This can be helped with such as 'life story' photo montages and 'memory' wallets.
Caring for carers
Looking after dementia sufferers can be exhausting and very upsetting, especially if they are related to the patient. Counselling and breaks for these people can help both them and the person with dementia.
Carers can become jaded and take their frustrations out on the sufferer, sometimes subtly and sometimes without realizing what they are doing. They can disempower the person, treat them as a child, discount their requests, objectify and even intimidate them. With support they can be taught to avoid such dysfunction.