Dementia

Neurological Disorders

What is dementia

Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior. Most types of dementia are non-reversible (degenerative). Non-reversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer's disease is the most common type of dementia. It is not a specific disease. People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there.

According to an estimate in 2010 there are more than 3.7 million Indians who are suffering from dementia. Dementia is one of the major causes of disability in late-life.

Causes

• Medical conditions that progressively attack brain cells and connections, most commonly seen in Alzheimer's disease, Parkinson's disease, or Huntington's disease.
• Medical conditions such as strokes that disrupt oxygen flow and rob the brain of vital nutrients. Additional strokes may be prevented by reducing high blood pressure, treating heart disease, and quitting smoking.
• Poor nutrition, dehydration, and certain substances, including drugs and alcohol. Treating conditions such as insulin resistance, metabolic disorders, and vitamin deficiencies may reduce or eliminate symptoms of dementia.
• Single trauma or repeated injuries to the brain. Depending on the location of the brain injury, cognitive skills and memory may be impaired.
• Infection or illness that affects the central nervous system, including Creutzfeldt-Jakob disease and HIV. Some conditions are treatable, including liver or kidney disease, depression-induced pseudodementia, and operable brain tumors.

Symptoms

• Memory loss
• Impaired judgment
• Difficulties with abstract thinking
• Faulty reasoning
• Inappropriate behavior
• Loss of communication skills
• Disorientation to time and place
• Gait, motor, and balance problems
• Neglect of personal care and safety
• Hallucinations, paranoia, agitation

Coping up

• Take care of your physical health through exercise, adequate rest, and nutrition.
• Schedule regular medical check-ups with professionals who have expertise in dementia.
• If you feel depressed, seek mental health treatment with a professional who has experience in this area.
• Take your medication as prescribed and avoid making changes to your regimen without medical advice.
• Avoid using alcohol as a coping mechanism.
• Join a dementia support group where you can connect with others and learn more about the disease.
• If you are still working, seek potential work options such as a reassignment to a more manageable position or early retirement.
• Keep the lines of communication open with family and friends. Continue to share your feelings with them. Do not hesitate to ask for help when you need it.
• Organize your belongings in such a way that things are easy to find. Try to put things in the same place every time. Putting labels on drawers and doors can be another helpful way of keeping track of things.
• Continue participating in your favorite activities as long as you can, and as long as you still enjoy them. Think of ways to modify your activities to adapt to your changing conditioning.
• Perform difficult tasks at times of the day when you feel your best and allow yourself enough time to complete them. If a task becomes too difficult break into pieces.
• Keep a written schedule handy to keep track of appointments, tasks, and medication schedules. Also, make a list of important phone numbers as well as your personal information (where you live, your phone number, and emergency contacts) and keep it with you in case of emergencies.
• Write down, express, and work through your feelings.
• Plan for the future. Decide how you want things to be handled when your disease progresses to the point where you can no longer care for yourself. Make necessary legal and financial arrangements (for instance, appointing trusted person to handle your money and affairs when you can no longer do so).

Diet

Meals often provide a sense of atmosphere and community. It can a pleasant activity to amuse and occupy the patient, such as laying or clearing the table. Maintaining eating habits is also important for the well-being of the patient.

Some people suffering from dementia will eat too much food because they can't remember their last meal or enjoy eating, and therefore will start gaining weight. Others lose weight as they don't enjoy the food. In addition, chewing or swallowing may physically become a problem. Following care must be taken:

• Try to sweeten the food artificially - also meat and vegetables. The patient may find this more tempting.
• If people have problems choking when drinking, you may want to add some thickening to their drinks (for example, adding yoghurt to milk)
• Sweet, porridge-like food is preferred.
• Hard food should be avoided.
• Offer several small meals throughout the day, also before bedtime
• Large handles, non-slip plates and later on spoons allow the patient to feed themselves. Don't be over-concerned if they are using their fingers to eat or play with the food as their abilities decrease.
• Make sure the patient sits upright when eating to avoid problems with swallowing
• Even if the patient is confined to bed you can stimulate a sucking and swallowing reflex; then you might be able to administer fluid using a straw or even a milk bottle.
• Pay attention to sufficient fluid intake, 1 to 2 L daily.

Toileting

Gradually people suffering from dementia and Alzheimer's disease will lose their ability to control their toileting and incontinence occurs. Sometimes patients can't find the way to the toilet or can no longer clean themselves. Incontinence is often a stressful problem for the caregiver. Following measures can be taken at home:

• Clearly mark the toilet (have a colorful door with a symbol)
• Make going to the toilet part of the daily routine.
• The inside of the toilet bowl should be dark e.g. by coloring the water. A totally white toilet does not allow orientation, especially for men while urinating in a standing position.
• Restlessness sometimes indicates a need to go to the toilet.
• Obtain information on nappies and sanitary towels in specialist shops and use a mattress protector.
• Avoid the use of a catheter or tube, even at an advanced stage as this may cause infection.
• Pay attention to skin care as faeces and urine attack the skin.
• Don't dramatize an 'accident', distract the affected person and clean up discretely.

Communication tips for caregivers

As dementia progresses, it becomes more and more difficult for dementia sufferers to express their thoughts and feelings and to understand what is being communicated to them. Here are some tips to help enhance communication with the person with dementia:

• Speak slowly, not too loud, using a low-pitched voice
• Face the person when you are speaking to him or her
• Use short, familiar words and short, simple sentences that clearly express what you want to say
• Allow sufficient time to respond. If the person does not respond, repeat your question with the same wording as before
• Ask only one question or give one instruction at a time.
• Break tasks down into smaller steps that are more manageable. For instance, even activities as simple as tooth brushing are made up of many smaller tasks, such as picking up the toothpaste, taking off the cap, picking up the toothbrush, putting toothpaste on the brush, etc.
• Give positive instructions; avoid saying “don’t” or giving negative commands. For example, instead of saying “Don't go in that room”, try saying “Let's go over here”.
• Avoid questions that require a lot of thought, memory, and words.
• Avoid instructions that require the patient to remember more than one action at a time (for example, avoid questions of the type “what film did you see last night?” or “What did you do this morning?”)
• Avoid arguing or disagreeing with the patient. Since dementia affects reason and logic, and arguing with someone requires logic, arguing is pointless.
• Address the feelings of a person with dementia rather than focusing on the facts or accuracy of what the person is saying.
• Avoid reorienting the person to reality if not necessary. For instance, if someone with dementia thinks that the year is 1970, and this is not hurting anyone, avoid trying to convince him/ her it’s not. Instead, try to identify feelings related to 1970 by asking more about it.
• Keep things more peaceful and simple. Try not to have too many people visit the patient simultaneously. Communication is often easier if the environment is calm, simple, safe, and quiet.