Dementia

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Dementia is an umbrella term used to describe a group of conditions that change and damage our brains.

Dementia can happen to anyone, but as people get older the chances of developing dementia increase.

It is caused by brain cells progressively dying over time, causing major changes to the brain structure and functioning. This leads to significant memory loss as well as other issues such as problems with language, attention, problem solving, planning and organising, and judgment.

Dementia is progressive, so symptoms gradually get worse as times goes on. How bad and how quickly this occurs is different in each individual.

Families and whānau can find dementia very difficult to come to terms with as the term itself is scary and the changes to a loved one may be distressing for family and friends.

However you aren’t alone: getting help, support and advice at an early stage makes a big difference and there are many people and services available to you.

What causes dementia?

Dementia is caused by brain cell death. New cells do not grow to replace the dead ones. There are various brain-related conditions that can lead to dementia symptoms. These are often named after the person who first recognised it, so you may see names such as:

  • Alzheimer’s disease (the most common form of dementia)
  • Vascular dementia (can occur after a stroke, and is the next most common form of dementia after Alzheimer’s)
  • Lewy body dementia (often talked about with Parkinson’s disease)
  • Alcohol-related dementia (can occur after years of excessive consumption of alcohol)
  • Frontotemporal dementia (uncommon and usually diagnosed from as early as 40 years)

These all differ slightly in their causes and actions, but exhibit enough similar symptoms to be grouped together as dementias.

Signs to look for (symptoms)

Alzheimers NZ and Alzheimer’s Australia refer to the Ten Warning Signs of Dementia. These are listed here for you:

1. Recent memory loss that affects daily life

  • It is normal to forget meetings, names or telephone numbers occasionally and then remember them late.
  • A person with dementia may forget things more often, and not remember them later.

2. Difficulty performing regular task

  • Busy people can become so distracted from time to time that they may leave the potatoes on the stove too long and burn them.
  • A person with dementia might prepare a meal and forget they made it altogether.

 3. Problems with language

  • Many people have trouble finding the right words sometimes.
  • A person with dementia may forget simple words or substitute inappropriate words.

4. Disorientation of time and place

  • It is normal to forget what day it is or where you are going temporarily
  • A person with dementia may become lost in their own street, not know where they are, how they got there, or how to get back home

5. Decreased or poor judgment

  • Dementia affects a person’s memory and concentration, which can affect their judgment. Many activities, such as driving, require good judgment.
  • It is normal to forget where you are going from time to time and take a wrong turn.
  • A person with dementia may forget which side of the road they are supposed to drive on and pose a threat to other road users.

6. Problems with abstract thinking

  • Balancing a cheque book might be difficult for many of us.
  • A person with dementia might completely forget what the numbers are and what needs to be done with them.

7. Misplacing things

  • Anyone can temporarily misplace a wallet or keys.
  • A person with dementia might repeatedly put things in inappropriate places.

8. Changes in mood or behaviour

  • Everyone becomes sad or moody from time to time.
  • A person with dementia can have rapid mood swings, from calm to tears to anger, for no apparent reason.

9. Changes in personality

  • People's personalities can change a little with age.
  • A person with dementia can become suspicious or fearful, or just apathetic and uncommunicative. They may also experience a loss of inhibition, or become over-familiar or more outgoing than previously.

10. Loss of initiative

  • It is normal for people to tire of housework, business activities or social obligations.
  • A person with dementia can become very passive or require cues to complete daily tasks.

(from Alzheimers New Zealand website)

How the doctor determines if you have dementia (diagnosis)

There’s no straightforward test for dementia. If dementia is suspected, your doctor will do tests to rule other possibilities, such as vitamin deficiencies, thyroid gland problems, depression, side effects of medication, infections, and brain tumours. Once these are excluded as the causes of your symptoms then the doctor is better placed to consider dementia.

Some things the doctor will do to help diagnose dementia:

  • They will spend time talking to you (or the person you are concerned about). They will look at the person's medical history and that of other family members. The way in which the person's problems have developed is important and usually the doctor will ask many questions about the changes that have occurred in the person in order to help determine that you or your loved one has dementia and not one of the treatable conditions mentioned above.
  • They will normally carry out a physical examination and may perform a number of tests, such as blood and urine tests, to identify other conditions that may be causing confusion.
  • They may ask a series of questions designed to test thinking and memory.

 At the end of their assessment, your doctor will let you know their findings and discuss what action needs to be taken. They may decide to refer you to a clinical psychologist for cognitive testing, or a different specialist such as a neurologist, psychiatrist or geriatrician for further tests.

After your specialist visit you will return to your doctor who will talk to you about the range of services available. It is useful to know what is available even if you might not need it right now.

Treatment options

There is no known cure for dementia at the present time. Researchers continue to look for new treatments to improve the quality of life for people with dementia and to help reverse the affects.

In the meantime, drug and non-drug treatments may help with both cognitive and behavioural symptoms. The goals of treatment are to:

  • slow the rate of decline
  • treat other factors that might make confusion worse.

Your doctor will recommend a mix of treatment options which best suits you. Common treatment options include:

Psychosocial treatments (therapy)

These are non-medical treatments (often called therapy or psychotherapy) involving a trained professional who teaches techniques such as behavioural management techniques for caregivers, and validation therapy for the person with dementia.

Medication

Medication, including antipsychotics, antidepressants and tranquillisers, is sometimes used in treating the complications of dementia.

Although drugs cannot stop dementia or reverse existing brain damage, they can improve symptoms and slow its progression.

Caregivers should be told what effects the medication may have and receive clear instructions about how they should be taken and what precautions are necessary.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Full time care

At some point it is likely that that you will need full-time care in a specialized residential care facility. It may help to prepare for this in good time, even if you think you are able to cope for a while yet.

It is helpful to look early at options for residential care so that you can understand what they provide and when it is needed.

Strategies for reducing difficult behaviours in a person with dementia

Because everyone is different, it‘s hard to know how quickly someone's symptoms will change. Some people stay the same for a long time. Others have good days and bad days.

Here are some suggestions to help you and your carer manage:

Communication

  • Be prepared to orientate the confused person often – have a white board with the day, date and season written on it.
  • Simplify tasks and requests. Ask only one thing at a time. Keep sentences short and repeat as necessary.
  • Do not ask questions repeatedly as this may increase their anxiety.
  • Don't confront or corner the person as this will make them anxious. Distract them from whatever is upsetting them. 
  • Always talk to a person with dementia by standing straight in front of them so that they can see you clearly (make sure however that you don't stand too close and overcrowd them).
  • Always explain what you are doing and give simple accurate information.
  • Never talk about them or whisper if they are in the same room.
  • Be patient and watch your voice tone and body language. Even people with severe dementia can correctly read aggressive or angry body language.
  • Be outwardly calm even if you don't feel it.

Activities

  • Develop a routine each day. This will make the person less anxious. On the other hand, this has to be flexible as people with dementia want their needs met immediately and can't remember to wait.
  • Make them feel useful by getting them to do what they can – e.g. peel potatoes, wash up or set tables, but do not expect them to be able to achieve everything you ask them to do.
  • Gentle exercise or supervised walks are useful to help sleep patterns.
  • People with dementia often respond to old time music or pets.
  • Maintain good physical health.
  • The person with dementia should avoid alcohol, too much coffee, tea or excess sugar in the diet.
  • Make sure the person drinks sufficient fluid and doesn't get constipated.

Safety

  • Remove disturbing objects, such as mirrors if the person doesn’t recognise himself or herself in it.
  • Alert neighbours if the person wanders.
  • Give them a Medic-Alert bracelet with name, address and telephone number.
  • Never leave a memory-impaired person alone in a parked car in case they wander.
  • Never leave a confused person alone in a bathtub or shower in case they burn themselves or get frightened.
  • It may help to leave a night light on, either in the room or the hallway, in case the person wakes and gets out of bed at night.
  • Question the need for sedative medication especially if it is being increased or additions made. Too much medication or drugs that interfere with each other’s actions cause many complications.

Caregiver education

Thanks to Janet Peters, registered psychologist, for reviewing this content. Date last reviewed: November 2014