Dementia is not something that happens suddenly, overnight, but a gradual worsening of cognitive functions. It could be described as a chronic brain impairment and not only a more serious memory loss, which may be frequent in elderly. It is much more than that and it is not a normal part of aging. Understanding that dementia is a disease with serious outcomes may help you to prepare for the worst times, when you might not be even recognized any more by your loved one.
A pile of problems, deterioration of ability to perform daily tasks, or manage overall affairs, manage time, control behavior, remember instructions, focus attention, plan things, doing the right things. These processes are called executive functions. Language, judgment, reading and comprehending also can be affected.
Early Dementia Signs
Unfortunately, early diagnosis often fail, as the signs are mostly attributed to aging, while they are mild:
-lack of concentration, attention
-lower ability to solve a problem
-difficulty with learning new information
Only when some more serious symptoms occur, dementia appears as a possibility to the observer (the person themselves, or a family member) and may be a reason for an examination:
-disorientation (in time and even place)
-obvious mood changes, to worse
-depression which consistently becomes worse,
-delusions and hallucinations
After these, many more are following, as the disease is progressive.
Dementia Risk Factors
If you read some of my previous articles on physical health and various illnesses related to age, you will find these causes familiar. More or less these are factors that increase risk of developing many diseases, and not only at old age. Only one or two are specific risks of dementia, the others are pretty much general risks for your overall health, as well:
-excessive use of alcohol,
-eating an unhealthy diet,
-high blood pressure,
cholesterol and/or blood sugar levels
-loneliness, social isolation,
-letting your brain rust, not challenging it
-side effects of certain medications
What Dementia Is Caused By?
While health experts believe the direct cause of the dementia are modifications in or around the brain cells caused by abnormal protein build-up into a form of plaque, which interferes with normal brain functioning, it is not very clear what exactly triggers this build-up.
There were researches and studies that indicate some protein structures are capable of independent replication once they are spontaneously formed. This formation is said to take several decades, though, but once it is formed, can rapidly multiply. Still, I was not able to find an explanation for the cause of this spontaneous formations during my research.
Another abnormality can lead to a form of dementia, specifically called vascular dementia. Here the vessels in the brain, carrying oxygen and nutrients to the brain cells get damaged. The small vessels can be narrowed by plaque, or can have a blockage. It may appear suddenly, after a stroke or TIA, for example, or it can develop gradually in accordance with the vessels narrowing.
There are many more forms of dementia, the best known of which is Alzheimer’s disease, which often accompanies vascular dementia. If a person suffers from one dementia, another form also may be present, which makes dealing with it more complicated.
Stages of Dementia
Mild dementia can be easily mixed with normal aging and it’s difficulties, as at this stage the sufferer have mild memory problems, perhaps forgetting names, or finding the right expression at the moment. Some organizational problems may occur and some lack of concentration. All these we usually attach to normal aging brain function decline.
At this stage a person is still capable of performing the daily activities and may require help with tasks like shopping, housekeeping, cooking, managing money, paying bills, perhaps transporting, although they probably still can drive themselves, as well.
Moderate dementia symptoms will rarely leave someone in doubt whether there is a need to visit the doctor or not. Signs are more pronounced, more obvious. Stopping in the middle of the sentence forgetting what they were about to say, not being able to follow others’ sentences, forgetting names of their interlocutors, are just a few examples. The same question might be repeated over and over, forgetting it was answered already…
They may forget where they are or where they came from, even the name of their street, not to mention the way home. Wandering is quite common in this stage and causes numerous headaches to their caregivers. Your loved one with dementia will fail to inform anyone about getting out. Having a personal alarm device with a built in tracker may be a good solution.
Depression or aggressiveness is not rare, either. An earlier mild, good-hearted person may now show complete lack of any empathy or even impatience, anger towards others. Some new fears may appear, irrational from our point of view, but very real to them. For example, a fear of water, which makes more difficult to maintain a normal personal care, as bathing, showering is often out of reach at this stage.
Delusions and hallucinations may make them see and hear things that you don’t. No persuasion of “but, no one is there, believe me…” type will help. It will only worsen things. If you care for someone with such manifestations of dementia, you’ll need to approach this with something like: “Oh, I see. Do you want me to ask them to leave, so you can rest?”
It will require a lot of patience and a lot of creativity to deal with such situations and that is partly the reason why it is so difficult to be a dementia patient’s carer.
Some physical appearances will in time include incontinence of urine and bowels, tremors, sometimes constant munching (even when not eating anything)…They are usually not aware of any of these. Try to remember this when you need to clean up the stains from the carpet as it was yet again mistaken for the toilet. None of that is done on purpose.
Their actions are very unpredictable and they may present danger for themselves, as they might decide, for example, to rearrange things in a room and break a foot bone by dropping a heavy statue on it, or set a fire in the middle of the kitchen, thinking they are having a picnic in the woods (both examples are real, sadly), so in this stage it already becomes essential that they are never left alone.
Severe Dementia is the advanced stage of the disease, where all the symptoms are highly enhanced. The communication becomes very difficult if not impossible altogether. Forgetfulness is always present and very often the person will forget in just minutes what happened, even if it was a dinner or a visit of a loved one.
They need to be prompted multiple times to drink, eat, or take medications. You could be asked to give a reason for administering the medication, and a simple “for your health” often isn’t good enough. You might be not understood whatever you say, so you just might want to try again a bit later. Dementia might also bring a person to be frightened of something particular, or generally frightened of everything.
At any moment a person might feel decades back in time and genuinely believe they are young and just dealing with some event that happened then. It can be such a realistic feeling that they are ready to go to work, or to the playground to play marbles with other boys, play with a doll or look for their mother. Again, they usually can’t recall any of this later.
They might recognize family, but forget or mix their names. They are incapable of performing ADSL (daily activities) and need a constant care with almost everything. Sometimes a feeding may be needed, as well. A physical deterioration might be also present to the point when walking is either very difficult, or impossible without aids or constant support.
Sleeping becomes more than an old age insomnia-it’s not rare that they change night for the day, which usually drives crazy the person caring for them. They can effectively doze the whole day in a chair, or even refuse to stand up in the morning and then require company at night as they can’t sleep. Or in the middle of the night they think it’s time to get up and go to work, or to an appointment, or meet a long gone friend, or catch a train… It will take a long reassuring or distracting conversation to get a person back into bed. It can be extremely tiring for the carer.
Is There a Cure for Dementia?
No, there isn’t. That said, although there are no known ways to cure or reverse dementia, (except in very rare cases, when the cause is an underlying treatable illness), there are ways to manage the symptoms to a certain level, either by medication, or by therapies.
It is not at all easy to accept dementia diagnose, neither for the person itself, nor for the loved ones. However, it is important to realize that the sooner it’s accepted as a reality, the sooner the proper treatment may be applied.
Memory-, problem solving skills- or language-improving exercises are called cognitive stimulation therapy and they can be fairly effective, mostly in the first, mild stage and somewhat in the second, moderate stage dementia.
Severe dementia will require medications, which will be determined by the doctor. Never try to add any medication or alternative remedies (various plants and vitamins that can be of help, but can also interfere with medications) without consulting a doctor first.
Dementia is a disease that has a huge impact not only on the person suffering from it, but on the family and the caregiver, as well. Coping with this illness is very complex and very exhausting.
In this article we only touched the tip of the iceberg, but hopefully you do understand now what is happening, why and what to look for if you suspect your loved one might be at the start of it. This can also give you a small glimpse into what to expect and how to start preparing for it.
I will be writing more about it, with more details on how to cope with various issues typical for dementia in my next posts.
Do you have any experience with dementia in your surroundings? Would you share it in the comments? We could all learn something…
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