Many people incorrectly use the terms dementia and Alzheimer’s disease synonymously. It is important to understand that dementia is an umbrella term that describes a set of symptoms in which thinking, reasoning, and memory are impaired, and these symptoms interfere with an individual’s ability to function in daily life. Alzheimer’s disease is only one type of dementia. This article is the first in a series which will explore the various causes and types of dementia.
First, it is important to determine if the signs an individual demonstrates are normal forgetfulness or actually dementia. It is not uncommon, especially as we age, to occasionally misplace items or forget a name or important date. But if an individual begins to ask repetitive questions, has difficulty following directions, puts things in odd places, or demonstrates confusion in familiar places or with familiar tasks (such as paying bills or cooking a meal), it is time to see the doctor.
An evaluation by a physician for symptoms of confusion and forgetfulness might yield some surprising results. For a diagnosis of dementia to be made, impairments must be present in at least two of the following primary mental functions: memory, communication and language, ability to focus and pay attention, reasoning and judgement, and visual perception (www.alz.org). There are some conditions which manifest themselves with these symptoms, and when the underlying condition is treated, the confusion and forgetfulness disappear. Some examples of conditions that cause reversible dementias are depression, infections (in the elderly, urinary tract infections are a classic cause), thyroid disease, nutritional deficiencies (especially the B vitamins), low blood sugar, medication side effects or interactions between medications, and substance abuse.
There are, however, other causes of dementia which are irreversible. Alzheimer’s disease is the most common, but other causes include Lewy body dementia, Pick’s disease, Parkinson’s disease, frontotemporal disorders, vascular dementia, head injury, and the less common Creutzfeldt-Jakob disease and Huntington’s disease. While some of these conditions may have no prevention and/or cure, early diagnosis and treatment may help slow the progression of symptoms and allow individuals and families time to plan and prepare for the changes that will occur. These conditions will be discussed in more detail in future articles.
The symptoms of dementia that develop will depend upon the area of the brain that is affected. The various underlying disease processes cause damage to brain cells in particular areas, interfering with their function and ability to communicate with each other, and leading to cell death. While memory impairment is most often associated with dementia, there are some types of dementia in which personality changes or deficits in executive function (tasks such as decision making or language) are the primary symptoms.
Despite a variety of underlying causes, there are some interventions that may be helpful for anyone experiencing symptoms of dementia. Communication and environment are the key factors for managing the care of an affected individual. A greater likelihood of successful communication occurs when individuals are allowed to live in their own reality. People often want to try to re-orient someone who is confused, and believe this approach is appropriate. However, attempts at logical reasoning with individuals who have dementia are futile exercises that only result in frustration on all sides. The Alzheimer’s Association website lists additional tips for how others should approach conversation with an individual with dementia, as well as how to help the affected individual communicate their thoughts. Visit www.alz.org and click “Life with Alzheimer’s,” “Caregiver Center,” and “Daily Care.” An individual with dementia can be easily overwhelmed, so an awareness of nonverbal cues and body language can help caregivers and families learn when to change course or avoid certain topics of discussion or situations that might trigger additional stress for both parties. An environment with adequate, low glare lighting, familiar objects, low noise levels, and a structured schedule can contribute to a greater sense of comfort and may promote greater stability in the individual’s functioning and behavior.
Watching the progression of dementia is a heart-breaking process. An individual’s general state of health and the underlying cause of the dementia determine how slowly or rapidly the dementia symptoms progress. Families may feel they have “lost” their loved one long before the individual dies. Medications may be used to try to slow the progression of symptoms or manage difficult behaviors, but the challenges of maintaining connections to the surrounding world and providing dignity remain. You can participate in the fight against dementia by joining a team for the Walk to End Alzheimer’s on September 20th at City Island. Visit the Alzheimer’s Association website or call our office (717-697-3223) to learn more.
Karen Kaslow, RN