About Dementia

People with dementia may have symptoms in common but they are all individuals.

How someone lives with dementia is influenced by their life experiences—these can shape the care they need.

What is dementia?

1.  It is an umbrella term covering impairment of memory, language, thinking,    reasoning and problem solving

2. It is a progressive brain disease that, as yet, has no cure. Treatment with     medication may slow down its progression but a person’s ability to live a normal everyday life will deteriorate

3. The most common forms are Alzheimer’s Dementia, vascular dementia,      mixed dementia, dementia with Lewy bodies and fronto-temporal  dementia        

4. It is thought to be influenced by:

·   Other existing health conditions

·   Sensory and mobility impairments

·   Personality

·   Life experiences to date

·   Richness of social life

It is estimated that there are around one million people in the UK with some form of dementia. In reality the figure is likely to be higher as diagnosis rates are variable throughout the country. Cornwall has a lower than average diagnosis rate.

 Types of dementia:

 Alzheimer’s Dementia (AD)

This is the most common having approximately 60% of all cases.

Early signs include:

·   difficulty remembering recent events

·   difficulty with language—finding the right (or any) words

·   difficulty in remembering routes or getting lost in familiar surrounding

 Vascular dementia

Approximately 15% of all cases

Brain tissue is damaged when blocked or leaking blood vessels starve it of oxygen. It may cause a stroke or transient ischemic attacks (TIAs). The effects will depend on which part of the brain is affected

 Mixed dementia (a mix of AD and Vascular Dementia)

Approximately 10% of all cases.

 Dementia with Lewy bodies

Approximately 10% of all cases

Lewy bodies are found in the brain and are abnormal deposits of the protein alpha-synuclein. Their presence affects normal brain chemistry leading to the following signs:  

·   Fluctuating awareness and alertness

·   Visual impairment—mistaking what is being seen or experiencing  hallucinations   

·   Tremor and muscle stiffness (like Parkinson’s)

·   Less evidence of memory loss

 Fronto-temporal dementia

Approximately 2% of all cases

Affects more people under the age of 65 and affects the frontal and temporal lobes of the brain.

Signs include:

·   Changes in personality, behaviour and language skills

·   Apathy

·   Lack of empathy

·   Uninhibited behaviour

·   Difficulty finding words and making conversation

Other dementias

Approximately 3%

Caused by other health conditions such as:

·   Huntingdon’s Disease

·   Creutzfeld-Jakob Disease (CJD)

·   Autoimmune dementia and encephalopathy (ADE)

·   Chronic traumatic encephalopathy (CTE)

Risk Factors across all dementias:

·   Age— Is the biggest risk but dementia is not a normal part of the ageing process

·   Genetics— A family history of AD is a risk factor but not a determining factor on its own

·   Medical conditions including— Multiple Sclerosis, HIV, Downs Syndrome, heart conditions, raised blood pressure, diabetes, obesity and head injury (especially sporting head injuries, e.g. repeated heading of a football or rugby tackling)

·   Lifestyle— There is no conclusive evidence but these may increase the risk: a poor diet, smoking, excessive alcohol consumption, a sedentary lifestyle and under-stimulation of the brain

 Why early diagnosis is important:

·       To rule out and treat other medical conditions that have similar symptoms

·       To help understand certain behaviours and experiences

·       To access treatment and slow the progress of dementia

·       To access advice and support

·       To help plan for the future

 Symptoms—an overview

·   Memory loss, especially recent events

·   Difficulty processing information

·   Difficulty finding the ‘right’ word

·   Difficulty carrying out every-day tasks (shopping, banking etc)

·   Sleep disruption

·   Mood changes

·   Hallucinations

·   Personality changes

·   Confusion (time/place)

Not all these symptoms will be present, especially early on, but dementia is a progressive condition and symptoms will get worse and may multiply.

Alternative diagnoses: 

·   Depression—low mood over a period of time causes forgetfulness or difficulty in making decisions. Symptoms improve with treatment. NB depression can often occur alongside dementia.

·   Delusions—short-term confusion can be caused by infection (high temperature), drug side-effects or dehydration. Symptoms improve with treatment and a full recovery made.

Effective and compassionate communication

People with dementia often have communication difficulties:

·   Word finding is impaired

·   Conversing is impaired

·   Processing information given in conversation is impaired

·   Speech may become garbled

All these things may mean a person disengages from social activities through embarrassment or discomfort.

How to help:

·   Slow conversation to their pace

·   Don’t hurry them or finish sentences for them

·   Speak to them about an interest they have

·   Use prompts such as pictures or objects to focus on

·   Steer the conversation to topics that are positive—past events, family members etc

Non-verbal forms of communication and distressing behaviour

Some people with dementia develop non-verbal ways of communication to compensate for loss of speech. They may use gestures, facial expressions, noises or certain behaviours. Sometimes ways of behaving may be more marked and the person appears frustrated, agitated or angry. This may be because they cannot say how they are feeling or may not know why they are feeling a particular emotion.

Here are some reasons why:

·   Thinking they are useless or being a burden 

·   Feeling frightened

·   Fearing an uncertain future

·   Experiencing frustration due to memory or speech impairment

·   Experiencing frustration when they are treated differently or ignored

·   Confusion and disorientation ‘Where am I?’

·   Angry because they cannot make themselves understood

·   Angry/sad because their lives have changed (for the worse)

Things that might help prevent distress:

·   Giving emotional and physical comfort to promote feelings of security.          Touch, tone of voice, music and calming gestures may help

·   Giving them a sense of their identity by helping them remember who           they are, using photos, videos or a ‘life story’ template as prompts

·   Nurturing their bond with other family members and friends, as well as        objects that have importance or significance

·   Helping them do things that have meaning and over which they can feel      some control. Promoting feelings of being useful and engaged.

·   Helping them feel included and part of a social world. Giving them               opportunities to engage and feel welcomed, valued and accepted

·   Giving them love so they feel fully accepted and embraced for who they      are and that their life story is ‘held and maintained’

Summary:

·       Dementia is an umbrella term used for several different brain diseases which affect thinking, reasoning and language

·       There are different symptom profiles for each of the different underlying brain diseases

·       The symptoms associated with dementia worsen over time and are similar to those of depression and delirium

·       The risk of developing dementia is affected by factors including age, genetics, medical conditions and lifestyle

·       People with dementia often have symptoms in common, but each is a unique human being with their own unique personal history

·       People living with dementia can find it difficult to communicate their needs verbally and may rely on non-verbal methods of communication

B Payton (collated from elearning notes taken during Tier 1&2 training provided by elearning for Health)