Dementia - The Silent Thief

19 Sep 2020
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With over 42,000 people in the UK under 65 living with dementia, this silent thief causes a serious effect on people's quality of life! In this article, we explore dementia in terms of the types, stages, assessment and where to seek help.

What is Dementia?

Dementia is an umbrella term describing a set of symptoms that may include memory loss and difficulties with thinking, problem-solving and language. These changes are often small at the start, but for the sufferer, they have become severe enough to affect their daily life. Mood and behaviour changes are also common. Caused by damage to the brain cells, (a loss of nerve cells), dementia can leave a person frightened, confused, and agitated.

What are the different types of Dementia?

There are different types of dementia, as listed below.

Alzheimer's disease is the most common type of dementia. Accounting for approximately half of all cases, it is recognised by the collection of protein on the brain, which forms plaques and tangles, causing the brain to work incorrectly.

In general, Alzheimer's disease is a gradual process and decline, and the illness may last several years. At first, changes may be subtle, but as the disease progresses, the changes become more prevalent.

Memory loss will often be one of the first symptoms. 

Vascular dementia is the second most common type of dementia, and it occurs when the blood supply to the brain is damaged. There are two main types of vascular dementia; one caused by stroke and the other by small vessel disease.

Multi-infarct dementia is a type of vascular dementia that is caused by small stokes. The strokes can be so tiny that no-one notices them happening, but the person may get worse quite suddenly and then not change again until the next stroke happens. As a result, the progression of this type of dementia often occurs in steps rather than gradual changes, such as in Alzheimer's disease.

Lewy body dementia is a type of dementia that shares characteristics with both Alzheimer's disease and Parkinson's disease. As with Alzheimer's disease, symptoms progress gradually over several years. The person may experience many of the symptoms of Alzheimer's disease but may also experience muscle stiffness, trembling of the limbs and a tendency to shuffle when walking. They may also experience hallucinations and fall asleep during the day and then not sleep at night.

Fronto-Temporal Dementia, including Picks Disease, is a rare type of dementia. During the early stages, a person's memory can be fine, but their personality, behaviour and language skills change. This dementia often causes a loss of insight, and so the person may say and do things at the wrong time and in the wrong place. This can be embarrassing for family members, and it is important to know that there is a physical cause for these changes. The progression of this disease is unpredictable, and in the later stages, symptoms are like those of Alzheimer's disease.

What are the main stages of Dementia?

There are generally three accepted stages of dementia

Dementia Stage 1:

The person becomes aware that they are not thinking and remembering as they did in the past.

Dementia Stage 2:

At this stage, memory lapses and confusion become more evident, and the person can no longer hide her memory gaps from family and friends. Their short-term memory is significantly impaired, and they may ask a lot of repetitive questions and be anxious about when events are happening.

Dementia Stage 3:
At this stage, the patient's family member is highly impaired by their loved one's dementia. It is evident to anyone speaking to them for more than a few minutes that something is wrong with their ability to think. Dementia may also limit their ability to communicate. Independence will usually be impaired.

How can Dementia be diagnosed?

Screening

Early diagnoses is essential for effective intervention. Dementia will only be diagnosed and managed when all other causes are excluded.

A combination of assessments and tests can support a diagnosis. 

  • Usually, the GP will take a full patient history.  
  • Cognitive checks will be carried out to ascertain the patient's mental ability. A standard test is the General Practitioner Assessment of Cognition (GPCOG).
  • A comprehensive physical check will be carried out- complete dementia blood screen (B12, Folate, TSH and other tests, if relevant, for example, Syphilis serology) and Computed Tomography (CT scan) head.
  • A biographical profile will be sought with family if required.

Most tests involve a series of pen-and-paper questions, each of which is then scored. Different trusts may have different assessment methods or tools. 

Tests assess several different mental abilities, generally including:

  • memory- both short and long term
  • concentration and attention span
  • language and communication skills
  • orientation - awareness of time and place

If these tests are inconclusive, a brain scan or MRI may be carried out. Scans such as SPECT scan or a PET scan may be recommended if the result of the MRI or CT scan is uncertain.

Symptoms

Everyone will experience dementia symptoms differently, and it depends on which areas of the brain are affected. For example, if cells start to die in the temporal lobe, leaving the person with language difficulties because that area of the brain controls language. 

What are the early signs of dementia?

Early signs can include:

  • memory loss
  • difficulty doing familiar tasks
  • language problems
  • poor judgement
  • misplacing things
  • withdrawal socially
  • relationship problems
  • deterioration to time and space

What is the best practice management for dementia? 

Once the diagnosis of dementia has been made, it is vital that early intervention and case management commerce. This needs to be holistic, person-centred and in line with current best practice guidelines. A care plan will be created with the patient at its core. Decisions should always be made by the individual if they have the capacity to do so. 

The care plan and treatment will be devised by the patient, family, care team and GP. The plan may include medication management, talk therapies, or counselling. A multidisciplinary team approach will be introduced to meet all the person's needs. care is individualised and the plan can not be generic-it must be tailored to each patient's own individuals requirements and situation. Once the care plan is developed, it requires regular review and monitoring in line with local and national standards, policy, and guidance. 

Conclusion

Dementia can steal a person's identity, so it is essential to promote independence where possible and to support the person in a respectful and dignified manner.

While there is no cure for dementia, it's up to all of us as a society to support dementia research and help raise awareness on the topic. Awareness campaigns such as World Alzheimer's Day on September 21st is an important landmark for all those involved or affected by dementia.

At ProMedical, we firmly believe everybody deserves the very best care possible. Quality and safe care for the person is our driving force. That's why we hire the very best professionals out there. 

Contact us today to explore our careers with a professional consultant to guide you.


More information at https://www.alzheimers.org.uk/

19 Sep 2020
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