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Dementia

Compiled by Helen L. Fiorini, B.Sc. (Hons)

 

Introduction

The use of the word ‘dementia’ is growing ever more familiar in everyday language due to a number of factors. The most influential factor is the ever increasing number of people being affected by the condition. Well established statistics reveal that one in twenty of people aged over sixty-five years have dementia while by eighty years this rises to one in five. Applying these statistics to the Maltese population reveals that potentially, a staggering three thousand (3000) persons in the Maltese Islands live with dementia.

Better living standards and better health care that have resulted in increased longevity and survival from disabling conditions, such as stroke and head injury. As the person with dementia grows increasingly dependent, family members find their roles changing into carers. Increased demands frequently necessitate the assistance of professional carers and healthcare workers to be involved in the individual’s care. In fact 3000 individuals would seem to be the tip of the iceberg when one considers that it is not only the life of the individual with the disease that is affected by dementia!!

 

What is Dementia?

The term ‘dementia’ is used to describe a progressive decline in cognitive function such as memory, orientation, comprehension, calculation, learning capacity, language and judgement exhibited as a feature of numerous disease processes. For a formal diagnosis to be made, memory must be one of at least two cognitive skills to be affected to such a degree as to render the individual unable of carrying out activities of daily living. Behavioural symptoms arising directly from changes in the brain, and as a consequence of the loss of mental skills is another determining factor.

Alzheimer’s Disease accounts for up to fifty per cent to sixty per centof cases of dementia, where the death of nerve cells in the brain leads to the disruption of brain function. Vascular Dementia usually arises from recurrent strokes, whilst Lewy Body Dementia arises from the disruption of brain function due to the formation of particular protein deposits in the brain. The latter two together account for a further twenty per cent of cases. Numerous other causes, which are relatively rare make up the remainder.

 

Diagnosis of Dementia

Although all individuals formally diagnosed with dementia exhibit memory difficulties, this is not necessarily the initial presenting feature of a dementing condition. Different causes of dementia will initially affect different areas of the brain, consequently giving rise to different symptoms. For example, a communication disorder may be an initial presenting feature and will become apparent in various ways in all types of dementia. The dementing process doesn’t proceed in a uniform pattern equally throughout the brain and thus creates a complex interaction between retained skills and impaired ones. This heterogeneity makes it essential for a correct diagnosis to be made. Advances in medicine and the growing impact of dementia on society, has directed research into its treatment and management. Though incurable, some drug treatments to treat some of the symptoms are available.

Aging brings with it…

  • Decline in sensory skill such as hearing and vision
  • Physical limitations such as decreased breath support
  • Increase in word finding difficulties, especially for names
  • Increased distractibility which necessitates a calmer, quieter environment when concentrating on a task
  • More time needed to learn something new
  • Occasional forgetfulness that leads one to mislay objects

…but not necessarily dementia!

When these cease to be merely an occasional nuisance and appear to be a regular, consistent feature then it is advisable to seek a multidisciplinary assessment.

Such an assessment would involve:

  • Varied tests and investigations
  • The review of current medication
  • Differential diagnosis of the cause of the dementia
  • Treatment of any other medical conditions
  • Treatment and control of problem behaviours
  • Monitoring of treatment
  • Education of carers and where appropriate, the person with dementia regarding the condition
  • Referral to other professionals such as occupational therapist, speech language pathologist, social worker, dietician, physiotherapist to either work directly with the person with dementia or to advise the carers so as to maintain optimal quality of life.

 

In Malta, Zammit Clapp Hospital not only offers the services of a Memory Clinic where a multidisciplinary assessment, as outlined above, is carried out but also a Memory Class is held on a yearly basis.

 

Tips how to help someone with dementia

Some tips how to help one’s memory:

  • Reduce worry and stress
  • Get a good night’s sleep
  • Keep active and interested in what is going on
  • Yearly check up for vision and hearing
  • Use memory aids such as wall calendars, notice boards, diaries, alarm clocks, paper and pen by the phone to write down messages
  • Be organized – put things in their place
  • Establish a routine and prioritize tasks
  • Summarize what you have been told to prevent misunderstanding

 

Tips how to help communicate with someone with dementia

Some tips on how to help communicate with someone with dementia:

  • Introduce yourself, providing some background information to your last meeting, if there was one
  • Comment on what is going on around you
  • Talk about a familiar topic, relevant to the person with dementia
  • Use a calm, friendly tone
  • Ensure that your body language is in sync with the verbal message that you are conveying
  • Use clear, simple sentences, i.e., say what you mean and mean what you say as the use of humour and sarcasm may be lost on the individual with dementia, giving rise to unnecessary misunderstandings
  • Give the person ample time to answer even if this means that there are periods of silence in your interaction
  • Observe their body language and emotional state for clues of what they are trying to express.

 

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