Dementia: Causes, Symptoms, Diagnosis, Care, Myths

There are as range of causes of Dementia, theses can include strokes. A stroke can cause a prevention of a normal blood flow, which in turn deprives the brain cells of Oxygen. This can cause Vascular Dementia, such symptoms can include memory loss, problems with reasoning and with judgement. Another cause of Dementia can be Alzheimer’s disease. “Alzheimer’s disease accounts for 60 to 80 percent of cases” (www.alz.org ) Alzheimer’s is said to be caused by different genetic and environmental factors that cause different effects on the brain over a period of time. Picks disease is also a cause of Dementia, this can be described as an age related dementia. “Picks disease is a rare type of age related dementia that affects the frontal lobes of the brain” (www.alzheimer.net ) This can cause problems with speech, behavioural issues and ultimately death. One of the most common causes of dementia is Lewy bodies. This type of dementia can take years to develop, gradually getting worse. It is unlikely to happen to a person under the age of 65. Symptoms of a sufferer with LBD can range from confusion, disturbed sleep, hallucinations and issues surrounding memory, understanding and judgement.

There are several types of memory impairment experienced by people with dementia, these can include; Decline in memory - With Alzheimer’s disease, memory loss is possibly one of the first signs of dementia. The decline of memory will become apparent to others as it becomes more noticeable. Memory loss will become more severe but normally will not be apparent to the individual. Memory loss affects different people in a variety of ways, some people can carry on doing regular day to day activities. On the other hand, there are people who require support very early on. “A person may recall a surprising range of facts or experiences, especially memories from earlier in their life, but may forget recent events or familiar”. (www.alzheimers.org) I recall a service user whom I cared for who had sever dementia, she had forgotten how to use cutlery and would not know what to do if a plate of food was put before her without reminding her it was to eat. However if I put on her favourite classical music, she would sing along word for word. This just shows how diverse memory loss can be. Changes in behaviour - Changes in behaviour can be described as a confusion or of somebody attempting to try and understand what is happening around them. Some dementia sufferers can develop depression or anxiety, but is hard for them to identify the symptoms within themselves. Other changes in behaviour can be seen as a repetitive action, sound or gesture. A dementia sufferer can sometimes be seen repeating the same activity or task, making a certain sound over and over or due to memory impairment, ask the same questions. Lack of reasoning - This may be a symptom of memory impairment, and is seen more frequently in frontotemporal dementia. “The reason for this is because this type of dementia affects the part of the brain which controls insight and reasoning” (www.brain.northwestern.edu) Reasoning is a way to think about something g in a logical way and rationalise what is happening around them. When somebody doesn’t have this skill, it can make them anxious, confused and unable to make safe decisions. Fluctuating abilities - A dementia sufferer may experience fluctuating ability. This may be that one day the individual might be able to undertake and complete a certain task, but may not have the capability the next day. People with Lewy body dementia are more likely to encounter fluctuations in their cognitive abilities. As their dementia progresses, the persons abilities may become worse and simple tasks might become too overwhelming. Fluctuating ability is not inclusive to physical activities, but can also manifest itself through the lack of ability to communicate or remember certain things, this can fluctuate on a day to day basis. Changes in communication - When a person develops dementia, they may be a change in how they communicate, this could be not being able to think of a certain word, talking without actually forming a comprehensible sentence or they may not understand what somebody is saying to them. A change in communication can be a very upsetting and frustrating time for dementia sufferers. As the illness advances, the individual will gradually have more issues surrounding communication.

We process information in several ways. The information processing system starts with our sensory organs. These organs convert stimuli into electrochemical signals, this allows the brain to make sense of what is happening around an individual, whether it be a picture they are looking at or a sound in a crowded room. The brain will process information to a certain degree but needs to be filtered. This is judged by the attention it is given. The attention filter needs to decide what is important and what is not. Once this decision is made, the brain will determine which cognitive process to use. Processing involves many stages, the processing results are regulated repeatedly by attention. The brain has to store information first before it can start to process it. There are several types of memory, these include sensory, working and long term. Once the information is stored it must be rediscovered from storage. This is a reconstruction process, which uses the details that the brain opted to store and is able to recollect. A person suffering from dementia will not process information the same. Thinking, behaviour and ability is affected with dementia. A person’s normal life is interfered with by the brains function. The consequence of dementia is of a decrease in cognitive ability. This can be seen more predominantly in vascular dementia. The damage to the blood vessels causes cognitive impairment, symptoms of this can include poor planning, poor concentration, memory loss and confusion. There are many changes or conditions that can be mistaken as dementia. One of these is infection, particularly a U.T.I. If a person is suffering from a urine infection, they may begin to have hallucinations. When a person who has a U.T.I. starts to hallucinate it is easy to confuse this with signs of dementia, as an individual with dementia can also suffer from them as well. Other symptoms of infection can include delirium, behavioural changes, poor motor skills and agitation, all of which can be associated with dementia. Depression is also often confused with dementia within the elderly community. The reason for this is because many people living with dementia can also suffer with depression or show signs of depression, they could develop low self-esteem and confidence, tearfulness, loss in appetite and memory issues, all of which are shared symptoms of depression.

Another change in a person that can appear as dementia is when a person moves house. I remember one of my service users broke her hip and spent quite some time in hospital. Subsequently she had to move to ground floor flat, as she could no longer manage in a house. In the weeks that followed she displayed several signs that I took to be dementia. The lady was restless and struggled to remember that she had moved, she was very confused and angry. We worked with her and later on during the time I spent caring for her she became more like her old self. A person with dementia’s needs and abilities can fluctuate due to a number of reasons, they can have good days and bad days. When a sufferer moves house due to changing needs, it can be very stressful for the individual, causing confusion and agitation. The person’s needs change and therefore may require a different approach to their care. They may need more time spent with them to help them to adjust to the environmental changes occurring around them. Another reason for changes in ability is viruses. A virus can change a persons ability to communicate as they once did and can cause delirium and confusion. A virus may speed up the advancement of the condition, leading to a change in care. Their care needs will alter whilst they have the virus. It could mean a increase in care until the infection has passed. A person with dementia needs and abilities are constantly changing on a day to day basis, as the disease progresses. An early diagnosis can have an impact with dementia. The progression of the condition can be slowed down by access to treatments at an early stage. An early diagnosis is beneficial as it can delay psychological and challenging behaviours. Cognition can be improved with early intervention and aid the person to keep self-esteem and control the start of depression.

If caught early on, the severity of conditions can be reduced, such as depression, stress, trauma, B12 deficiency and hormone imbalance. The individual can also benefit from early diagnosis psychologically. The initial shock of the diagnosis can be upsetting, but once the individual has come to terms with it can then start to make plans and prepare for the future. Early diagnosis is also beneficial as the person will still have the ability to process the information and make informed decisions. It may also put the individuals mind at rest and explain the symptoms they have been experiencing. The purpose of early diagnosis would be to allow for access to support and a plan of treatment and care. Psychological treatment can delay hospitalization and cognitive ability improved. A financial benefit could also come from early diagnosis. It can enable financial preparations for any situation that arises. Early diagnosis can also enable the family to prepare for eventualities in the future i.e. care, living arrangements and eventually death. The family will also have access to support groups and information. As with the individual, after the initial shock has worn of, it can be empowering to have a diagnosis so that the situation makes more sense, plus when you have a name to put to the symptoms, you can then find relevant treatments, information and support. Care planning can be made easier once an early diagnosis has been made, this is because it is easier to conduct a person centred care plan, as the individual will have better cognitive ability and decision making skills early on in the diagnosis. Plans can be put in place to provide the best care and the right care package to suit the person. The care that the individual will receive can be tailored to the needs and wishes of dementia sufferer. If care is already in place, and a diagnosis has been made, it enables the carers to make informed choices on how they deliver the care based upon the diagnosis.

The importance of recording and reporting is vital to assist with an early diagnosis of dementia. Carers and family members should be vigilant when it comes to reporting signs of dementia. Carers should report to the relevant people, their concerns regarding the service user. It is important to ensure the recording meets the required legislation and standards so that there can be a correct medical diagnosis, referred pathway and care planning. The carer must report all concerns to a supervisor/manager, they should then observe and record all issues. The concerns highlighted would then be passed over to a healthcare professional who can then begin tests to diagnose the individual. Treatment and care packages can then be arranged following the diagnosis of dementia. "Person centred care, put simply is about focusing care on the needs of the person rather than the needs of the service.” (www.rcni.com) When putting together a person centred care plan, the individual is involved in the process, it is tailored to meet their needs. An individuals opinions should be listened to and respected.

Non person centred care is when care is provided to the needs of the care service. The needs and wishes of the individual are not taken into account whilst delivering care. For example, Brian was losing weight as he was not eating. The carers had been giving him porridge every morning as they assumed that he liked it. Brian could not communicate that he didn’t. The carers carried on giving it thinking he was just been awkward, without talking to the family or trying to communicate with Brian in a different way. The benefits of person centred care is it can help to assure people with dementia can enjoy the rest of their lives doing what they like to do. With a non-centred approach the individual would not necessarily have the option to discuss what they would like to do. Another comparison between both ways of care is that person centred care can help manage behavioural issues that may arise and possibly prevent them. Whereas a non-centred approach would only hinder such difficulties.

Person centred care is about treating the individual with respect and dignity. My companies policy when involving service users in their care, aims to identify the different ways that Calderdale Homecare involves its service users and also complies with essential standards of quality and safety. It states that carers should make sure that people without capacity are involved in decision making to the best of their abilities. Calderdale home care expresses its commitment to equality, diversity and inclusion by

• Respecting service users ethnic, cultural and religious practices.
• Accepting service users as individuals, not as cases or stereotypes.
• Involving service users to express their individuality and to follow their preferred lifestyle.

This policy can ensure that any service user is equally listened to, respected and treated in a manner that the individual would like. With such a policy, the care provided is at a high level, the service user is able to continue to live their life with support that suits them. There are many techniques that can be used to meet fluctuating needs in dementia. One technique that can be used is by placing notes/sticky labels around the house as reminders of certain things to help individuals with declining memory. Communication requires different techniques dependant on the individual. Some of the techniques than can be used include talking clearly and slowly, giving them enough time to process the information and not pressure them into responding quickly. Body language is a great technique if verbal communication isn’t an option. This can be effective if a carer remains patient and clam. A person should be able to communicate however they can and should be encouraged to do so.

As a persons needs fluctuate certain techniques or measures must be implemented to ensure the health and safety of an individual. For example, I remember John, he had suffered from dementia for a while and had progressively got worse. John had started leaving the house and almost immediately he forgot where he was and therefore was lost wandering the streets. To ensure John was always safe, we took the measure of obtaining a ‘Buddi’ tracker. The device would sound an alarm in his family’s house to alert them that John had stepped out of his house. This was not to invade his privacy but to enable family to prevent harm coming to John. There are many myths and stereotypes surrounding dementia. One of the stereotypes that immediately springs to mind is that people with dementia are incapable of doing anything g for themselves. This is a serious assumption to make and can lead to a dementia sufferers condition worsening more rapidly. This can happen as a carer who assumes that an individual can’t do anything will do everything for them, therefore leaving the individual with decreasing abilities to undertake any tasks and a loss of independence.

Another stereotype is that people with dementia are all aggressive. This preconception can lead to social isolation. People may shun individuals with dementia so they can avoid aggression and confrontation. The person will feel alone and could lead to depression and withdrawal from everyday life or communication. This can make caring for that person difficult and ultimately the person will not experience the care they deserve or want. Some people think that people with dementia don’t understand anything. They will talk about the individual as though they are not present. They may also talk for the person, assuming that they don’t understand. If this situation occurs, the person can feel like they don’t matter, they could develop a feeling of worthlessness, leading to changes in behaviour. Carers that stereotype dementia patients are working with a lack of dignity for the individual. This is not a person centred approach to care.

Carers may have fears about caring for people with dementia, this could be from stories they have heard, past experience or through general stereotypes and myths that surround dementia. Carers can be supported to overcome these fears by being given adequate and sufficient training. A carer will feel more prepared to care for a person with dementia if they have had correct training. It also helps an individual with dementia receive the best care possible. A carer should be supervised until they are confident they can provide satisfactory care to any person with dementia. This also serves to create a support network for the carer involved. A person centred plan provides information to the carer about the particular service user. This is a useful tool and can help the carer to understand the individual and should ease their fear. There are many outside agencies that specialise in dementia support. These organisations can provide not only support but information and guidance. A carer can access these agencies and prepare before they commence care. In addition there are several meetings that carers can attend to discuss any issues, fears or general topics regarding dementia.

References:

1. Alzheimer’s association 2018. What Is Alzheimer’s? 2018. (ONLINE) Available: www.alz.org/alzheimers-dementia/what-is-alzheimers (Accessed 30/11/2018)
2. Alzheimers.net 2000. What Is Pick’s Disease? (ONLINE) Available: www.alzheimers.net/what-is-picks-disease. (Accessed 30/11/2018)
3. Alzheimer’s society 2018. Memory Loss and Dementia. (ONLINE) Available: www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/memory-loss-dementia (Accessed 30/11/2018)
4. Cognitive Neurology and Alzheimer’s Disease Centre. (Updated Marc h 26th 2012) Frontotemporal Dementia.(ONLINE) Available: www.brain.northwestern.edu/dementia/frontal.html (accessed 30/11/2018)
5. Royal college of nursing 2016. What Person-Centred Care Means? (ONLINE) Available: www.rcni.com/hosted-content/rcn/first/steps/what-person-centred-care-means (accessed 30/11/2018)