Understanding Dementia: An Overview
If you are reading this article, you might be a family member trying to wrap your mind around the devastating news that a loved one has been diagnosed with some type of dementia. Perhaps you are further into this multi-year journey, and you have arrived at the conclusion that, for the good of everyone, your loved one needs the constant care and supervision available in various types of Memory Care communities or Skilled Nursing Facilities. Wherever you are in this process, I have experience both as a family member facing this situation and as an elder care professional who can help you make the tough and important decisions you are facing.
As noted by the Alzheimer’s Association, “1 in 3 seniors dies with Alzheimer’s or another dementia. It kills more than breast cancer and prostate cancer combined.”
This article is designed to help you understand the basic science behind dementia and give you some sense of how to prepare.
What is Dementia?
Dementia is an organic breakdown of the brain’s ability to do its many functions. Dementia is not a cause of this breakdown, rather it is a state of being, a result of some disease or damage. The treatment and medications for each type of dementia vary drastically. It is very important to get an accurate diagnosis from medical professionals, especially since some patients suffer from more than one type of dementia simultaneously.
Here are some of the most common causes of Dementia:
Degenerative Neurological Diseases
This is far and away the most common cause of Dementia. These diseases are progressive and include Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and some types of Multiple Sclerosis. They move at different speeds for people, but they get worse over time and typically result in death, directly or indirectly.
Again, according to the Alzheimer’s Association, “Alzheimer’s disease is the sixth leading cause of death in the United States.” And “5.8 Million Americans are living with Alzheimer’s. By 2050, this number is projected to rise to nearly 14 million.”
Lewy Body Dementia, Frontotemporal Dementia, Mixed Dementia
These are some of the less common disease processes of the brain that lead to dementia.
Vascular Disorders
This condition causes damage to the brain via reduced circulation of blood to the brain.
Brain Injuries
Brain injuries, such as those caused by car accidents or repeated concussions, can cause dementia.
Infections of the Central Nervous System
These infections include Meningitis, HIV, and Creutzfeldt-Jakob disease. Infections in the brain are difficult to treat, ironically, because the feature of the brain called the Blood/Brain barrier. This process is designed to protect the brain from blood-borne infections and it also makes it difficult to pass medication directly into the brain.
Long-Term Alcohol or Drug Use
Long term abuse can lead to brain damage and dementia.
What Are the Risk Factors for Dementia?
Age
Dealing specifically with neurological diseases such as Alzheimer’s, the biggest risk factor is age. Although there is a cohort of people who begin to show signs of dementia in their 50s and 60s, most people develop Alzheimer’s, specifically, later in life. We all know people who, in past times, would have been said to have been suffering from senility. This catch-all term for the condition of being old is not used any longer, but the connection between age and dementia is a valid one. Other neurological conditions start at different times in a person’s life.
Genetics
Neurological conditions like Alzheimer’s and Parkinson’s runs in families. Not everyone gets the bad combination of genes, of course, and often generations are skipped completely. Huntington’s is also called Woody Guthrie’s disease, and Woody’s children have spoken about their fear when passing through the age at which Huntington’s typically is diagnosed. (They both did not develop this disease.) If a relative developed a neurological condition, following generations are at an increased risk for developing the condition, too.
Other Causes
For various reasons (mainly around blood flow and brain oxygenation) smoking, poor diet, heart disease, vitamin deficiency, sleep apnea, heavy drinking, lack of exercise, and repeated brain trauma can also lead to dementia.
What are the Major Signs and Symptoms of Dementia?
The brain is very much like a computer. This is no coincidence – early computer scientists had the brain as an example of an information processing machine, and they designed computers with brains in mind. Our brains share at least three main characteristics with computers – Short Term Memory (known as RAM in computers), processing Functions, and Long-Term Memory. For people with dementia, problems with Short Term Memory are typically the first indicator that something is wrong. It just becomes difficult to hold onto new information, even for a few minutes. This has to do with the chemical and physical nature of the brain, and how new information is stored. An important note here is that we all have “Reserve Capacity” in our brains. A disease process like Parkinson’s or alcohol-related dementia might be operating for some time before repeated short term memory deficits are noted – the brain’s Reserve Capacity is covering for the initial brain damage. Once the Reserve Capacity is exhausted, though, the Short Term Memory difficulties become more obvious.
We also share Processing functions with computers. This processing power is used to accept sensory data and information and then respond to it. “I’m cold, I need a sweater,” is an example of simple processing. Part of Processing Power, too, is the brain’s ability to ‘order’ action from the rest of the body – move a leg, for example. Fairly early in the dementia process, families will notice that people with dementia cannot put information together quickly, or at all. They will also note that control of the body becomes more difficult. This is a period of the highest frustration for people with dementia and is usually the most difficult period for families, too. Watching loved ones not be able to put together a thought, or have increasing difficulty talking and walking, is hard for everyone.
Long-Term Memory is often retained by someone with dementia for some time. Because of short term memory problems and difficulty in processing, in fact, many people with Dementia end up living much of their lives in a previous time and even another place. For many people, this indicates something of a middle stage in the disease. This period, too, is when wandering (leaving where one is and trying to get to a new location that is not grounded in fact) typically starts. Wandering can be very dangerous for seniors with dementia. They are looking for a location that literally does not exist and are typically not aware of traffic or other dangers in their search.
How Does My Family Handle a Dementia Diagnosis?
Here is some straight talk about Dementia in seniors. It’s hard. It’s very hard. And it’s sad. A once vital loved one is increasingly unable to participate in the day to day world. To help them, we end up living in their world, where, with training and compassion we can comfort them.
1. Stick close to your doctors. There are medications that can help, particularly early in some of the disease processes.
2. Find your local patient support groups, like the Alzheimer’s Association. They can help both the individual with dementia and their family. “Day Programs” for people with dementia can be wonderful; they help the senior stay grounded, help the family understand the process, and give the family a break in caretaking. Everyone wins, and the programs are often offered free or very inexpensively by various public entities.
3. Learn how to communicate with those with dementia. There are plenty of courses available. The basics are – 1. Don’t argue, 2. Live in their world, and 3. Redirect requests you cannot help them with and redirect from things that confuse or frighten them.
When Living at Home No Longer Works
One of the most valuable pieces of advice I even received relative to dementia in seniors was this: “This is a terrible disease. Don’t let it take down an entire family or multiple generations of a family.” Some families have the resources to take care of a senior with dementia at home. Some just don’t, for a wide variety of reasons. For these families, it’s not defeat to consider a qualified Memory Care Community. It’s a kindness, for both the senior and the rest of the family.
Call Assisted Living Locators Long Island to discuss any aspect of care for your loved one with dementia. We can help.