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Abstract Dementia is characterized by evidence of short term and long term memory impairment with impaired abstract thinking, impaired judgment, disturbances of higher cortical thinking, and personality changes. It is basically a progressive decline of cerebral utility such as logic, remembrance, language, problem solving, or concentration. This disease greatly harms the day by day performance of a person and is seen more in older people, however, is not a normal part of aging. . INTRODUCTION 1. 1. Aim The aim of this dissertation is to analyze the effects of dementia in older people and to suggest possible solutions for its prevention and treatment. 1. 2. Objectives Primary objective of this research is to see how effective the health care management systems are for the diagnosis, treatment and prevention of dementia syndrome specially keeping in view the population of UK. 1. 3. Dementia defined
The International Dictionary of Psychology (Sutherland, 1989) defines it as “an impairment or loss of mental ability, particularly of the capacity to remember, but also including impaired thought, speech, judgment, and personality. It occurs in senile dementia and in conditions involving widespread damage to the brain or narrowing of the blood vessels”. In the preceding definition, Sutherland introduced a different term, senile dementia. Senile is derived from the Latin adverb senex pertaining to age or growing old. This shows that some dementias occur at later or older ages for reasons not known.
Definition of senile dementia as per The International Dictionary of Psychology is that it is “a progressive syndrome starting in old age with no clear cause, in which intellect, memory, and judgment are impaired; it is often accompanied by apathy or irritability” (Sutherland, 1989, p. 397). 1. 4. How common is dementia? In England only, there are approximately 570,000 people living with dementia. It is expected that this number would double in the coming 30 years (Barberger-Gateau, 2007). Generally dementia arises in people who are 65 years of age above.
The chances of developing it are more as one gets old as compare to young people. Roughly, it is anticipated that dementia occurs in: •1. 4% of men and 1. 5% of women aged between 65 and 69, •3. 1% of men and 2. 2% of women aged between 70 and 74, •5. 6% of men and 7. 1% of women aged between 75 and 79, •10. 2 % of men and 14. 1% of women aged between 80 and 84, and •19. 6% of men and 27. 5% of women aged 85 or over. 2. LITERATURE REVIEW In the preceding paragraphs, we will discuss in detail the different kinds of dementia that occur to people at older age along with a number of causes that lead towards this syndrome. . 1. Types of dementia Following are the different types of dementia recognized so far (Davidson, 2005): •Alzheimer’s disease, where tiny clusters of protein, known as plaques, start to build up around brain cells. This upsets the regular workings of the brain. •Vascular dementia, where troubles with blood distribution result in uneven supply of blood and oxygen to certain parts of the brain. •Dementia with Lewy bodies, where irregular structures, known as Lewy bodies, grow inside the brain. •Frontotemporal dementia, where the two parts of the brain, frontal and temporal lobes, start to shrink.
Not like other types of dementia, frontotemporal dementia typically grows in people who are below 65 years of age and is very rare than other types of dementia. 2. 2. Different Kinds of Dementia Different kinds of dementing disorders exist. One way of classification is according to parts of the brain being affected. Some frequently used classifications are as follows: •Cortical dementia: This type of dementia damages the brain particularly affecting the brain’s cortex, or outer layer. Problems such as memory, language, thinking, and social behavior results due to this disoder. Sub cortical dementia: It affects parts of the brain below the cortex and causes changes in emotions and movements along with damaging memory. •Progressive dementia: It gets worse with the passage of time, thus interfering more and more with cognitive abilities. •Primary dementia: This denotes to that form that does not result from any other disease such as AD. •Secondary dementia: This type of dementia occurs due to some physical disease or injury. •Treatable Dementia: About 10 percent of conditions that cause dementia are treatable.
With treatment, the dementia can either be upturned or at least halted. Instances of conditions that cause treatable cases of dementia comprise of the following: ?Normal pressure hydrocephalus ?A brain tumor or brain cancer ?Hypothyroidism ?Vitamin B12 deficiency ?Neurosyphilis ?Reactions to medications ?Poisoning. •Non-Treatable Dementia: Types of dementia that currently have no cure include: •Lewy body dementia •Binswanger’s disease •Frontotemporal dementia •Corticobasal degeneration •Certain conditions that can cause childhood dementia •HIV-associated dementia Other infections within the brain, such as Creutzfeldt-Jakob disease •Huntington’s disease and other rare hereditary dementias •Head trauma, such as dementia pugilistica (also known as boxer’s syndrome). Several types of dementia fit into more than one of these classifications. For instance, AD is considered both a cortical as well as progressive dementia. 2. 3Causes 2. 3. 1Alzheimer’s disease It is the most common cause of dementia, affecting around 417,000 people in the UK. German neurologist Alois Alzheimer first described Alzheimer’s disease.
According to him, it is a physical disease affecting the brain. All through the course of the disease, plaques and tangles develop in the brain, thus leading to the loss of brain cells. Shortage of some important chemicals in the brain also results due to this disease. These chemicals are concerned with the spread of messages within the brain. 2. 3. 2Vascular dementia Vascular dementia is the second most common form of dementia after Alzheimer’s disease. It is caused by problems in the supply of blood to the brain. There are a number of conditions that can cause or increase damage to the vascular system.
These include high blood pressure, heart problems, high cholesterol and diabetes. This means it is important that these conditions are identified and treated at the earliest opportunity. 2. 3. 3Dementia with Lewy bodies Dementia with Lewy bodies (DLB) is a form of dementia that has characteristics similar to both Alzheimer’s and Parkinson’s diseases. It makes around four per cent of all cases of dementia in older people. Lewy bodies, named after the doctor who first identified them in 1912, are tiny, spherical protein deposits found in nerve cells.
Their presence in the brain disrupts the brain’s normal functioning, interrupting the action of important chemical messengers, including acetylcholine and dopamine. Researchers have yet to understand fully why Lewy bodies occur in the brain and how they cause damage. 2. 3. 4Fronto-temporal dementia The term ‘fronto-temporal dementia’ includes conditions such as Pick’s disease, frontal lobe degeneration, and dementia associated with motor neurone disease. All these are due to damage to the frontal lobe and/or the temporal parts of the brain. These areas are responsible for our behaviour, emotional responses and language skills. . 3. 5Korsakoff’s syndrome Korsakoff’s syndrome is a brain disorder usually linked with heavy alcohol utilization over a long period. Sometimes it is referred to as ‘alcohol amnestic syndrome’ ? ‘amnestic’ meaning loss of memory ? although in rare cases alcohol is not the cause. Although Korsakoff’s syndrome is not strictly speaking a dementia, people with the condition suffer loss of short-term memory. 2. 3. 6Creutzfeldt-Jakob disease Prions are contagious agents that onslaught the central nervous system and then occupy the brain, causing dementia.
Known prion disease is Creutzfeldt-Jakob disease, or CJD. It was first reported by two German doctors (Creutzfeldt and Jakob) in 1920. 2. 3. 7Aids-related cognitive impairment Individuals with HIV and AIDS occasionally develop cognitive impairment – particularly in the later stages of their sickness. AIDS (acquired immune deficiency syndrome) is caused by the presence of the human immunodeficiency virus (HIV) in the body. HIV attacks the body’s immune system, making the person affected more susceptible to infection. HIV-related cognitive impairment can be caused by: ? The direct impact of HIV on the brain Infections (called ‘opportunistic infections’) that take advantage of the weakened immune system. 2. 3. 8Binswanger’s disease Binswanger’s disease is a unusual form of vascular dementia in which harm occurs to the blood vessels in the deep white matter of the brain. Symptoms of Binswanger’s mostly occur in people over the age of 60 and it is usually linked with long-term hypertension. The disease chiefly affects memory and mental abilities such as thinking and learning. The individual may also experience mood swings, tremors, seizures and problems with walking. 2. 3. 9Huntington’s disease
Huntington’s disease is a progressive inherited disease. It typically becomes obvious in adults in their 30s, even though it can occur earlier or later. There is also a puerile type of Huntington’s, which affects children. The route of the disease varies for each person, and dementia can occur at any stage of the illness. 2. 4Diagnosis Diagnosis of dementia is based on the following: •History •Physical exam •Tests The process of identifying dementia is made only if two or more brain functions such as memory and language skills are extensively damaged without loss of consciousness.
An early and precise dementia diagnosis can help in early treatment of dementia symptoms and maybe reversing the dementia or stopping its development, if the cause of dementia is reversible (such as normal pressure hydrocephalus, a brain tumor, or B12 deficiency). •Patient History History taking is a very important step in identifying dementia. It is important to know how and when symptoms developed and about the patient’s overall medical condition. Is there any risk factor involved or there is any family history of similar symptoms along with any medication the person is taking.
Physician also try to evaluate the patient’s emotional state and the degree of day to day actions being affected in spite of of the fact that patients with dementia frequently are ignorant of or in denial about how their disease is affecting them. Typically the family members also deny the reality of the disease because they take this in the beginning as a usual procedure of aging. Therefore, additional steps are necessary to confirm or rule out a dementia diagnosis. •Physical Exam: A physical examination can help in the following: ?Rule out treatable causes of dementia Classify signs of stroke or other disorders that can add to dementia ? Identify indications of other illnesses, such as heart disease or kidney failure that can be related with dementia. A thorough neurological assessment is performed to evaluate the balance, sensory function, reflexes, and other functions of the patient and to spot signs of conditions that may have an effect on the diagnosis of dementia. •Tests Used in Diagnosing Dementia Tests that are used to diagnosis dementia include the following: ?Cognitive and neuropsychological tests (Mini-Mental State Examination (MMSE) ? Brain scans (MRI or CT scan) Laboratory tests ?Psychiatric evaluations ?Pre-symptomatic testing. •Cognitive and Neuropsychological Tests for Dementia Tests are done to measure memory, language skills, math skills, and other abilities associated to mental functioning to help them analyze a patient’s condition precisely. A test called the Mini-Mental® State Examination (MMSE™) is used to judge cognitive skills in people with assumed dementia. This test examines: ? Orientation ?Memory ?Attention Doctors also use a diversity of other tests and rating scales to categorize explicit types of cognitive problems and abilities. •Brain Scan Tests for Dementia
Brain scans are carried out to recognize strokes, tumors, or other problems that can result dementia. A brain scan may also demonstrate cortical atrophy (the progressive loss of neurons causes the ridges to become thinner and the sulci to grow wider), which is the deterioration of the brain’s cortex (outer layer) and is frequent in many forms of dementia. Brain scans can also spot changes in the brain’s organization and function that would propose Alzheimer’s disease. •Computed Tomography Scan or Magnetic Resonance Imaging The most general types of brain scans are computed tomography (CT) scans and magnetic resonance imaging (MRI).
A CT scan of the brain frequently suggested in a patient with suspected dementia. These scans, which use x-rays to detect brain structures, can show evidence of: ?Brain atrophy ?Strokes and transient ischemic attacks (TIAs) ?Changes to the blood vessels ?Other problems (such as hydrocephalus and subdural hematomas). MRI scans use magnetic fields and focused radio waves to detect hydrogen atoms in tissues within the body. They can detect the same problems as CT scans but they are better for identifying certain conditions, such as brain atrophy and damage from small TIAs. •Electroencephalograms (EEGs)
Electroencephalograms (EEGs) are another tool to assist in inspecting people with suspected dementia. In an EEG, electrodes are placed on the scalp over several parts of the brain in order to detect and record patterns of electrical activity and to check for abnormalities. This electrical activity can indicate cognitive dysfunction in part or all of the brain. Many patients with moderately severe to severe Alzheimer’s disease have abnormal EEGs. An EEG may also be used to detect seizures, which occur in about 10 percent of people with Alzheimer’s disease. It can also help diagnose Creutzfeldt-Jakob disease. •Other Brain Scan Tests
Several other types of brain scans allow researchers to watch the brain as it functions. These scans, called functional brain imaging, are not often used as diagnostic tools, but they are important in research and they may ultimately help identify people with dementia earlier than is currently possible. Types of functional brain scans include: ?Functional MRI (fMRI): It uses radio waves and a strong magnetic field to measure the metabolic changes that take place in active parts of the brain. ?Single photon-emission computed tomography (SPECT): It shows the distribution of blood in the brain, which generally increases with brain activity. Positron emission tomography (PET): This scans can detect changes in glucose metabolism, oxygen metabolism, and blood flow, all of which can reveal abnormalities of brain function. ?Magneto encephalography (MEG): This can show the electromagnetic fields produced by the brain’s neuronal activity. •Laboratory Tests for Dementia Doctors may use a variety of laboratory tests to help diagnose dementia or rule out other conditions, such as kidney failure, which can contribute to symptoms. A partial list of these tests includes: ?A complete blood count (CBC) Blood glucose test, which measures sugar levels in the blood ? Urinalysis ?Drug and alcohol tests (toxicology screen) ?Cerebrospinal fluid analysis (to rule out specific infections that can affect the brain) ? Analysis of thyroid and thyroid-stimulating hormone levels. ?A doctor will order only the tests that he or she feels are necessary to improve the accuracy of a diagnosis. •Psychiatric Evaluation The healthcare provider may recommend a psychiatric evaluation to determine if depression or another psychiatric disorder may be causing or contributing to a person’s symptoms. Pre-Symptomatic Testing In most cases, testing people before symptoms begin in order to determine if they will develop dementia is not possible. However, in cases involving disorders such as Huntington’s where a known gene defect is clearly linked to the risk of the disease, a genetic test can help identify people who are likely to develop the disease. Since this type of genetic information can be devastating, people should carefully consider whether they want to undergo such testing. 2. 5Treatment
For about 10 percent of conditions that cause dementia, treatment is available that can help reverse or at least slow down its progression. Some examples of these treatable causes of dementia include: •A brain tumor •Normal pressure hydrocephalus •Hypothyroidism. For most cases, treatment does not exist to reverse or halt the disease’s progression; however, this does not mean that nothing should be done. People with dementia can benefit to some extent from such things as medications and cognitive training. There are also options for the family to help them cope. 2. 6Risk Factors
Scientists have found a number of risk factors for dementia that affect the likelihood of developing one or more kinds of dementia. While these are not causes of dementia, they may increase a person’s chances of developing the symptoms referred to collectively as dementia. Some dementia risk factors can be treated or controlled and some cannot Some of these risk factors for dementia are modifiable, while others are not.. Also, certain risk factors are more likely to increase the risk for certain types of dementia. For example, the risk of vascular dementia is strongly correlated with risk factors for stroke.
Finally, the more dementia risk factors you have, the greater your chances of having dementia. An example of risk factors for dementia that you cannot change involves getting older (the risk of dementia tends to increase with age). Other dementia risk factors you cannot control include having: •Age •A family history of dementia •Down syndrome •Mild cognitive impairment •History of a stroke. Dementia risk factors that you can control include: •Hypertension •hypercholesterolemia •Diabetes •Atherosclerosis •Smoking •Heavy alcohol use. •Homocysteine levels in the blood.
There are also things that can be controlled that increase your risk for developing diabetes, atherosclerosis, and other conditions that may increase your risk of developing dementia. These include: •Being overweight or obese •Lack of physical activity •Unhealthy diet. ?Age Age is the utmost risk aspect for dementia. Dementia influences one in 14 people over the age of 65 and one in six over the age of 80. However, Alzheimer’s is not limited to aged people: in the UK, there are 15,000 people under the age of 65 with dementia, although this figure is likely to be an underrated. ?Genetic inheritance
Several people fear that they may become heir to Alzheimer’s disease, and scientists are presently exploring the hereditary background to Alzheimer’s. In most of the cases, the effect of inheritance appears to be minute. If a parent or other family member has Alzheimer’s disease, probability of developing the disease is only a slight elevated than if there were no cases of Alzheimer’s in the direct family. ?Environmental factors The ecological factors that may add to the onset of Alzheimer’s disease have yet to be discovered. Not many years ago, there were concerns that revelation to aluminum might cause Alzheimer’s disease.
Nevertheless, these fears have largely been discounted. ?Other factors Because of the dissimilarity in their chromosomal structure, people with Down’s disorder who live into their 50s and 60s may develop Alzheimer’s disease. People who have had stern skull or whiplash wounds also come out to be at increased risk of developing dementia. Boxers who get frequent blows to the head are at risk too. Study has also revealed that people who smoke, and those who have elevated blood pressure or sky-scraping cholesterol levels, augment their risk of developing Alzheimer’s. 2. 7 Care of people with dementia
People with moderate and advanced dementia typically need round-the-clock care and supervision to prevent them from harming themselves or others. They may also need assistance with daily activities such as eating, bathing, and dressing. Meeting these needs requires patience, understanding, and careful thought from the person’s caregivers. For people involved with dementia care, there are some important things to consider. These include such things as: •Making the home safe •Helping to reduce stressors •Providing mental stimulation. Good dementia care always involves the issue of driving.
One of the hardest things to do is to take away a person’s independence that comes with driving. However, for a number of reasons that we will explain later, people with dementia should not drive. 2. 7. 1Dementia Care and the Home A typical home environment can present many dangers and obstacles to people with dementia, but simple changes can overcome many of these problems. For example, sharp knives, dangerous chemicals, tools, and other hazards should be removed or locked away. Other safety precautions include: •Installing bed and bathroom safety rails •Removing locks from bedroom and bathroom doors Lowering the hot water temperature to 120°F (48. 9°C) or less to reduce the risk of accidental scalding. People with dementia should also wear some form of identification at all times in case they wander away or become lost. Caregivers can help prevent unsupervised wandering by adding locks or alarms to outside doors. 2. 7. 2Reducing Stressors People with dementia often develop behavioral problems because of frustration with specific situations. Understanding and modifying or preventing the situations that trigger these behaviors may help to make life more pleasant for the person with dementia as well as his or her caregivers.
For instance, the person may be confused or frustrated by the level of activity or noise in the surrounding environment. Reducing unnecessary activity and noise (such as by limiting the number of visitors and turning off the television when it’s not in use) may make it easier for the person to understand requests and perform simple tasks. Caregivers may also reduce confusion in people with dementia by: •Simplifying home decorations •Removing clutter •Keeping familiar objects nearby •Following a predictable routine throughout the day. Calendars and clocks also may help patients orient themselves. . 7. 3Mental Stimulation as Part of Dementia Care Caregivers should encourage people with dementia to continue their normal leisure activities as long as they are safe and do not cause frustration. Activities such as crafts, games, and music can provide important mental stimulation and improve mood. Some studies have suggested that participating in exercise and intellectually stimulating activities may slow the decline of cognitive function in some people. 2. 7. 4Is Driving Safe? Many studies have found that driving is unsafe for people with dementia.
They often get lost and they may have problems remembering or following the rules of the road. They may also have difficulty processing information quickly and dealing with unexpected circumstances. Even a second of confusion while driving can lead to an accident. Driving with impaired cognitive functions can also endanger others. Some experts have suggested that regular screening for changes in cognition might help to reduce the number of driving accidents among elderly people, and some states now require that doctors report people with Alzheimer’s disease to their state motor vehicle department.
However, in many cases, it is up to the person’s family and friends to ensure that the person does not drive. 2. 7. 5How the local authority assesses need Local authority social services departments are the main providers of care and support services. If a person with dementia or their carer is in need of support, they should contact the local social services department to explain. The department will then carry out an assessment of the person’s needs and identify what services would be appropriate to meet those needs.
This is known as a community care assessment If the department assesses a person as being in need of certain services, it has a duty to provide the services that fall within their eligibility criteria (locally set rules on what type of needs the local authority will meet). The person may have to contribute towards the cost of these services. Local authorities can provide services directly themselves, or may make arrangements for private or voluntary-sector organizations to provide care on their behalf. Services ary from area to area, but range from those that allow someone to remain independent in their own home (such as meals on wheels, day care, equipment and home adaptations) to residential care. The views and preferences of the person receiving the service should always be taken into account. 2. 7. 6Care plans If, after assessing the person’s care needs, the social services department agrees that certain services should be provided, it will give the person a written care plan outlining these services. This applies whether the person lives at home or in a care home.
Care plans should be reviewed regularly and as needs change. If a review has not been carried out recently, or if one may be necessary, the person or their carer should contact social services and ask for a review. In addition, care homes must provide an individual care plan for each resident. This must be regularly reviewed to take account of changing needs. 2. 7. 7Thinking through the options Once the social services department has confirmed what services the person is eligible to receive, the person and their carer can begin to think through the options.
Even if the assessment concludes that the person’s needs are not yet urgent enough to receive help from social services, or if some services are not available under the local authority’s eligibility criteria, an assessment will give everyone clearer information about the situation and the kinds of help available from other sources. The person or their family or carer could arrange services themselves, or through a voluntary organization or private agency. A key decision is whether the person can remain in their own home, or whether they would prefer to move into sheltered housing or a care home.
If they stay in their own home, there are many additional support options available. It is also important to consider the financial implications of the options available. Social services should be able to give an idea of how much the person will have to pay towards the costs of the various services that are arranged through them. Services provided by the NHS, such as community nursing, are free. Anyone who is arranging services themselves, whether through a voluntary organisation or a private agency, will need to make their own enquiries. It is important not to rush into a decision.
It might help to also talk to friends and relatives, other carers and your local Alzheimer’s Society branch. Local voluntary organisations are a source of further information, advice and practical help. Below is some guidance about what to consider when you are thinking about the kind of care the person in question needs. 2. 7. 8Understanding and respecting the person with dementia It’s very important that people with dementia are treated with respect. It is important to remember that a person with dementia is still a unique and valuable human being, despite their illness.
If you can understand what the person is going through, it might be easier for you to realise why they behave in certain ways. When a person with dementia finds that their mental abilities are declining, they often feel vulnerable and in need of reassurance and support. The people closest to them – including their carers, health and social care professionals, friends and family – need to do everything they can to help the person to retain their sense of identity and feelings of self-worth. 2. 7. 9Helping the person feel valued
The person with dementia needs to feel respected and valued for who they are now, as well as for who they were in the past. There are many things that the people around them can do to help, including: •trying to be flexible and tolerant •making time to listen, have regular chats, and enjoy being with the person •showing affection in a way they both feel comfortable with •finding things to do together. Our sense of who we are is closely connected to the names we call ourselves. It’s important that people address the person with dementia in a way that the person recognises and prefers. Some people may be happy for anybody to call them by their first name or nickname. •Others may prefer younger people, or those who do not know them very well, to address them formally and to use courtesy titles, such as Mr or Mrs. Make sure you explain the person’s cultural or religious background, and any rules and customs, to anyone from a different background so that they can behave accordingly. These may include: •respectful forms of address •what they can eat •religious observances, such as prayer and festivals particular clothing or jewellery that the person (or those in their presence) should or should not wear •any forms of touch or gestures that are considered disrespectful •ways of undressing •ways of dressing the hair •how the person washes or uses the toilet. Many people with dementia have a fragile sense of self-worth; it’s especially important that people continue to treat them with courtesy, however advanced their dementia. •Be kind and reassuring to the person you’re caring for without talking down to them. •Never talk over their head as if they are not there – especially if you’re talking about them.
Include them in conversations. •Avoid scolding or criticising them – this will make them feel small. •Look for the meaning behind their words, even if they don’t seem to be making much sense. Whatever the detail of what they are saying, the person is usually trying to communicate how they feel. •Try to imagine how you would like to be spoken to if you were in their position. •Try to make sure that the person’s right to privacy is respected. •Suggest to other people that they should always knock on the person’s bedroom door before entering. If the person needs help with intimate personal activities, such as washing or using the toilet, do this sensitively and make sure the door is kept closed if other people are around. •Everyone involved – including the person’s friends, family members, carers, and the person with dementia themselves – reacts to the experience of dementia in their own way. Dementia means different things to different people. There are lots of things you can do to help the person with dementia feel good about themselves. This factsheet offers some suggestions.
When you spend time with someone with dementia, it is important to take account of their abilities, interests and preferences. These may change as the dementia progresses. It’s not always easy, but try to respond flexibly and sensitively. Dementia affects people’s thinking, reasoning and memory, but the person’s feelings remain intact. A person with dementia will probably be sad or upset at times. In the earlier stages, the person may want to talk about their anxieties and the problems they are experiencing. •Try to understand how the person feels. Make time to offer them support, rather than ignoring them or ‘jollying them along’. •Don’t brush their worries aside, however painful they may be, or however insignificant they may seem. Listen, and show the person that you are there for them. •Make sure that, whenever possible, you inform and consult the person about matters that concern them. Give them every opportunity to make their own choices. •Always explain what you are doing and why. You may be able to judge the person’s reaction from their expression and body language. •People with dementia can find choice confusing, so keep it simple.
Phrase questions so that they only need a ‘yes’ or ‘no’ answer, such as ‘Would you like to wear your blue jumper today? ‘ rather than ‘Which jumper would you like to wear today? ‘ •Avoid situations in which the person is bound to fail, as this can be humiliating. Look for tasks that they can still manage and activities they enjoy. ive plenty of encouragement. Let them do things at their own pace and in their own way. •Do things with the person, rather than for them, to help them retain their independence. •Break activities down into small steps so that they feel a sense of achievement, even if they can only manage part of a task. Our self-respect is often bound up with the way we look. Encourage the person to take pride in their appearance, and compliment them on how they look. Make sure that anyone involved in caring for the person has as much background information as possible, as well as information about their present situation. This will help them see the person they’re caring for as a whole person rather than simply ‘someone with dementia’. It may also help them to feel more confident about finding conversation topics or suggesting activities that the person may enjoy. 2. 8How effective is heath care management?
Health care management involves several techniques to cater the needs of the patient. It should be kept in mind that patient is not responsible for the disease and therefore should not be ignored or avoided. With the advancement in technology, different techniques can be used to look after the suffer of this disorder. However, these techniques and ways could only help the victim survive a bit since. Those kinds of dementia which are treatable and such patients have a different perspective and outlook of life as compared to those who are the victims of the untreatable ones.
So the care also varies with these two kinds of patients. Effectiveness of the present day health care management system is satisfactory but as said earlier it cannot bring back the life of the victim, however could let him or her survive for few more days with a happy face. 3. DEMENTIA IN UK Following statistics give a clear cut idea about the ratio and proportion of dementia patients in UK: •There are currently 700,000 people with dementia in the UK. •There are currently 15,000 younger people with dementia in the UK. •There are over 11,500 people with dementia from black and minority ethnic groups in the UK. There will be over a million people with dementia by 2025. •Two thirds of people with dementia are women. •The proportion of people with dementia doubles for every 5 year age group. •One third of people over 95 have dementia. •60,000 deaths a year are directly attributable to dementia. •Delaying the onset of dementia by 5 years would reduce deaths directly attributable to dementia by 30,000 a year. •The financial cost of dementia to the UK is over ? 17 billion a year. •Family carers of people with dementia save the UK over ? 6 billion a year. •64% of people living in care homes have a form of dementia. Two thirds of people with dementia live in the community while one third live in a care home. 4. LIVING WITH DEMENTIA People with dementia have become increasingly involved in the work of the Alzheimer’s Society since 2000. Through a national programme called ‘Living with Dementia’, people with dementia have been sharing their experiences and knowledge, and raising awareness of dementia at local and national levels. This contribution is crucial to ensure that the Alzheimer’s Society develops appropriate information and support for people with dementia. It ensures that people with dementia can influence the work that the Society carries ut on their behalf. On a national level the Living with Dementia programme consults with people with dementia in support of the Alzheimer’s Society’s work of influencing government policy. •People with dementia in action People with dementia are involved in the Alzheimer’s Society in a variety of ways: ? Giving presentations and raising public awareness. ?Organising the unique UK wide convention of people with dementia. ?Lobbying MPs and commenting on government legislation. ?Being interviewed by national press and television. ?Recruiting and inducting new staff at the Alzheimer’s Society. ?Helping to make the website easier to use. Developing information for other people with dementia and their families. ?Participating in the national consultative body, the Living with Dementia Working group. These are just a few examples. There are many opportunities in the Living with Dementia programme •Living with Dementia Programme Various initiatives in the Alzheimer’s Society have focused on ways of supporting people living with dementia. Many started as two year pilots in 2001 and 2002, but are now established as a core part of the Alzheimer’s Society activity. Examples of current initiatives are listed below: •West Kent Computer project
Started in 2001. It supports people with dementia using computer equipment, to find new ways of communicating, pursuing interests and have fun. •Living with Dementia presentation skills training For people with dementia. Everyone affected by dementia has their own unique story to tell. Personal experiences and views are a powerful way of raising awareness about dementia, making issues come alive. Training people with dementia to share their experience on TV, press and at meetings, helps to reduce the misunderstanding that surrounds dementia and offers hope to people facing the same situation.
Providing key skills enables people to undertake publicity work with confidence. •Helpcard for people with dementia Developed in 2007 by people with dementia and piloted by people with dementia. The helpcard enables people with dementia to feel confident, not alone and able to ask for help at anytime. It is very useful in emergency situations, and is an effective communication tool that informs others of a person’s circumstances. There are three different designs, with three different options for describing particular situations. •National conference for people with dementia
The Alzheimer’s Society has hosted three conferences for people with dementia in London, Newcastle and Birmingham (Thompson, Nanni & Schwankovsky, 1990). The latter two involved members from the Living with Dementia Working group and the Scottish Dementia Working Group, making them the only UK wide events for people with dementia. In Newcastle the ‘Improving Our Lives’ feedback included: ?Get out and enjoy life ?Laugh! Confidence ?Remaining the same person after diagnosis ?Open positive communication ?Speak up – have your voice listened to ?Speak to your MP Being denied treatment – medication because of a ‘cost cutting’ exercise – it’s a disgrace ? Set up an email group ?Done more since having dementia – living my life to the full 5. RESEARCHES Currently, scientists are conducting research on many different aspects of dementia. This research promises to improve the lives of people affected by such symptoms and may eventually lead to ways of preventing or curing the disorders that result in dementia. Some areas of focus for dementia research include: •Causes and prevention •Diagnosis •Treatment. Researching the Causes and Prevention of Dementia
Research on the causes of Alzheimer’s disease (and other disorders that are causes of dementia) includes studies of: •Genetic factors •Neurotransmitters •Inflammation •Factors that influence programmed cell death in the brain •The roles of tau, beta amyloid, and the associated neurofibrillary tangles and plaques in Alzheimer’s disease. Some other dementia research scientists are trying to determine the possible roles of cholesterol metabolism, oxidative stress (chemical reactions that can damage proteins, DNA, and lipids inside cells), and microglia in the development of Alzheimer’s disease.
Current research on dementia prevention and causes includes the following: •Research to better understand the role of aging-related proteins (such as the enzyme telomerase) in the development of dementia. •Studies of abnormal clumps of proteins in cells. Researchers are trying to learn how abnormal clumps of protein in cells develop, how they affect cells, and how the clumping can be prevented. •Studies that examine whether changes in white matter — nerve fibers lined with myelin — may play a role in the onset of Alzheimer’s disease.
Myelin may erode in Alzheimer’s disease patients before other changes occur. This may be due to a problem with oligodendrocytes, the cells that produce myelin. •Work being done by scientists to search for additional genes that may contribute to Alzheimer’s disease. These researchers have identified a number of gene regions that may be involved in the development of Alzheimer’s. Some researchers suggest that people will eventually be screened for a number of genes that contribute to Alzheimer’s disease and that they will be able to receive treatments that specifically address their individual genetic risks.
However, such individualized screening and treatment is still years away. •Studies on insulin resistance. Insulin resistance is common in people with Alzheimer’s disease, but it is not clear whether the insulin resistance contributes to the development of the disease or if it is merely a side effect. •Several dementia research studies have found a reduced risk of dementia in people who take cholesterol-lowering drugs called statins. However, it is not yet clear if the apparent effect is due to the drugs or to other factors.
Therefore, more research is being currently being done be better understand this possible relationship between statins and dementia. • A 2003 dementia research study found that people with HIV-associated dementia have different levels of activity for more than 30 different proteins, compared to people who have HIV but no signs of dementia. The study suggests a possible way to screen HIV patients for the first signs of cognitive impairment, and it may lead to ways of intervening to prevent this form of dementia. Research in this area continues. Research Involving Diagnosis of Alzheimer’s Disease Improving early diagnosis of Alzheimer’s disease and other disorders that may cause dementia is important not only for patients and families, but also for researchers who seek to better understand the causes of dementia and find ways to reverse or halt them at early stages. Improved diagnosis can also reduce the risk that people will receive inappropriate treatments. •In some research, scientists are investigating whether three-dimensional computer models of positron emission tomography (PET) and magnetic resonance imaging (MRI) can identify brain changes typical of early Alzheimer’s disease, before any symptoms appear.
This research may lead to ways of preventing the symptoms of Alzheimer’s disease. •One study found that levels of beta amyloid and tau in spinal fluid could be used to diagnose Alzheimer’s disease with an accuracy of 92 percent. If other studies confirm the validity of this test, it may allow doctors to identify people who are beginning to develop the disorder before they start to show dementia symptoms. •This would allow treatment at very early stages of the disorder, and may help in testing new treatments to prevent or delay symptoms of the disease.
Other researchers have identified factors in the skin and blood of Alzheimer’s disease patients that are different from those in healthy people. They are trying to determine if these factors can be used to diagnose the disease. Treatment Research •Researchers are continually working to develop new drugs for Alzheimer’s disease and other causes of dementia. Many researchers believe a vaccine that reduces the number of amyloid plaques in the brain might ultimately prove to be the most effective treatment for Alzheimer’s disease. In 2001, researchers began one clinical trial of a vaccine called AN-1792. The research study was halted after a number of people developed inflammation of the brain and spinal cord. •Despite these problems, one patient appeared to have reduced numbers of amyloid plaques in the brain. Other patients showed little or no cognitive decline during the course of the study, suggesting that the vaccine may slow or halt the disease. Researchers are now trying to find safer and more effective vaccines for Alzheimer’s disease. Researchers are also investigating possible methods of gene therapy for Alzheimer’s disease. In one case, researchers used cells genetically engineered to produce nerve growth factor and transplanted them into monkeys’ forebrains. The transplanted cells boosted the amount of nerve growth factors in the brain and seemed to prevent degeneration of acetylcholine-producing neurons in the animals. •This suggests that gene therapy might help to reduce or delay symptoms of the disease. Researchers are now testing a similar therapy in a small number of patients. Other researchers have experimented with gene therapy that adds a gene called neprilysin in a mouse model that produces human beta amyloid. They found that increasing the level of neprilysin greatly reduced the amount of beta amyloid in the mice and halted the amyloid-related brain degeneration. They are now trying to determine whether neprilysin gene therapy can improve cognition in mice. •Since many studies have found evidence of brain inflammation in people with Alzheimer’s disease, some researchers have proposed that drugs that control inflammation, such as NSAIDs, might prevent the disease or slow its progression.
Studies in mice have suggested that these drugs can limit production of amyloid plaques in the brain. Early studies of these drugs in humans have shown promising results. •However, a large NIH-funded clinical trial of two NSAIDs (naproxen and celecoxib) to prevent Alzheimer’s disease was stopped in late 2004 because of an increase in stroke and heart attack in people taking naproxen (Aleve®, Naprosyn®, Anaprox®, Naprelan®), and an unrelated study that linked celecoxib (Celebrex®) to an increased risk of heart attack. Some research studies on dementia have suggested that two drugs, pentoxifylline and propentofylline, may be useful in treating vascular dementia. Pentoxifylline improves blood flow, while propentofylline appears to interfere with some of the processes that cause cell death in the brain. •One research study is testing the safety and effectiveness of donepezil (Aricept®) for treating mild dementia in patients with Parkinson’s dementia, while another is investigating whether skin patches with the drug selegiline can improve mental function in patients with cognitive problems related to HIV. . CONCLUSION An appropriate cost effective workup of dementia includes a complete history, a complete physical examination (including a neuropsychiatric evaluation), a CBC, blood glucose, serum electrolytes, serum calcium, serum creatinine, and serum thyroid stimulating hormone (Whitlatch, Feinberg & Tucke, 2005). Other tests should be done only if there is a specific indication for e. g. vitamin B12 and folate if macrocytosis is present (Wilkinson & Lennox, 2005).
A CT or MRI should be considered if the onset of dementia is before the age of 65 years, symptoms have occurred for less than 2 years, there is evidence of focal or asymmetrical neurological deficits, the clinical picture indicates normal pressure hydrocephalus, or there is a recent history of fall or other head trauma. If a patient has a history of cancer or is on anticoagulation therapy, then neuro imaging should also be considered. Thus to conclude, it is sufficient to say that dementia, though a dangerous disorder, having not much cures, can be prevented by undergoing certain precautionary measures as illustrated above.
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