What is dementia?

Dementia is a progressive disease that causes loss of cognitive function to such an extent that it interferes in your day-to-day functioning, sometimes even accompanied by a change in personality. Cognitive function refers to your mental skills that deal with acquiring information, retaining it, and developing and transforming it. They include:

• Attention
• Memory
• Language
• Perception
• Decision making
• Problem-solving

How is aging different from dementia?

Dementia is not a normal part of aging. People can live up to 90 years and beyond without any signs of dementia. Mild changes in cognition are part of the aging process. They are slow and generally affect the speed of thinking. A person is diagnosed with dementia by a physician when he has a significant decline in cognitive function that starts to affect his daily life, such as paying bills, driving safely, managing medications, losing interest in work, and so on. Added to the complexity is that symptoms vary from person to person, and it is indeed challenging even for a physician to define the line of “significant decline” for a patient that determines whether he has dementia or not.

What is the cause of dementia?

The brain is a complex network of neurons or nerve cells that continuously transmit information to each other and muscles and gland cells. These interconnected nerve cells contribute to the structure and function of the brain. At the cellular level, dementia results when nerve cells lose function and they ultimately die, causing a shrinkage at that part of the brain.
Dementia could be the manifestation of various diseases, some are progressive diseases, and some can be reversed.

The most common causes of dementia are:

• Alzheimer’s disease
• Vascular dementia
• Mixed dementia
• Lewy body dementia
• Frontotemporal dementia

How is dementia diagnosed?

Family physicians are the best people to detect changes in thinking and behavior that might indicate dementia when reported by the individual or family members. There is no single test to establish whether a person has dementia or not. Your family medicine physician will carry out a physical examination and several laboratories and diagnostic tests to check if there is an underlying condition that could be causing these symptoms and whether it can be treated.

These could be conditions that can be reversed with appropriate treatment, such as:

• Thyroid problems
• Vitamin Deficiencies
• Alcohol consumption
• Medication side effects
• Sleep apnea
• Depression

The family medicine physician will make a thorough study of the past medical history and family history to study the risk factors that the person has for dementia. He will also study the psychiatric history and history of cognitive and behavioral changes.

Physicians would also conduct:

• Neurological exam: To check for balance, sensory function, reflexes, and other functions related to the brain
• Neuropsychological exam: These are sensitive tests conducted by a neuropsychologist and helps identify areas of the brain which are functioning well and which ones are doing poorly
• Mental cognitive status tests: These are screening tests that will assess your cognitive functions. They are vital in diagnosing dementia and can give information on the different types of dementia. They can also determine mood and diagnose depression.
• Structural brain imaging such as MRI and CT: These brain imaging techniques show brain changes and can rule out conditions such as strokes, tumors, and hydrocephalus or fluid in the brain.

Thus, after studying the clinical picture and the results of the above investigations, the physician would decide whether a person should be given the diagnosis of dementia or not.

How do you treat dementia?

There is no cure for dementia. Some medications like Aricept and Namenda are used to reduce symptoms in patients with mild to moderate dementia.
Physicians may also prescribe other medications to treat problems brought on by dementia, such as depression, trouble sleeping, and irritability.
Therapies such as reminiscence therapy, validation therapy, music therapy have been used to increase the well-being of a person who has dementia.

How do you take care of people with dementia?

Early stages: Each person with dementia experiences different symptoms and has a different progression curve for these symptoms.

• You are the best person to tailor care according to your family member’s needs. Giving instructions one at a time, keeping a daily schedule, being patient as they get on with a task could all go towards supporting the patient calm and less frustrated. Your loved ones may not need much caregiving assistance in the early stages. Your role would be to provide an environment that would allow your loved one to accept the diagnosis and stay as active and healthy as possible.
• Physical activity such as walking, dancing, and gardening will slow down dementia symptoms and ease anxiety and depression.
• A well-balanced, nutritious diet is vital for overall health, and what your loved one eats will affect their brain too. Some studies have shown that diets such as the Mediterranean diet, which include high amounts of fruits, vegetables, whole grains, legumes, fish, and other seafood, and unsaturated fats such as olive oils and low amounts of red meat, eggs, and sweets have shown a slower rate of cognitive decline.
• Keeping your loved one’s mood and thoughts cheerful by getting them to pursue some hobby, taking them to meet family members and friends, listening to music, etc., could go a long way in keeping them alert and social.
• You could also organize your home to suit their needs by keeping a calendar with day-to-day events; keeping medicines in a pillbox; and removing items that create noise, such as TV and radio.
• Safety is an essential issue while living with people who have dementia. Keeping dangerous articles such as knives and scissors out of reach, check if doors are locked, checking water temperature to avoid burns, and keeping lighters and matchsticks at safe places are things that have to be paid attention to.

Later stages:

The later stages are much more difficult for the family and the patient. Most people with dementia need total care at the end and are usually transferred to a facility. However, some people care for their family members at home with a lot of support from those around them. One of the most disturbing times for the family could be when the family member has progressive memory loss and cannot recognize close family members. They may even have difficulty understanding what is said to them. At such times, it is important to keep communicating with them, as they still have the ability to understand emotions such as kindness and love.

A patient with late dementia could have:

• Difficulty swallowing
• Need assistance to walk
• Need full-time help with personal care

Adapting to foods that can be swallowed easily, maintaining bowel and bladder function, skin health, keeping good dental health, and coping with pain are some of the challenges that will have to be faced. This can be very demanding and time-consuming, but your caregiving and support could make the most significant difference to your loved one at this stage. At such times, you can express your caring by playing their favorite music, bringing them flowers, reading to them, sitting and talking with them even if they find it difficult to respond.

One must keep in mind that caregiving in the later stages could put your own health and emotional well-being at risk, and hence it is necessary to share the burden. You could use professional help or support from family, friends, and local and community groups. The ultimate aim would be to provide support and care while maintaining the dignity of the patient and not letting the caring neglect your health and your needs.

Dementia is a term used to describe cognitive deteriorations that interfere with the ability to perform activities of daily living. Dementia is not a part of the normal aging process, and many people live beyond their 80s and 90s without any dementia. However, age is a significant risk factor for dementia, and it is generally seen in the older population. Caring for patients with dementia is difficult and very demanding. However, a dedicated caregiver plays a significant part in the treatment plan. The later stages of dementia require intensive care, where the caregiver focuses on the patient’s quality of life and dignity. Caregiving could also affect the physical and mental well-being of the caregiver. Hence, the caregiving burden should be shared such that both can cope with the fallouts of the disease.

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