Dementia is a disorder in which major deterioration in several cognitive functions from the patient’s previous intellectual level occur. The Australian government announced dementia as a health priority in 2005 with about 250,000 Australians suffering from this disease, and expectations of the patient count in Australia to rise to over 730,000 by 2050.
The likelihood of suffering from dementia doubles every five years after the individual reaches 65 years of age. Individuals over 85 years have a one in four chance to have dementia. Patients under 65 years can suffer from Younger Onset Dementia (YOD). This disease affects 9,600 patients in Australia, and the number of patients I expected to rise to 14,220 patients by 2020. The likelihood of dementia affecting younger patients is still significantly lower than it is for older patients, however.
- 1% of individuals below 64 years may develop dementia
- 1.5% of individuals in the age group of 65-74 may develop dementia
- 6.3% of individuals in the age group of 75-84 may develop dementia
- 30% of individuals over 85 years my develop dementia
The most essential characteristic feature of dementia and the most prominent of dementia symptoms is impaired memory according to the American Psychiatric Association. This feature is associated with one of more of these cognitive disturbances:
- Agnosia: Inability to identify objects although sensory functions are intact
- Apraxia: Weakened abilities to perform motor activities although motor functions are intact
- Aphasia: language disturbances
- Problems in executive functioning such as organising, planning, sequencing and abstracting
The disturbance is severe enough to interfere with work and school, usual social activities, and relationships with others. The diagnosis of dementia is not made if these symptoms occur only in the presence of reduced ability to maintain or shift attention to external stimuli, as in delirium; however, delirium and dementia may coexist.
Causes of dementia:
Although dementia is found predominantly in the elderly, some neuropsychiatric disorders such as traumatic brain injury or degenerative brain disorders may cause dementia in childhood and adolescence. The diagnosis of dementia may be made at any time after the IQ is fairly stable (usually by age 4 to 6 years).
Alzheimer’s type dementia is the most common type of dementia, comprising 50-60% of all cases. Vascular dementia is the second most common cause of dementia, accounting for 13% of all cases. Examples of medical conditions that may induce dementia in children or adolescents would include:
- Head injury
- Brain tumours
- Human immunodeficiency
- Virus infection
- Cerebrovascular accidents
- Huntington’s disease
- Creutzfeldt-Jakob disease
- Drug abuse
Clinical evaluation of dementia
- All patients presenting with cognitive deficits should be evaluated to determine the aetiology of the dementia. Some causes of dementia are treatable and reversible.
- A complete medical, psychiatric history and physical examinations are performed. Full psychiatric assessment, with neurological examination should be done.
- Differentiation of dementia from depression can be very difficult in the elderly. When the diagnosis is unclear, a trial of antidepressants may be useful because depression is reversible and dementia is not.
Stages of dementia
- No cognitive impairment: At this stage, there aren’t any memory problems. The disorder cannot be diagnosed at this stage.
- Very mild cognitive decline: Here, some memory loss which can be related to age takes place. This stage is also difficult to be diagnosed
- Mild cognitive decline: Memory loss starts to show more prominently. The patient starts to forget names or words. In this stage, the patient’s work performance is usually affected, and the memory decline can be observed by the patient’s family or by the physician.
- Moderate cognitive decline: A lot of cognitive problems are diagnosed during this stage, especially impaired abilities to plan or concentrate. This, beside the memory loss usually results in social withdrawal.
- Moderately severe cognitive decline: The patient’s memory loss increases and s/he becomes unable to recall his/her own address or phone number. At this stage, the patient needs assistance to compete daily activities.
- Severe cognitive decline (Middle Dementia): The memory loss continues to worsen, and incontinence problem becomes an issue at this stage. Personality changes along with psychological disorders like anxietyand compulsion may appear at this stage.
- Very Severe Cognitive Decline (Late Dementia): The patient loses communication with surroundings, and s/he loses his/her psychomotor abilities.
Treatment of dementia
- The mode of onset, subsequent course, and clinical management of dementia depend substantially on the underlying aetiology. The use of CNS depressants should be minimized. Patients function best if highly stimulating environments are avoided.
- The carer for dementia patients and/or family members should receive psychological support. Support groups, psychotherapy, and day-care centres are helpful.
- Improving the performance of cognitive functioning by practicing some tasks such as memory aids can enhance dementia patients’ the quality of life.
- Dangerous behaviour by dementia patients can be controlled using behaviour modification methods such as rewarding and ignoring behaviour.
Discussing treatment options with your doctor is essential. Although medical treatment can’t reverse dementia in most cases, some dementia forms can be treated, especially if caught at an early stage. When reversing the disorder’s symptoms is not possible, medications can help to slow its progression. Your doctor may recommend other treatment methods in addition to medications such as memory aids like notes and mnemonics.
Counselling is not only recommended for dementia patients; a carer for the dementia patient and his/her family are usually in need of support. If you are a family member or a carer for a dementia patient, you may find it helpful to discuss the situation with a professional counsellor or psychologist to get an idea of the kind of help you are expected to provide, the patient’s treatment options, and what to expect from these treatment methods.
If you are a carer for someone with declining mental health or dementia, Australia Counselling can link you with counsellors, psychologists and psychotherapists who provide support for this distressing condition. Search the Family Caregiver Stress page or search for a counsellor or psychotherapist in your local area by location or therapeutic approach.
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