Dementia is an umbrella term for several diseases affecting memory, other cognitive abilities, and behavior that interfere significantly with someone’s ability to maintain their activities of daily living. These functions include memory, language skills, visual perception, problem-solving, self-management, and the ability to focus and pay attention. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of living. Although age is the most known risk factor for dementia, it is not a normal part of aging.
Fifty million people worldwide currently live with dementia, a condition that causes significant psychological burden as well as social and financial distress to those living with it, their carers, and families. There are nearly 10 million new cases every year. Two in three people with dementia live in low- and middle-income countries.
There is often a lack of awareness and understanding of dementia, resulting in stigmatization and barriers to diagnosis and care. The impact of dementia on carers, family, and society at large can be physical, psychological, social, and economical.
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 60–70% of cases. Other major forms include vascular dementia, dementia with Lewy bodies (abnormal aggregates of protein that develop inside nerve cells), and a group of diseases that contribute to frontotemporal dementia (degeneration of the frontal lobe of the brain). The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
There is no treatment currently available to cure dementia or to alter its progressive course. Numerous new treatments are being investigated in various stages of clinical trials. The principal goals for dementia care are:
1.Early diagnosis to promote early and optimal management
The early stage of dementia is often overlooked, because the onset is gradual. Common symptoms include: forgetfulness, losing track of the time and becoming lost in familiar places.
2.Optimizing physical health, cognition, activity and well-being
As dementia progresses to the middle stage, the signs and symptoms become clearer and more restricting. These include:
- becoming forgetful of recent events and people’s names
- becoming lost at home
- having increasing difficulty with communication
- needing help with personal care
- experiencing behaviour changes, including wandering and repeated questioning.
3.Identifying and treating accompanying physical illness
The late stage of dementia is one of near total dependence and inactivity. Memory disturbances are serious and the physical signs and symptoms become more obvious. Symptoms include:
- becoming unaware of the time and place
- having difficulty recognizing relatives and friends
- having an increasing need for assisted self-care
- having difficulty walking
- experiencing behaviour changes that may escalate and include aggression.
4.Detecting and treating challenging behavioural and psychological symptoms
The following are used to temporarily improve dementia symptoms.
- Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.
- Side effects can include nausea, vomiting and diarrhea. Other possible side effects include slowed heart rate, fainting and sleep disturbances.
- Memantine. Memantine (Namenda) works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory. In some cases, memantine is prescribed with a cholinesterase inhibitor.
- A common side effect of memantine is dizziness.
- Other medications. Your doctor might prescribe medications to treat other symptoms or conditions, such as depression, sleep disturbances, hallucinations, parkinsonism or agitation.
Several dementia symptoms and behavior problems might be treated initially using non drug approaches, such as:
- Occupational therapy. An occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior; and prepare you for the dementia progression.
- Modifying the environment. Reducing clutter and noise can make it easier for someone with dementia to focus and function. You might need to hide objects that can threaten safety, such as knives and car keys. Monitoring systems can alert you if the person with dementia wanders.
- Simplifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine also help reduce confusion in people with dementia.
5.Providing information and long-term support to carers.
Dementia symptoms and behavior problems will progress over time. Caregivers might try the following suggestions:
· Enhance communication
· Encourage exercise
· Engage in activity
· Establish a nighttime ritual
· Keep a calendar
· Plan for the future
· Learn as much as you can about memory loss and dementia.
World Alzheimer’s Month is the international campaign to raise awareness about dementia. September 2020 will mark the 9th World Alzheimer’s Month.