Dementia and Alzheimer's

Dementia is a term used to describe the symptoms for a large group of illnesses; there are, in fact, over 100 conditions that can cause it. It is estimated that more than 56,000 new cases of dementia will be diagnosed this year.

Dementia has been used to describe loss of memory, intellect, rationality, social skills and normal emotional reactions. The most common symptoms include confusion, personality change, apathy, withdrawal and loss of ability to do everyday tasks.

Most people develop symptoms gradually over a period of years. The progression is largely unpredictable and what symptoms develop depend on which part of the brain is affected. This can lead to people failing to recognise that something is wrong - they often mistakenly assume their behaviour is a normal part of the ageing process. Sometimes people refuse to seek help even when they know something is wrong.

Dementia rarely affects people under the age of 65. Currently, there are just 9600 younger Australia who suffer dementia. About one in 15 Australians aged over 65, however, suffer moderate to severe dementia. By the time we reach 80 to 84, the rate is one in nine; above 85, this falls to one in four. Dementia is indeed the second largest cause of ‘disability burden' after depression, and by 2015 it is expected to become the largest cause of this in our community.

Dementia is the fourth leading cause of death in older people, and affects more women than men. A person with dementia will live for an average of four to eight years, depending on their age at diagnosis. Dementia is also a major determining factor in the entry to residential care - at least 60 of people in high care and 30 percent of people in low care facilities have dementia.

Don't just assume it is dementia

It is important to remember that many conditions have similar symptoms to dementia, so do not assume that someone has dementia just because some of the symptoms are present. Other causes could include strokes, depression, alcoholism, infections, hormone disorders, nutritional deficiencies and brain tumours; they all have dementia-like symptoms and many of them can be treated.

Consulting a doctor at an early stage is critical

A complete medical and psychological assessment may either identify a condition and ensure that it is treated correctly, or confirm the presence of dementia. A medical assessment may include:

A detailed medical history, provided if possible, by the person with the symptoms as well as a close relative or friend. This helps to establish whether there has been a slow or sudden onset of symptoms and their progression.

A thorough physical and neurological examination, including tests of the senses and movement function to rule out other conditions, and to identify any medical conditions which may worsen the confusion associated
with dementia.

Laboratory tests, including a variety of blood and urine tests to identify any possible illness which could be responsible for the symptoms.

Neurophysiological testing to identify retained abilities and specific problem areas such as comprehension, insight and judgement.

Other specialist tests such as x-rays, ECGs or CT scans.

A mental status test to check the range of intellectual functions such as memory, the ability to read, write and calculate which may be affected by dementia.

Psychiatric assessment to identify treatable disorders such as depression which can mimic dementia and to manage any psychiatric symptoms such as anxiety or delusions which may occur alongside dementia.

Is that dementia? 10 warning signs to look for

The Alzheimer's Association New South Wales provides a checklist of common symptoms for dementia. To help you know the warning signs to look for, we have edited their list of symptoms to check. If you make several check marks, the individual with the symptoms should see a doctor for a complete examination.

1. Memory loss that affects day-to-day function: It's normal to occasionally forget appointments or a friend's phone number and remember them later. A person with dementia may forget things more often or not remember them at all.
2. Difficulty performing familiar tasks: People can get distracted from time to time and they may forget to serve part of the meal. A person with dementia may have trouble with all the steps involved in preparing a meal,or forget that they made it.
3. Problems with language: Everyone has trouble finding the right words sometimes, but a person with dementia may forget simple words or substitute inappropriate words, making sentences difficult to understand.
4. Confusion about time and place: It's normal to forget the day of the week - or your destination for a moment. A person with dementia may have difficulty finding their way to a familiar place, or feel confused about where they are.
5. Problems with abstract thinking: Balancing a chequebook may be disconcerting when the task is more complicated than usual. Someone with dementia could forget completely what the numbers are and what needs to be done with them.
6. Poor or decreased judgement: A person with dementia can become so immersed in an activity they can temporarily forget a child they are watching. They may also dress inappropriately, wearing several shirts or blouses.
7. Misplacing things: Anyone can temporarily misplace a wallet or keys. A person with dementia may place things in an inappropriate place, i.e. an iron in the freezer or a wristwatch in the sugar bowl.
8. Changes in mood or behaviour: Everyone becomes sad or moody from time to time. Someone with dementia can exhibit rapid mood swings - from calm to tears to anger - for no apparent reason.
9. Changes in personality: People's personalities ordinarily change somewhat with age. A person with dementia can become suspicious or fearful or just flat, apathetic and uncommunicative
10. Loss of initiative: It is normal to tire of housework, business activities or social obligations. The personwith dementia may become very passive and require cues prompting him or her to become involved, even in previously enjoyed activities.

The first step

The best place to start the diagnostic process is with your doctor, though some may resist the idea. Some people do not realise or simply deny there is anything wrong with them. This can be due to the brain changes of dementia that interfere with the ability to recognise and appreciate one's memory problems. Others may be afraid of having their fears confirmed.

One of the most effective ways to overcome this problem is to find another reason to visit the doctor. Perhaps suggest an examination of the heart, a blood pressure check or a review of long-term medication. Another way is to suggest it is time for both of you to have a physical checkup. Be sure to provide a lot of reassurance - a calm, caring attitude at this time can help overcome the person's worries and fears. If the person still will not visit the doctor, talk with other families and carers who may have had to deal with similar situations or contact the aged care assessment team (ACAT). Alternatively, you can call the National Dementia Helpline on 1800 100 500 or visit www.alzheimers.org.au

Alzheimer's Disease

Alzheimer's disease is the most common form of dementia, accounting for between 50 to 70 percent of cases. It is a physical condition which attacks the brain, resulting in impaired memory, thinking and behaviour. As brain cells shrink or disappear, abnormal materials build up as ‘tangles' in the centre of the brain cells and ‘plaques' outside them. These disrupt messages within the brain, damaging connections between brain cells. The brain cells eventually die and this means information cannot be recalled. Depending on the area of the brain, certain functions or abilities are lost. Memories of recent events are the first to be affected, but as the disease progresses long-term memory is also a lost. The disease further affects many of the brain's other functions and consequently many aspects of behaviour are affected.

Once an ability is lost it can be rarely regained or relearned. Researchers are still trying to find the cause of Alzheimer's. Direct inheritance occurs only in the far less common Familial Alzheimer's Disease; it affects a very small number of Australians, usually in their 40s and 50s. Direct inheritance does not occur over the age of 65.

Vascular dementia is the second most common form of dementia after Alzheimer's disease. It is a broad term for dementia associated with circulation of blood to the brain. Anyone can be affected by vascular dementia but several factors increase the risk. These include high blood pressure, smoking, diabetes, high cholesterol, history of mild warning strokes, evidence of disease in arteries elsewhere and heart rhythm abnormalities. While treatment cannot reverse the damage it can prevent additional damage being done.

For more information on Alzheimers or Dementia please visit this website http://www.alzheimers.org.au/

 

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