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DEMENTIA - a patient's guide
Dr Geoff Green - Physician
What is it?
Dementia is defined as an acquired, usually persistent
impairment of intellectual function, including memory problems
and at least one of the following - language impairment,
visuospatial (orientation) problems, difficulties with calculations,
reasoning, and abstraction. Personality change may occur.
Despite these impairments, the person remains fully alert.
However, these intellectual losses are severe enough to
interfere with work or social activities.
Dementia is a syndrome and as such does not refer to a
specific disease. There are a large number of causes. The
more important causes include:
Alzheimer's disease
Multiple strokes ("vascular dementia")
Alcohol
Head injuries
Brain tumours
Hydrocephalus (water on the brain)
Parkinson's disease (but not all patents with Parkinson's
disease get dementia)
Infections such as meningitis, AIDS and certain viruses
Vitamin deficiencies (especially Vitamin B12)
Hormonal disturbance such as an under-active thyroid gland
*The first two causes account for the majority of cases.
Dementia becomes more common with age. Five percent of
the population over 60 are said to have dementia, but this
rises to 20% of the population over 80 years. It appears
to affect all ethnic groups. It is a common cause of disability
in the elderly, and is common in residents of rest homes
and geriatric hospitals.
What are the symptoms?
The changes tend to be slowly progressive, and subtle
at first. It is common to notice memory problems initially.
However, this needs to be distinguished from mild memory
loss that occurs with age and is not related to dementia.
Often the changes are noticed first by family and friends,
rather that the patient.
With time, the initial memory loss becomes more severe
and obvious. Long term and short term memory becomes affected.
Other intellectual functions become affected. The person
may have difficulty in balancing their chequebook, difficulty
counting change, may show poor judgement with purchases,
and their self-hygiene may decline. A personality change
may occur with the person becoming more slovenly, rude,
and sometimes uninhibited. All these symptoms occur at different
rates and to different degrees, depending on the underlying
cause.
Dementia needs to be distinguished from:
Delirium, a temporary condition of brain dysfunction,
associated with disturbed consciousness, which typically
fluctuates. It is usually caused by some physical illness.
Depression
Strokes which may, for example, produce speech difficulties
without dementia
Sensory impairment, such as severe deafness
It is important for people with suspected dementia to
see a physician, so that the diagnosis can be confirmed,
the cause can be determined, and so that treatment can begin.
What tests are needed?
Usually a clinical assessment is needed, a few blood tests
and a brain scan. Sometimes neuropsychological tests, including
various "puzzles" are performed to determine which part
of the brain is most affected. Occasionally other tests
such as analysis of spinal fluid and electroencephalograms
(brain wave measurement) are required.
What can be done to help?
Treatment depends on the cause. In some circumstances,
treatment of the underlying cause results in a considerable
intellectual improvement. However, in the majority of cases,
dementia is persistent and often gets worse (progressive).
It is important for sufferers of dementia to be well informed
regarding their diagnosis and prognosis, so that they can
anticipate the future. They require advice on wills, appointing
Powers of Attorney, financial planning etc. It is important
to provide support for their caregivers, such as relief
care. Maintaining a familiar environment and routine is
helpful and avoids episodes of acute confusion. Unnecessary
medications should be withdrawn (under the supervision of
a physician).
Specific remedies depend on the cause. In certain cases,
drugs are beneficial. Depending on the cause, other interventions
may help. For example, cessation of alcohol in alcoholics;
surgery in hydrocephalus; control of blood pressure and
aspirin in vascular dementia; certain drugs in Alzheimer's
disease. Behavioural symptoms often respond to non-pharmacological
interventions. Recognising patterns of behaviour, and avoiding
precipitants of undesirable behaviour (which are often recognised
in time), and behaviour management strategies are helpful.
Future trends
A vast amount of research is continuing into dementia.
New discoveries are being made regularly. For example, new
drugs have recently become available for the treatment of
Alzheimer's Disease.
There is growing confidence that in the future, our ability
to prevent and treat dementia will improve greatly.
Getting help
All patients with suspected dementia should have an assessment
by a physician. Specialists who may be asked to see the
patient include neurologists, gerontologists (geriatricians),
and neuropsychologists. Physical therapists (physiotherapists)
and occupational therapists also have an important role
in assessment and treatment. Your local Assessment Treatment
and Rehabilitation Unit (Geriatric Unit) can often provide
comprehensive assessments.
A number of support organisations are available. In New
Zealand, the Alzheimer's Foundation (phone 09-6255280) is
a useful source of information and support. They have a
library of information, as well as a 24-hour telephone information
line (09-6255678). The Health Funding Authority of New Zealand
funds courses on dementia for caregivers.
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