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Understanding Dementia

Dementia is defined as a syndrome, usually of a chronic or progressive nature, which involves deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It impacts thinking, memory, orientation, comprehension, calculation, learning capacity, language, and judgment. It does not affect consciousness.  The degeneration in cognitive function is normally accompanied, and occasionally anteceded, by declension in emotional control, social behaviour, or motivation.

Dementia can take many forms. The most common form is that of Alzheimer disease which contributes about 60%-70% of cases. Other major forms of dementia encompass 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.

 

Diagnostic Criteria

DSM-5 replaces the term “dementia” with major neurocognitive disorder and mild neurocognitive disorder.

Mild Cognitive Disorder

DSM-5 defines a Mild Cognitive Disorder by the following criteria :

  • There is an evidence of meagre cognitive diminishment from a prior level of performance in one or more of the domains, based on the concerns of the individual, a knowledgeable informant or the clinician; and a decline in neurocognitive performance, typically involving test performance in the range of one and two standard deviations below appropriate norms (i.e. between the third and sixteenth percentiles) on formal testing or equivalent clinical evaluation.

  • The cognitive deficits are insubstantial to obstruct with independence (for example instrumental activities of daily living such as complex tasks such as paying bills or managing medications, are preserved), but greater effort, compensatory strategies, or accommodation may be required to maintain independence.

  • The cognitive deficits do not occur exclusively in the context of a delirium.

  • The cognitive deficits are not primarily attributable to another mental disorder (for example major depressive disorder and schizophrenia).

Major Cognitive Disorder

In DSM-5, a Major Cognitive Disorder is defined in a following way:


  • There is evidence of substantial cognitive deterioration from a preceding level of performance in one or more of the domains, based on the concerns of the individual, a knowledgeable informant, or the clinician; and a decline in neurocognitive performance, typically involving test performance in the range of two or more standard deviations below appropriate norms (i.e. below the third percentile) on formal testing or equivalent clinical evaluation.

  • The cognitive deficits are competent enough to interfere with independence (i.e. requiring minimal assistance with instrumental activities of daily living).

  • The cognitive deficits do not occur exclusively in the context of a delirium.

  • The cognitive deficits are not primarily attributable to another mental disorder (for example major depressive disorder and schizophrenia).

 

SIGNS & SYMPTOMS

Although age is known as the most common cause of dementia, it’s not true in totality. Furthermore, dementia is not said to have affected older people exclusively – the young onset of dementia accounts for up 9% of cases. According to the experts, both genetic factors ( variants of genes passed down from parents) and changeable lifestyle factors (diets, smoking, physical activity) all become conducive in the development of dementia, perhaps collectively.


Studies have evidence which shows that people can lower the risk of dementia by avoiding substance abuse (alcohol or drugs), indulging in healthy eating and exercising regularly. Additional risk factors include low educational attainment, depression, cognitive inactivity and social isolation.  


SIGNS AND SYMPTOMS 

The effects of dementia impacts each individual in a different way. The signs and symptoms of  it can be divided into three stages :


EARLY STAGE: The early stage of dementia is often ignored or overlooked because of the gradual onset. The symptoms include the following 

  • Losing track of time 

  • Forgetfulness 

  • Becoming lost in familiar places


MIDDLE STAGE: As dementia transmutes to the middle stage, the signs and symptoms become more distinct and more limited. These include the following :

  • Experiencing behaviour shifts, including roaming and persistent questioning 

  • Needing assistance in personal care 

  • Becoming forgetful of recent events and people’s names 

  • Having issues with communicating 

  • Forgetting recent events and people’s names 


LAST STAGE: This stage involves absolute dependence and inactivity. Serious disturbances take place in the memory and the physical signs and symptoms become more clear. Symptoms include the following :

  • Undergoing behaviour changes that may escalate and include aggression

  • Having difficulty in walking 

  • Struggle in recognizing relatives and friends 

  • Becoming unaware of the time and place 

  • Having an increased need for assistance in self-care 

 

TREATMENT

There is no specific treatment currently available to cure dementia or to make alterations to its progressive nature. Although, new treatments are being cross-examined in various stages of clinical trials.Nevertheless, support can be offered to improve the lives of people and their families and caretakers.


The principal goals for dementia care are:

  • Handling information and providing long-term support to caretakers. 

  • Recognizing and dealing with challenging behavioural and psychological symptoms. 

  • Diagnosing and treating accompanying physical illness

  •  Enhancing physical health, cognition, activity and well-being

  • Early detection in order to promote early and essential care. 

 

Communicating with People who have Dementia

Credits: Covid19 Helpline India

Dementia will gradually affect the way a person communicates. Their ability to present rational ideas and to reason clearly will change. If you are looking after a person with dementia, you may find that as the illness progresses you'll have to start discussions to get the person to make conversation. This guide will help you with cues to communicate with individuals with Dementia.

Dementia Information Book

Credits: Bupa Care Services NZ

This guide will provide you with some useful information about dementia, and how you can help to look after your relative or friend. We also remind you to look after yourself, because we understand that caring for someone with dementia can be difficult.

 

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