Fri | Aug 18, 2017

Ann-Merita Golding | Dementia - The living nightmare we need to better understand

Published:Wednesday | June 22, 2016 | 6:00 AM
Elder couple

Cognitive dysfunction or forms of cognitive decline is often a taboo topic of discussion among those whose family members may be showing notable changes in their behaviour or personalities, particularly in a culture that stigmatises changes in a 'normal' person's brain function as 'mad' or 'crazy'.

However, when compared to other medical diagnoses, dementia is an equally legitimate medical condition that should be treated just like any other crippling and progressive disease or disorder.

Growing older is a natural part of the lifecycle. Speech-language pathologist and American Speech-Language Hearing Association (ASHA) Fellow, Dr Joan C. Payne, PhD, points out that accepting ageing in oneself and others is critical if one is to thrive during the inevitable changes that accompany growing old. As individuals grow older, many will begin to show cognitive changes that we have come to expect with normal ageing, while others exhibit signs of decline that are abnormal or 'unusual' and may, in fact, be symptoms of Alzheimer's disease or other types of dementias caused by comorbidities that should not be ignored.

Dementia is a group of symptoms related to cognitive impairment which can be caused by a number of diseases and conditions that result in progressive memory loss and overall cognitive dysfunction.

Most types of dementias can be severe enough to interfere with a person's daily functioning; various types of dementia are considered progressive and are usually irreversible.

 

NOT A DISEASE ITSELF

 

It is important to reiterate that dementia is not a disease itself, but rather a group of symptoms that are caused by various diseases or conditions. According to the World Health Organization, 47.5 million people worldwide have dementia, with 13.9 per cent of adults 71 years and older having some form of dementia. There are 7.7 million new cases every year, and in the United States alone, one in every nine persons over 65 years suffers from dementia.

Dementia affects a person's behaviour and ability to perform simple everyday activities. It affects memory and the ability to think, reason, make sound judgement and carry out complex tasks. Dementia can also affect a person's ability to produce or understand speech and language, recognise familiar people and identify common objects, as well as significantly increase a person's safety risks.

Alzheimer's disease is the most common type of dementia which accounts for 60-80 per cent of dementia cases. However, there are many types of dementia and varying stages, including Vascular dementia, Dementia with Lewy Bodies (DLB), FrontoTemporal Dementia and Mixed Dementia. Each type of dementia can be attributed to varying diseases that I will address in greater detail in subsequent articles in this series.

Many signs of dementia often go unrecognised or are simply dismissed as normal ageing. A diagnosis is often not made until well into the course of dementia and intervention not sought because of cultural dynamics and the perceived stigma of mental illness. It is important to highlight that memory loss by itself is not sufficient evidence of dementia.

There are five categories of change in a person exhibiting signs/symptoms of dementia:

- Cognitive changes (confusion, forgetfulness, disorientation difficulty following simple directions/instructions)

- Psychiatric symptoms (withdrawal and apathy)

- Personality changes (inappropriate friendliness or exchanges with strangers)

- Behavioural disturbances (agitation, physically and verbally combative).

- Changes in daily functioning (wandering/getting lost, difficulty driving/operating household electronics, difficulty eating/swallowing, dressing and toileting).

Note that signs/symptoms of dementia may only be reversible if brought on by specific contributing factors, which include but are not limited to:

- Delirium - often experienced with drug usage or a very high fever, depression

- Depression

- Medication (prescription pain medication etc.)

- Metabolic dysfunction

- Thyroid problems and vitamin deficiencies

- Intracranial masses cause by a tumour or traumatic brain injury

- Arteriosclerotic complications

- Chemotherapy

- Alcohol abuse

- Dehydration

- Neurosyphilis

- Hearing loss

Dementia-like symptoms may be reversed with treatment or surgery, depending on the contributing factors.

A complete medical workup by a medical doctor is necessary to diagnose dementia and rule out other possible causes of cognitive impairment. Additionally, neuropsychologists, speech-language pathologists, and occupational therapists together with family members and caregivers may be able to determine whether a person has dementia. Medical speech-language pathologists, who specialise in the ageing population, are trained to evaluate and treat cognitive dysfunction with the objective of improving daily functioning and safety through the use of repetitive/learnt compensatory strategies and caregiver training.

It is important to reiterate that those who are part of the ageing population, 60 years and older, may show changes and limitations in their ability to do and participate in everyday activities that once seemed effortless. Many of these changes may be considered behaviours associated with normal ageing. However, research has shown that person's with mild cognitive impairment that progresses over time are at greater risk for Alzheimer's disease. It is, therefore, important to recognise the signs of normal ageing, mild cognitive impairment and the onset of Alzheimer's disease or other types of dementia. Early detection increases the possibility of treatment including therapy, to adjust to changes associated with the progression of the disease, and also allows for better management of this reality.

In subsequent articles, I will highlight the different types of dementia, the factors which increase one's risk of developing dementia, and effective ways of dealing with it.

- Ann-Merita Golding, MS,CCC-SLP, is a speech-language pathologist, licensed and certified by the American Speech-Language Hearing Association (ASHA). Email: annmerita@gmail.com; yourhealth@gleanerjm.com.