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Dementia Paper


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  • 1. Dementia 1 Running Head: UNDERSTANDING DEMENTIA Understanding Dementia Psych 320 Nicole Reinke Pacific Lutheran University
  • 2. Dementia 2 Understanding Dementia What could be worse than losing your mind, while your body has many years to run? Yet, that is precisely what happens to three in ten people over the age of 70 (Ballard, 2005). In Europe alone 1 million people develop impaired memory every year, more than half of which will be later diagnosed with dementia. About 70% of dementia is caused by Alzheimer’s disease, with cerebrovascular dementia. Saying someone has dementia is like saying someone has a fever; it does not tell you why someone has it (Bowen, 2006). Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Particularly affected areas may be memory, attention, language, and problem solving. People dealing with dementia may be disoriented in time, not knowing what day of the week it is, place, not knowing where they are, and person, not knowing who they are (Ballard, 2005). Dementia is a non-specific term that encompasses many disease processes, such as Alzheimer’s disease, Parkinson’s disease, Down syndrome, and Huntington’s disease. The prevalence of dementia in the global community is rising as the global life expectancy is rising. Particularly in Western countries, there is increasing concern about the economic impact that dementia will have in future, older populaces. The purpose of this research paper is to have a better understanding of dementia and the affects the disease has on an individual. This class is geared towards understanding the psychology of a person through development, and dementia tends to happen to a person, but not everyone, as the person goes through the aging process. It has been reported that in any given year, “nearly 20% of older community dwellers have a psychiatric disorder, with estimates increasing to approximately 90% of older nursing home residents” (Bowen, 2006).
  • 3. Dementia 3 Although dementia has always been somewhat common, it has become even more common among the elderly in recent history. Dementia is one of the most serious disorders affecting the elderly. The prevalence of dementia increases rapidly with age. The prevalence of dementia has been difficult to determine, partly because of differences in definition among different studies, and partly because there is some normal decline in functional ability with age. Dementia is most common in elderly people; it used to be called senility and was considered a normal part of aging. Dementia affects 5–8% of all people between ages 65 and 74, and up to 20% of those between 75 and 84 (Crown, 2005). It is not clear if this increased frequency of dementia reflects a greater awareness of the symptoms or if people simply are living longer and thus are more likely to develop dementia in their older age (Ballard, 2005). With the aging of the U.S. population, a better understanding of the presentation and impact of dementia is essential to the future of public health. For this paper, I want to focus on two specific diseases of dementia; Alzheimer’s disease and Parkinson’s disease, because these disease affect different types of people and I want to have a better understanding of the whole disease. I also want to investigate the issues of the cost of treatment regarding patients with dementia. For future use, I would like to learn some interventions medical professionals have with patients that have dementia, so that as I begin work in the medical field I will be able to help patients but also help my coworkers understand patients with dementia. First, I want to discuss late adulthood, because this is normally when the onset of dementia occurs. It is a myth that dementia is a result of aging. Some of the symptoms that occur with dementia are changes that are suppose to happen with aging, but just not the full extent. The five senses are not as sharp at age 65 as at age 16. It is harder to process information and understand it. Once information reaches the brain, it is analyzed and placed
  • 4. Dementia 4 into the appropriate memory part of the brain. Although many elderly ignore sensory deficits because they are unaware of them and discard some input if it comes too fast, the opposite occurs with short and long term memory. Lastly, control processes may be less effective with age, particularly the ability to focus attention and inhibit irrelevant responses. These are all normal signs of aging, not to be confused with dementia. Dementia is a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, such as memory and orientation. Consciousness is not clouded. Impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation (Bond, 2000). All types of dementia are progressive. This means that the structure and chemistry of the brain become increasingly damaged over time. The person's ability to remember, understand, communicate and reason gradually declines (Bonifati 1999). Early symptoms of dementia often consist of changes in personality or in behavior. Often dementia can be first evident during an episode of delirium. Dementia can affect language, comprehension, motor skills, short-term memory, the ability to identify commonly used items, reaction time, personality traits, and executive functioning. (Byrne, 2005) Some examples of a person with dementia would possibly include, beginning to get lost while driving roads that they once knew very well, and asking for questions to be repeated because the questions and answers are quickly forgotten. The long-ago memories are retained and dwelled upon. Personality changes occur, and the person may manifest changes that are the complete opposite from their previous personality. Poor judgment and impulse control often go hand-in-hand (Bond, 2005).
  • 5. Dementia 5 As of now, there is no cure for dementia; however, there are drugs and other types of treatment available. Treatment of dementia begins with treatment of the underlying disease, where possible. The underlying causes of nutritional, hormonal, tumor-caused and drug- related dementias may be reversible to some extent (Byrne, 2005). Treatment for stroke- related dementia begins by minimizing the risk of further strokes, through smoking cessation, aspirin therapy, and treatment of hypertension, for instance. Aspirin, estrogen, vitamin E, and selegiline have been evaluated for their ability to slow the rate of progression (Bonifati, 1999). However, none of these have been proven effective. In fact, in 2002 and 2003, research revealed that non-steroidal anti-inflammatory agents (NSAIDs) did not help prevent Alzheimer’s disease and dementia (Byrne, 2005). In the same two years, the Women's Health Initiative, a large clinical trial, was halted because of detrimental effects of combined estrogen and progestigin therapy, or hormone replacement therapy (HRT). Not only was HRT found to increase risk of breast cancer, stroke, and other heart disease, but the risk of probable dementia was twice that for women taking HRT than for those taking a placebo (Yanagisawa, 2004). Further, those taking HRT had a substantial and clinically important decline in indicators of cognitive ability. Studies still debate the effects of vitamin E on slowing the progression of moderately severe Alzheimer’s disease. Since dementia usually progresses slowly, diagnosing it in its early stages can be difficult. However, prompt intervention and treatment has been shown to help slow the effects of dementia, so early diagnosis is important. Several office visits over several months or more may be needed. Diagnosis begins with a thorough physical exam and complete medical history, usually including comments from family members or caregivers. A family history of either Alzheimer’s disease or cerebrovascular disease may provide clues to the cause of
  • 6. Dementia 6 symptoms. Simple tests of mental function, including word recall, object naming, and number-symbol matching, are used to track changes in the person's cognitive ability (Crown, 2005). Depression is common in the elderly and can be mistaken for dementia; therefore, ruling out depression is an important part of the diagnosis. Distinguishing dementia from the mild normal cognitive decline of advanced age also is critical. The medical history includes a complete listing of drugs being taken, since a number of drugs can cause dementia-like symptoms. The prognosis for dementia depends on the underlying disease. On average, people with Alzheimer's disease live eight years past their diagnosis, with a range from one to twenty years. Vascular dementia usually is progressive, with death from stroke, infection, or heart disease. The most common type of dementia is Alzheimer’s disease. Alzheimer’s disease is a neurodegenerative disease characterized by progressive cognitive deterioration together with declining activities of daily living. The earliest symptom is short term memory loss, amnesia, which usually manifests as minor forgetfulness that becomes steadily more pronounced with illness progression, with relative preservation of older memories. As the disorder progresses, cognitive impairment extends to the domains of language, aphasia, skilled movements, apraxia, recognition, agnosia, and those functions closely related to the frontal and temporal lobes of the brain as they become disconnected from the limbic system (Chapman, 2006). These changes make up the essential human qualities and thus Alzheimer’s is sometimes described as a disease where victims suffer the loss of qualities that define human existence. The ultimate cause of the disease is unknown. Genetic factors are known to be important, in
  • 7. Dementia 7 three different genes have been identified that account for a much smaller number of cases of familial and early onset of Alzheimer’s (Crown, 2005). Alzheimer's disease is the most frequent type of dementia in the elderly and affects almost half of all patients with dementia. Correspondingly, advancing age is the primary risk factor for Alzheimer's. Among people aged 65, 2-3% show signs of the disease, while 25 - 50% of people aged 85 have symptoms of Alzheimer's and an even greater number have some of the pathological hallmarks of the disease without the characteristic symptoms (Byrne, 2005). Every five years after the age of 65, the probability of having the disease doubles (Chang, 2006). The share of Alzheimer's patients over the age of 85 is the fastest growing segment of the Alzheimer's disease population in the US, although current estimates suggest the 75-84 population has about the same number of patients as the over 85 population (Chapman, 2006). Women are more likely than men to develop Alzheimer’s disease; this may be age-related, as women live longer than men. There is currently no cure for Alzheimer's disease. Currently available medications offer relatively small symptomatic benefit for some patients but do not slow disease progression. Alzheimer's is a major public health challenge since the median age of the industrialized world's population is increasing gradually (Chapman, 2006). Indeed, much of the concern about the solvency of governmental social safety nets is founded on estimates of the costs of caring for baby boomers, assuming that they develop Alzheimer's in the same proportions as earlier generations. For this reason, money spent informing the public of available effective prevention methods may yield disproportionate benefits (Chang, 2006). Another type of dementia that is not as common as Alzheimer’s but is becoming more relevant is Parkinson’s disease. Parkinson’s disease is a degenerative disorder of the central
  • 8. Dementia 8 nervous system that often impairs the patient’s motor skills and speech caused by the reduction of dopamine production in the brain. Parkinson’s disease belongs to a group of conditions called movement disorders, but it also a subcortical dementia, which means this dementia originates in the subcortex of the brain (Yanagisawa, 2004). It is often characterized by muscle rigidity, tremor, a slowing of physical movement, which is called bradykinesia, and in extreme cases, a loss of physical movement, which is akinesia. (Byrne, 2005) Symptoms of Parkinson's disease have been known and treated since ancient times. However, it was not formally recognized and its symptoms were not documented until 1817 in An Essay on the Shaking Palsy by the British physician James Parkinson. (Yanagisawa, 2004) Parkinson’s disease affects both men and women in almost equal numbers. It shows no social, ethnic, economic or geographic boundaries. In the United States, it is estimated that 60,000 new cases are diagnosed each year, joining the 1.5 million Americans who currently have Parkinson’s disease. While the condition usually develops after the age of 65, 15% of those diagnosed are under 50 (Crown, 2005). There is no specific cause of Parkinson’s disease, but researchers have found that genetics, toxins, head trauma, and drug-induced Parkinson's disease all play a role in Parkinson’s disease. Somebody who has Parkinson's disease is more likely to have relatives that also have Parkinson's disease. However, this does not mean that the disorder has been passed on genetically (Yanagisawa, 2004). There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic Parkinson’s disease. Therefore the diagnosis is based on medical history and a neurological examination. The disease can be difficult to diagnose accurately. At
  • 9. Dementia 9 present, there is no cure for Parkinson’s disease, but medications or surgery can provide relief from the symptoms (Crown, 2005). Both these diseases are very important for our society to understand because as our population ages, health care workers and overall citizens need to understand the complications of diseases that typically occur in older adults. Another important issue is the cost of care. With older adults projected to represent a greater proportion of the U.S. population, the cost of caring for people with dementia will become an increasingly important public health consideration. Dementia increases the mean annual health care cost per older patient by $4,134, with 75% of these increased costs attributable to increased hospitalization and expenditures on skilled nursing facilities (Jeste, 2003). In a global study conducted during 2003, researchers found a total cost for caring for someone with dementia estimate includes a newly determined figure of $92 billion for informal care costs, combined with the team’s previous estimate, published earlier this year, of $156 billion for direct care costs. The findings are based on a worldwide prevalence estimate of nearly 28 million people with dementia, a number that is predicted to grow sharply as the world population continues to age (McBrien, 2000). The estimated economic costs of Alzheimer’s disease in the United States total at least $100 billion annually; it is considered the third most expensive disease to treat. Per patient costs for nursing home care alone for persons with Alzheimer’s disease range from $42,000 to $70,000 a year (Byrne, 2005). What can we do? As I begin to work in the medical environment it is important to understand that there are currently no cures for dementia, just medications that can slow progression and lessen symptoms of the a disease. However, there have been several research
  • 10. Dementia 10 projects currently under way to develop a vaccine to treat and perhaps prevent dementia, most particularly Alzheimer’s disease (Chang, 2006). Most research centers around using the body’s own immune system to generate antibodies to attack and clear the beta-amyloid plaques found in the brains of Alzheimer’s disease patients (Jeste, 2003). Public health efforts to heighten awareness of the importance of early evaluation of older adults showing signs of cognitive impairment are clearly warranted, as are efforts to educate the public about the heterogeneity and potential reversibility of cognitive impairment. Perhaps most significantly, dementia is increasingly recognized as the endpoint of a continuum of cognitive decline among older adults, with the detection of mild cognitive impairment suggesting new opportunities for intervention (Chapman, 2006). Unquestionably, caregivers assume a vital role in the well-being of people with dementia by helping them with appropriate nutrition and exercise, providing them with memory aids, and assisting with behavioral interventions (Jeste, 2003). Teaching caregivers strategies for managing the behavioral problems of individuals with dementia, and, in some cases, providing case management and community services for individuals with dementia have been reported to decrease depressive symptoms among caregivers. Similarly, providing adult day services for individuals with dementia has been shown to reduce the time caregivers spend on problematic behaviors. The provision of respite care for individuals with dementia has been shown to decrease caregivers' stress and enhance their quality of life (Chapman, 2006). There are several psychological techniques to help people cope with dementia. These include reality orientation, which involves regularly reminding patients of information such as the day, date, season, and where they are. Since the memory of distant events is rarely
  • 11. Dementia 11 impaired, reminiscence therapy which encourages people to talk about the past, may also help by bringing past experience into consciousness. Aromatherapy and art or music therapies are also thought to be beneficial, though there is no scientific evidence to support this (Bond, 2000). Some health care organizations are taking their own steps to help improve the lives of people dealing with dementia. A local organization in Ohio, created a group called AID (Activities and Interventions for Dementia), this group specializes in the cognitive issues that surround people with brain damage and related cognitive impairments. This includes the difficulties experienced by older adults with varying types of dementia, as well as the cognitive issues that affect aging individuals with mental retardation and dementia. It is groups like this that can help improve the lives of people with dementia (Chapman, 2006). Dementia is associated with significant disability and impaired quality of life among older adults. Dementia encompasses an array of syndromes featuring some distinct forms of presentation posing important implications for intervention. Public health efforts designed to foster awareness of the signs of cognitive impairment among older adults are needed, as early intervention may forestall further decline in cognitive functioning. Essentially, older adults, their health care providers, and others around them need to be better informed that dementia is not an expected aspect of aging, but rather a real disorder amenable to intervention. Recent research results suggest that pharmacologic and psychosocial interventions may forestall cognitive decline among people with dementia, provided they are implemented early in the course of the disease. Related efforts are needed to destigmatize dementia and its treatment, thereby removing significant barriers to the continued health and functioning of older adults.