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 ofwhich will be later diagnosed with dementia. About 70% of dementia is caused byAlzheimer’s disease, with cerebrovascular dementia. Saying someone has dementia is likesaying 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 inthe brain beyond what might be expected from normal aging. Particularly affected areas maybe memory, attention, language, and problem solving. People dealing with dementia may bedisoriented in time, not knowing what day of the week it is, place, not knowing where theyare, and person, not knowing who they are (Ballard, 2005). Dementia is a non-specific termthat encompasses many disease processes, such as Alzheimer’s disease, Parkinson’s disease,Down syndrome, and Huntington’s disease. The prevalence of dementia in the globalcommunity 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, olderpopulaces. The purpose of this research paper is to have a better understanding of dementia andthe affects the disease has on an individual. This class is geared towards understanding thepsychology of a person through development, and dementia tends to happen to a person, butnot everyone, as the person goes through the aging process. It has been reported that in anygiven year, “nearly 20% of older community dwellers have a psychiatric disorder, withestimates increasing to approximately 90% of older nursing home residents” (Bowen, 2006).
Dementia 3Although dementia has always been somewhat common, it has become even more commonamong the elderly in recent history. Dementia is one of the most serious disorders affectingthe elderly. The prevalence of dementia increases rapidly with age. The prevalence ofdementia has been difficult to determine, partly because of differences in definition amongdifferent studies, and partly because there is some normal decline in functional ability withage. Dementia is most common in elderly people; it used to be called senility and wasconsidered a normal part of aging. Dementia affects 5–8% of all people between ages 65 and74, and up to 20% of those between 75 and 84 (Crown, 2005). It is not clear if this increasedfrequency of dementia reflects a greater awareness of the symptoms or if people simply areliving 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 andimpact of dementia is essential to the future of public health. For this paper, I want to focuson two specific diseases of dementia; Alzheimer’s disease and Parkinson’s disease, becausethese disease affect different types of people and I want to have a better understanding of thewhole disease. I also want to investigate the issues of the cost of treatment regarding patientswith dementia. For future use, I would like to learn some interventions medical professionalshave with patients that have dementia, so that as I begin work in the medical field I will beable 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 ofdementia occurs. It is a myth that dementia is a result of aging. Some of the symptoms thatoccur with dementia are changes that are suppose to happen with aging, but just not the fullextent. The five senses are not as sharp at age 65 as at age 16. It is harder to processinformation and understand it. Once information reaches the brain, it is analyzed and placed
Dementia 4into the appropriate memory part of the brain. Although many elderly ignore sensory deficitsbecause they are unaware of them and discard some input if it comes too fast, the oppositeoccurs with short and long term memory. Lastly, control processes may be less effective withage, particularly the ability to focus attention and inhibit irrelevant responses. These are allnormal signs of aging, not to be confused with dementia. Dementia is a syndrome due to disease of the brain, usually of a chronic or progressivenature, in which there is disturbance of multiple higher cortical functions, such as memoryand orientation. Consciousness is not clouded. Impairments of cognitive function arecommonly accompanied, and occasionally preceded, by deterioration in emotional control,social behavior, or motivation (Bond, 2000). All types of dementia are progressive. Thismeans that the structure and chemistry of the brain become increasingly damaged over time.The persons 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 affectlanguage, comprehension, motor skills, short-term memory, the ability to identify commonlyused items, reaction time, personality traits, and executive functioning. (Byrne, 2005) Someexamples of a person with dementia would possibly include, beginning to get lost whiledriving roads that they once knew very well, and asking for questions to be repeated becausethe questions and answers are quickly forgotten. The long-ago memories are retained anddwelled upon. Personality changes occur, and the person may manifest changes that are thecomplete opposite from their previous personality. Poor judgment and impulse control oftengo hand-in-hand (Bond, 2005).
Dementia 5 As of now, there is no cure for dementia; however, there are drugs and other types oftreatment 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, andselegiline 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 preventAlzheimer’s disease and dementia (Byrne, 2005). In the same two years, the Womens HealthInitiative, a large clinical trial, was halted because of detrimental effects of combined estrogenand progestigin therapy, or hormone replacement therapy (HRT). Not only was HRT found toincrease risk of breast cancer, stroke, and other heart disease, but the risk of probabledementia 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 inindicators of cognitive ability. Studies still debate the effects of vitamin E on slowing theprogression of moderately severe Alzheimer’s disease. Since dementia usually progresses slowly, diagnosing it in its early stages can bedifficult. However, prompt intervention and treatment has been shown to help slow the effectsof dementia, so early diagnosis is important. Several office visits over several months or moremay be needed. Diagnosis begins with a thorough physical exam and complete medicalhistory, usually including comments from family members or caregivers. A family history ofeither Alzheimer’s disease or cerebrovascular disease may provide clues to the cause of
Dementia 6symptoms. Simple tests of mental function, including word recall, object naming, andnumber-symbol matching, are used to track changes in the persons 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 themild normal cognitive decline of advanced age also is critical. The medical history includes acomplete listing of drugs being taken, since a number of drugs can cause dementia-likesymptoms. The prognosis for dementia depends on the underlying disease. On average, peoplewith Alzheimers disease live eight years past their diagnosis, with a range from one to twentyyears. Vascular dementia usually is progressive, with death from stroke, infection, or heartdisease. The most common type of dementia is Alzheimer’s disease. Alzheimer’s disease is aneurodegenerative disease characterized by progressive cognitive deterioration together withdeclining activities of daily living. The earliest symptom is short term memory loss, amnesia,which usually manifests as minor forgetfulness that becomes steadily more pronounced withillness 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 temporallobes 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 sometimesdescribed 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
Dementia 7three different genes have been identified that account for a much smaller number of cases offamilial and early onset of Alzheimer’s (Crown, 2005). Alzheimers disease is the most frequent type of dementia in the elderly and affectsalmost half of all patients with dementia. Correspondingly, advancing age is the primary riskfactor for Alzheimers. Among people aged 65, 2-3% show signs of the disease, while 25 -50% of people aged 85 have symptoms of Alzheimers and an even greater number have someof 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 Alzheimers patients over the age of 85 is the fastest growingsegment of the Alzheimers disease population in the US, although current estimates suggestthe 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; thismay be age-related, as women live longer than men. There is currently no cure forAlzheimers disease. Currently available medications offer relatively small symptomaticbenefit for some patients but do not slow disease progression. Alzheimers is a major public health challenge since the median age of theindustrialized worlds population is increasing gradually (Chapman, 2006). Indeed, much ofthe concern about the solvency of governmental social safety nets is founded on estimates ofthe costs of caring for baby boomers, assuming that they develop Alzheimers in the sameproportions as earlier generations. For this reason, money spent informing the public ofavailable effective prevention methods may yield disproportionate benefits (Chang, 2006). Another type of dementia that is not as common as Alzheimer’s but is becoming morerelevant is Parkinson’s disease. Parkinson’s disease is a degenerative disorder of the central
Dementia 8nervous system that often impairs the patient’s motor skills and speech caused by thereduction of dopamine production in the brain. Parkinson’s disease belongs to a group ofconditions called movement disorders, but it also a subcortical dementia, which means thisdementia originates in the subcortex of the brain (Yanagisawa, 2004). It is oftencharacterized by muscle rigidity, tremor, a slowing of physical movement, which is calledbradykinesia, and in extreme cases, a loss of physical movement, which is akinesia. (Byrne,2005) Symptoms of Parkinsons disease have been known and treated since ancient times.However, it was not formally recognized and its symptoms were not documented until 1817in 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 showsno social, ethnic, economic or geographic boundaries. In the United States, it is estimated that60,000 new cases are diagnosed each year, joining the 1.5 million Americans who currentlyhave Parkinson’s disease. While the condition usually develops after the age of 65, 15% ofthose diagnosed are under 50 (Crown, 2005). There is no specific cause of Parkinson’sdisease, but researchers have found that genetics, toxins, head trauma, and drug-inducedParkinsons disease all play a role in Parkinson’s disease. Somebody who has Parkinsonsdisease is more likely to have relatives that also have Parkinsons disease. However, this doesnot 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 indiagnosing sporadic Parkinson’s disease. Therefore the diagnosis is based on medical historyand a neurological examination. The disease can be difficult to diagnose accurately. At
Dementia 9present, there is no cure for Parkinson’s disease, but medications or surgery can provide relieffrom the symptoms (Crown, 2005). Both these diseases are very important for our society to understand because as ourpopulation ages, health care workers and overall citizens need to understand the complicationsof 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 costof caring for people with dementia will become an increasingly important public healthconsideration. Dementia increases the mean annual health care cost per older patient by$4,134, with 75% of these increased costs attributable to increased hospitalization andexpenditures on skilled nursing facilities (Jeste, 2003). In a global study conducted during 2003, researchers found a total cost for caring forsomeone with dementia estimate includes a newly determined figure of $92 billion forinformal 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 prevalenceestimate of nearly 28 million people with dementia, a number that is predicted to growsharply as the world population continues to age (McBrien, 2000). The estimated economiccosts of Alzheimer’s disease in the United States total at least $100 billion annually; it isconsidered the third most expensive disease to treat. Per patient costs for nursing home carealone 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 tounderstand that there are currently no cures for dementia, just medications that can slowprogression and lessen symptoms of the a disease. However, there have been several research
Dementia 10projects currently under way to develop a vaccine to treat and perhaps prevent dementia, mostparticularly Alzheimer’s disease (Chang, 2006). Most research centers around using thebody’s own immune system to generate antibodies to attack and clear the beta-amyloidplaques found in the brains of Alzheimer’s disease patients (Jeste, 2003). Public health efforts to heighten awareness of the importance of early evaluation ofolder adults showing signs of cognitive impairment are clearly warranted, as are efforts toeducate the public about the heterogeneity and potential reversibility of cognitive impairment.Perhaps most significantly, dementia is increasingly recognized as the endpoint of acontinuum of cognitive decline among older adults, with the detection of mild cognitiveimpairment suggesting new opportunities for intervention (Chapman, 2006). Unquestionably, caregivers assume a vital role in the well-being of people withdementia by helping them with appropriate nutrition and exercise, providing them withmemory aids, and assisting with behavioral interventions (Jeste, 2003). Teaching caregiversstrategies for managing the behavioral problems of individuals with dementia, and, in somecases, providing case management and community services for individuals with dementiahave been reported to decrease depressive symptoms among caregivers. Similarly, providingadult day services for individuals with dementia has been shown to reduce the time caregiversspend on problematic behaviors. The provision of respite care for individuals with dementiahas 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. Theseinclude reality orientation, which involves regularly reminding patients of information such asthe day, date, season, and where they are. Since the memory of distant events is rarely
Dementia 11impaired, reminiscence therapy which encourages people to talk about the past, may also helpby bringing past experience into consciousness. Aromatherapy and art or music therapies arealso 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 ofpeople 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 thatsurround people with brain damage and related cognitive impairments. This includes thedifficulties experienced by older adults with varying types of dementia, as well as thecognitive issues that affect aging individuals with mental retardation and dementia. It isgroups 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 amongolder adults. Dementia encompasses an array of syndromes featuring some distinct forms ofpresentation posing important implications for intervention. Public health efforts designed tofoster awareness of the signs of cognitive impairment among older adults are needed, as earlyintervention 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 isnot an expected aspect of aging, but rather a real disorder amenable to intervention. Recentresearch results suggest that pharmacologic and psychosocial interventions may forestallcognitive decline among people with dementia, provided they are implemented early in thecourse 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.