Explain what is meant by the term “dementia” (201. 1. 1) Dementia describes a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language. These changes are often small to start with, but for someone with dementia they have become severe enough to affect daily life. Dementia is caused when the brain is damaged by diseases, such as Alzheimer’s disease, vascular dementia, Lewy body disease, a series of strokes or even a group of symptoms which may result from brain injury, vitamin/hormonal imbalance, drugs and alcohol.
These diseases have factors in common and can cause a person to have their mental functions affected in lots of different ways. An inability to retain new information, they may lose the ability to understand written/spoken language, they may lose the ability to speak and be understood by others, finally they may lose the ability to process and understand visual information.
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The specific symptoms that someone with dementia experiences will depend on the parts of the brain that are damaged and the disease that is causing the dementia.
The main symptoms are usually confusion, loss of memory, changes in personality and behavior, problems with speech and understanding and the decline in the ability of daily living tasks. Dementia causes permanent and progressive damage to the brain so confusion will most likely be present. Describe the key functions of the brain that are affected by dementia (201. 1. 2) The cerebral cortex (the largest part of the brain) is divided into different regions which are known as lobes. Each lobe controls different functions.
Temporal lobe – Learning new information, recording and storage of verbal memory (such as names), and visual memory (such as faces). Frontal lobe – Organising and planning actions, language, logic, personality, regulating behaviour, learning tasks, theoretical thought, initiating and stopping. Parietal lobe – Sentence construction, calculation, locating objects, body sense, remembering sequences of actions, interpreting info received from the occipital lobe. Occipital lobe – Processing info about shape, colour, and movement received from the eyes. Every type of dementia involves progressive physical damage to the brain.
The main areas affected in most dementias are the Temporal lobe, frontal lobe and the parietal lobe. Explain why depression, delirium and age related memory impairment may be mistaken for dementia (201. 1. 3) Depression is often difficult to tell apart from dementia. Depression will usually start over a period of days, weeks or months. People may speak, think and move more slowly and they may become ill-tempered or disconcerted and recent memory might be impaired. Depression and dementia can coexist. Depression leads to difficulties with activities of daily living.
Dementia is associated with other psychiatric symptoms such as depression in 1/3 of cases. Delirium can be caused by physical illness, drug and alcohol abuse. An individual suffering from delirium may experience visual hallucinations, confusion, misperceptions, clouded thinking and awareness, disturbed sleep and day/night reversal, agitation and poor attention. Common causes for delirium are: Chest, skin, ear and urinary infections, prescribed drugs, alcohol, and hypoxia and so on.
Changes to our normal cognitive abilities will occur as part of the ageing process. This could mean that we can’t remember things as we used to or think as quickly as we used to. This could be mistaken for dementia. The changes should be gradual and not get in the way with daily activities. If however the changes are more dramatic and affecting daily activities it could possibly indicate dementia. Outcome 2 Understand key features of the theoretical models of dementia Outline the medical model of dementia (201. 2. 1) The medical model of dementia sees dementia as a condition which nothing can be done. The focus of the medical model is dementia as a disease and the loss of ‘normality’ of those affected by it.
It focuses on the diagnosis and treatment of the illness, however, in its most narrow form can sometimes fail to address some other important influences on health and wellbeing. The medical model is concerned with the pursuit of cures for the disease. Outline the social model of dementia (201. 2. 2) The social model emphasises a broader range of factors rather than just physical ones. It places more importance on the interaction of social and biological factors in the development of dementia. It’s based on the understanding and complexity of human health and wellbeing.
It takes into account the importance of supporting people who are vulnerable, and values the knowledge and understanding of those who experience dementia and their carers. It is about focussing on individuals abilities instead of their losses. There is growing evidence to show that people are adapting to living with dementia. Explain why dementia should be viewed as a disability (201. 2. 3) Dementia which was views as a disease is now viewed as a disability. It allows us to view people with dementia as individuals coping with their own impairment and entitled to an adequate quality of life and comfort.
To do this it is necessary for us to shift our way of thinking from focusing on dementia as a disease that degenerative without a cure, to focusing on the whole person and seeing dementia as a disability of certain parts of the persons brain. Outcome 3 Know the most common types of dementia and their causes List the most common causes of dementia (201. 3. 1) Alzheimer’s disease – accounts for 60% of all cases Gradual onset with a progressive, unremitting course Onset usually over the age of 45 years Definitive diagnosis only made at post mortem Slightly more common in women that in men.
Vascular dementia – for example strokes, accounts for 15-20% of all cases Often sudden onset, with focal neurological signs Onset usually over the age of 45 years Slightly more common in men than women Uneven decline in skills and personality changes Dementia with Lewy bodies – accounts for 15-20% of all cases Restlessness Hallucinations and delusions prominent Frontotemporal dementia – accounts for 5% of all cases Describe the likely signs and symptoms of the most common causes of dementia (201. 3. 2) Alzheimer’s disease – usually loss of memory, especially for learning new information and later challenging behaviour may occur.
Symptoms commonly include: depression, agitation, psychosis, wandering, aggression, lethargy, incontinence and altered eating habits. Vascular dementia – can present after an acute vascular event e. g. stroke, a loss of ability to perform previously learned tasks, planning problems. Challenging behaviour is also common. Depression and lethargy is more frequent. Dementia with Lewy bodies – regular visual hallucinations, random cognitive disturbance, falls, loss of consciousness, rapid eye movement, sleep disorders. Frontotemporal dementia – Language disturbance, challenging behaviour.
Outline the risk factors for the most common causes of dementia (201. 3. 3) Growing old – Old age is a key risk factor for dementia. One in 14 people over the age of 65 has dementia, over the age of 80 this figure increases to 1 in 6. High blood pressure – increases the risk of developing vascular dementia and Alzheimer’s disease. Smoking – significantly increases the risk of vascular dementia and Alzheimer’s disease. Eating a lot of saturated fat – can cause narrowing of the arteries and increase the risk of vascular dementia.
Drinking large amounts of alcohol regularly – Alcohol related dementia can result from excessive consumption of alcohol over a long period of time. Heavy drinking can increase the risk of vascular dementia. Having a close relative with dementia – Makes your own chance of developing it slightly higher than someone who doesn’t have a relative with dementia. This risk is minor. Downs Syndrome – people with downs syndrome are at risk of developing Alzheimer’s disease as they grow older. Approx 1/3 of people with downs syndrome in their 50s have Alzheimer’s and over 1/2 in their 60s.
Obesity – increases a person’s risk of developing dementia later in life. Identify prevalence rates for different types of dementia (201. 3. 4) Alzheimer’s disease – 62% – Affects around 417,000 people in the UK. Approx 98% of people with Alzheimer’s are over the age of 65. Less commonly, Alzheimer’s can develop in younger people affecting approx 5,000 people under the age of 65 in the UK. Vascular dementia – 17% – Affects around 112,000 people in the UK. The risk of vascular dementia increases with age, but it is one of the most common types of dementia among the 15,000 younger people with dementia in the UK. Mixed – 10%
A diagnosis of mixed dementia means that progressive damage to the brain is being caused by both Alzheimer’s and vascular dementia. Dementia with Lewy Bodies – 4% – Affects around 25,000 people in the UK. More common in people over 65, in rare cases people under 65 may develop it. Frontotemporal Dementia – 2% – Affects around 11,000 people in the UK. More likely to affect people under the age of 65. Outcome 4 Understand factors relating to an individuals experience of dementia Describe how different individuals may experience living with dementia depending on age, type of dementia, and level of ability and disability (201. 4. 1)
Dementia is a progressive condition. Some people will retain good communication abilities, while others develop severe problems with verbal communication. Many people retain their continence while others may lose this ability. Peoples experience with dementia is unique to them. Not 2 people will experience dementia in the same way. There are many factors that play a part, the type of dementia the person has, their marital status, whether they have any other form of disability, ethnicity, where they live, age and so on. Any of these factors can affect a person’s ability to deal with the changes they experience, such as the following:
Changes to social life Fatigue due to extra demand the illness places on their cognitive processes Strong emotions and sensations due to effects on the parietal lobe Physiological change as dementia affects different parts of the brain Inability to interpret what you see Younger people are more vulnerable to the unusual forms of dementia such as frontotemporal dementia. Each form of dementia has characteristic symptoms as well as more general symptoms. Dementia can be more severe in a younger person and is often associated with physical symptoms and rapid progression.
If the frontal lobe or temporal part of the brain is damaged a person may start to display inappropriate behavior. People with Lewy body dementia may experience visual hallucinations, falls and irregular sleeping patterns. Young people with dementia normally have very different circumstances in life to older people with dementia. They are usually fit and healthy and this needs to be maintained for their wellbeing. It is important to remind them to attend routine check ups such as the dentist, health screenings etc as they may forget. A healthy diet is also important.
The person should have a valuable role in life to give some sort of sense of achievement, confidence, empowerment etc. Younger people diagnosed with dementia may be in employment, have dependants, and have financial commitments. All of these influence the experience of living with dementia. This means services need to work to be accessible and appropriate for a younger person. As people with dementia are stereotyped as being of old age it may be difficult to find activities to suit the younger sufferers. Activities in a range of settings such as day facilities/care homes are often planned with much older and less physical people in mind.
An activity that is suitable for an 87 year old woman with limited mobility may be unsuitable for an active 50 year old man with frontotemporal dementia who just wants to walk all day. As dementia is so strongly associated with older people, younger suffers can feel discriminated against. Outline the impact that the attitudes and behaviours of others may have on an individual with dementia (201. 4. 2) When a person with dementia finds that their mental abilities are declining, they often feel vulnerable and in need of reassurance and support.
The people closest to them including their carers, friends and family need to do everything they can to help the person to retain their sense of identity. Positive relationships and communication help to enable positive feelings. We can support people to experience a sense of well-being by helping to boost their self-esteem and confidence by providing activities which can give a sense of purpose. Although we cannot change many of the difficult realities of people’s lives with dementia, we can attend to people’s feelings. Younger people diagnosed with dementia can feel extra stigma and discrimination.
This is because dementia is so strongly associated with older people, that a younger person may not be believed when they say they have dementia, which can add to their problems. Unhelpful responses from other people can make matters a lot worse. We can support people to express their difficult feelings and gain support through doing so. And, very importantly, we can help people to experience positive feelings and achieve a sense of well-being. Much of what we hear and read about dementia does not suggest that there is any possibility of living well with it.
In order to learn how to provide constructive support to people with dementia, it is important to discard some of these unhelpful views. People with dementia do not lose their identity. It is important to talk in terms of ‘living with’ dementia rather than ‘suffering from’ it. The starting point for positive intervention and support is an understanding of the lived experience of the person with dementia, recognition of the person’s strengths and abilities, and an understanding that the person with dementia is still a unique individual with his or her own preferences, needs and story.