Description

Dementia, by definition, is a progressive degenerative disease of the brain. There are many different types of dementia. The two most common types of dementia are Alzheimers Dementia and Vascular Dementia. Other less common types of Dementia include Dementia associated with Parkinson's Disease, Pick's Disease and Creutzfeldt-Jacob Disease. Dementia is usually divided into Mild, Moderate, Severe and End Stages.

Since Dementia has so many different causes, the symptoms commonly associated with each stage may overlap and progress at different rates. Common early symptoms of Dementia include: progressive forgetfulness leading to short term memory loss, impaired judgment, difficulty in performing normal activities ( such as picking out appropriate clothing, forgetting how to brush your teeth), loss of ability to plan (such as planning the sequence of steps necessary to cook a meal), disorientation, depression, lack of emotional or physical vigor (no longer excited about life events that use to cause excitement), forgetting the right word to use or name of a person, forgetting how to operate commonly used tools or equipment.

As Dementia progresses there is increased difficulty with language, social withdrawal, behavioral issues as inhibitions diminish, agitation, restlessness, wandering, difficulty in recognizing people or understanding what is being said to them, loss of ability to think in abstract terms, disturbances in sleep, repetitive action and speech, and in some people hallucinations and delusions.

As people enter into the final stages of Dementia, physical, emotional and mental loss will continue. These losses include: loss of ability to transfer, reposition self or walk, inability to feed themselves leading to an inability to swallow food or liquids, decrease in ability to communicate and in some people the total loss of ability to speak, incontinence of bowel and bladder, progressive weight loss and increased frailty. As Dementia progresses, meeting care giving and safety needs becomes the focus.

Talking with your medical provider regarding options will help you to establish an individualized plan of care. In the final stages, people will be totally dependent on others to see to their needs. However, when possible, keeping the person with Dementia in familiar surroundings with daily contact by familiar faces offers the best outcome for all involved. Care giving is an arduous task. Hiring paid care givers and in home support may be necessary.

Questions

• What do you mean when you say forgetfulness (everyone can become forgetful when under stress or over tired)?
• Is there difficulty with them finding the correct word or is there actual short term or long term memory loss?
• Is there any difficulty in organizing thoughts or planning or carrying out a series of steps?
• Has there been any change in their personality or behavior?
• Has there been any change in their ability to perform the tasks of daily grooming, dressing, toileting, etc.?
• Is there any difficulty in their swallowing (coughing, choking or history of unexplained pneumonia) or changes in their appetite or weight loss?
• Are their normal social interactions as before?
• Does the person repeat themselves again and again?
• Is the person walking with a steady gait, is there an increased risk of fall?
• Is the person wandering or pacing about the house?
• If the person left the home, could they find their way back home?
• Can the person drive a car or operate machinery safely?
• What is your ability to care for the person-are they receptive or resistive to your care?
• Does the person become agitated easily-is it dependent on how the person is approached?
• Is there any evidence of confusion or disorientation? Any hallucinations?
• Is there a time of day or night when behavior becomes a problem?
• Is the person still able to handle their own finances as before?
• Is the person experiencing sleep disturbance?
• Is the person experiencing any changes in bowel or bladder control?

Important Points to Consider

The diagnosis of Dementia is devastating to all involved. It is important to find out what type of Dementia has been diagnosed, as each will have specific issues which need to be recognized and managed. Understanding medications prescribed for Dementia itself and for managing symptoms is essential.

Care giving is difficult work, especially knowing that Dementia is progressive, irreversible and terminal. Dementia is a disease of a thousand losses. Watching someone lose their ability to care for themselves, interact meaningfully with others, and finally losing their self identity is heartbreaking. Community support is available, ask your health care provider about community resources in your area. Resources are also available on line.

Related topics

Bedside Care
Managing dementia