A GP will give a full physical examination. The doctor will ask about the symptoms and other aspects of a persons’ health. The doctor will organise some blood tests and ask about any medications that patients may be on, and other conditions (see pgs. 3, 4) because sometimes other conditions can give off symptoms similar to dementia and these need to be ruled out. Additionally the GP may refer a person to a specialist mental health service to carry out some mental exercises, this is to measure any problems with the memory or the ability to think clearly.
One of these exercises is called, the mini mental state examination (MMSE) and tests for things like short- and long-term memory, attention span, concentration, language and communication skills. Ability to plan and the ability to understand instructions. The MMSE is not a test to diagnose dementia. However, it is useful for assessing the level of mental impairment that a person with dementia may have.
Test scores may also be influenced by a person's education level. For example, someone who cannot read or write very well may have a lower score, but they may not have dementia. Similarly, someone with a higher level of education may achieve a higher score but still have dementia. Some other tests used are, General Practitioner Assessment of Cognition (GPCOG), Abbreviated Mental Test (AMT) and 7 Minute Screen.
Dementia brain scans
Brain scans are usually used for diagnosing dementia as well. They are needed to check other problems that could explain a person's symptoms, such as a major or a .
Importance of diagnosis -
Being diagnosed early is important for many reasons. It helps you to get the right treatments and to find the best sources of support, as well as to make decisions about the future.
Diagnosis can help uncertainty, this uncertainty can be distressing for both the person experiencing difficulties, and their family and friends. While a diagnosis of dementia can be devastating news, an explanation of what the problem is and what can be done about it can help people feel empowered and reduce some of the worry caused by uncertainty
Some people find it helpful to discuss with doctors and nurses how the dementia may affect them or their loved one in the future, and there is advice available about how to and .
and are neurodegenerative conditions, this means they gradually damage the brain. Cholinesterase inhibitor medications have been shown to have benefits in Alzheimer’s disease and dementia with Lewy bodies. These (donepezil, rivastigmine and galantamine) improve symptoms by making the remaining brain cells work a bit harder. Additionally Memantine is another medication that can help in Alzheimer’s disease. Even though it is not a cure, these types of medications can make a big difference to a person’s everyday living and functioning.
Whether or not there are certain treatments for the cause of the dementia affecting, having the right diagnosis is important for getting the right advice and support. There is a lot of help and information out there for people with dementia and their families. The kind of help available include,
, day centres and respite care, community mental health teams, speech and language therapists, dieticians and occupational therapists.
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Advice regarding and planning for the future.
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(such as Disability Living Allowance and Council Tax reduction).
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Advice about driving (see ).
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Advance care planning and help with setting up a if the dementia is progressive. This enables a person to be involved in discussions about their future when they are still able to do so effectively.
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Information and support groups. There are a number of sources of information and advice that are easier to find if you have a diagnosis (for example, the Alzheimer’s Society and ). Access to a support group is easier if a diagnosis is clear because support groups can provide specialist information and links to others in similar situations.
Getting the correct diagnosis is also important for research and planning. Understanding the causes of dementia, and how common these causes are important in planning services available so that help and support can be put in place that people need, locally and nationally.
Dementia in young people
Many people assume that Alzheimer's disease and other causes of dementia only affect older people. In fact, about 1 person in every 1000 below the age of 65 develops dementia. While rare, it can affect people in their 40's and 50's. Any dementia beginning before the age of 65 is known as early onset dementia.
Everybody’s experience of dementia is different. Although the symptoms of dementia are similar whatever a person's age, younger people with dementia have different needs. They may:
- Be in work at the time of diagnosis
- Have dependent children still living at home
- Have financial commitments
- Be physically fit and behave in ways that other people find challenging
- Be more aware of their disease in the early stages
- Find it hard to accept and cope with losing skills at such a young age
- Find it difficult to access information, support and services for younger people with dementia
It may harder for a young person to be diagnosed with dementia because more than likely symptoms will be put down to other conditions purely because of their age. In contrast to older people, dementia is usually the first illness thought about, relating to the symptoms.
Planning ahead can make it easier for a person and their family to manage. It can also mean that the person who is going to get the illness may be able to get involved in planning for their future and make sure that their wishes are carried out. For example, with finances a person may decide before their illness who deals with their finances (power of attorney) these arrangements cannot be made when the person is already ill.
Q2-3- Types of dementia, signs and symptoms
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Alzheimer’s disease – is the most common cause of dementia, it can affect people in the middle age however is normally a disease of old age. It can affect men or women and is unrelated to their intellectual abilities, class or race. It is a progressive physical disease which causes a decline in the ability to learn, to think, to remember and to reason. There is no cure as yet but recently there is a pill that is said to cure the disease but at the moment
Medicals are concentrating on relieving the symptoms to better a person’s quality of life.
Multi- infarct dementia (vascular) – the second most common type of dementia. An individual suffers from many small strokes destroying small parts of the brain. Infarction means the death of brain tissue. This happens when blood vesicles are blocked in the brain or burst by blood clots this kinds of damage leads to dementia. Multi-Infarct and Alzheimer’s disease can happen together.
Symptoms vary depending on the part of the brain affected by the poor blood supply. Brain scans can show what parts are affected.
Early signs include memory loss, language and personality for example a person may become agitated or unmotivated. People are more aware they have vascular than Alzheimer’s disease, this is because of being able to see on brain scans the poor blood flow and where a person has had small strokes.
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Dementia with Lewy bodies (Fronto-Temporal) is the third most common cause of dementia in the UK and more common in men. Early symptoms of Lewy dementia can show symptoms of Parkinson’s disease which include shaking in the hands, stiffness and not being able to get about as good as before.
Symptoms also show spells of confusion, hallucinations (seeing things that are not there such as animals or people and a rapid decline to death.
Rarer types of dementia
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Pick’s disease- affects the front of the person’s brain leading to loss of judgement and inhibitions.
Pick disease is a rare kind of that is alike , except that it affect only certain parts of the brain.
In the damaged areas of the brain, People with Pick disease have abnormal substances (called Pick bodies and Pick cells) inside the nerve cells.
Pick bodies and Pick cells contain an abnormal form of a protein called tau. This protein is found in all nerve cells. But some people with Pick disease have an abnormal amount or type of this protein.
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Huntington’s disease is an inherited degenerative brain disease which is slowly progressive and usually starts between the ages 30 -50. First Symptoms include slight twitching of the limbs or muscles of the face. This type of disease usually shows with frontal symptoms which affect problems with planning, thinking and personality changes. Not so much memory problems at first.
- Creutzfeldt-Jakob Disease (CJD)
Generally happens in old age. It is caused by a protein called a prion. The risk factor of this disease is not yet known although has known to run in families. Severe difficulties with movement and blindness happens quickly. A person may die within a year of developing this condition.
Q4) Effects Dementia may have on the family members
When an individuals is diagnosed with dementia, everyone is affected in some way. Children and young people may cope better than the adults as they don’t understand as much which then shows them to be more patient, loving and caring. Additionally a teenager may find is especially difficult to handle as they are also in a time of their life when many changes are happening to them.
Living with a partner could be very hard and the relationship would be definitely tested. The frustration and anger that is felt could be taken out on each other as it is only natural that when a person feels mixed emotions, is to show it to the person closest to them, furthermore there may be financial worries and it may be difficult to find the time for a walk, or just getting out and about or even making love.
Family members may possibly need to get help themselves with physiological and emotional problems due to the demanding care they are giving. Their own health may be neglected and maybe be suffering as a result.
Family members may feel anger, grief and despair but at the same time as love and compassion. They may be very protective over loved one.
Emotional pain and distress are understandable and appropriate to watching someone who has dementia. It must be mind bearing, watching them do strange things all day, things that you are not use to seeing them do.
Embarrassment
A family member may feel ashamed that it has happened to their family. When a family member’s behaviour changes and becomes anti- social (which shows to happen in some cases of dementia) they may suffer from severe embarrassment. This may affect other relationships of the carer and if it is a partner, they may not want friends to come to their house because of how there partner behaves.
Loneliness.
The family member may not want to ask for help as they may feel they are letting the person down if they do.
Anxious
Personality change may be hurtful and the demands of adapting to a different person can be tense and anxious.
Relief
Relief when the illness is diagnosed then there might be more support and help for the person suffering.
Loss
The feeling of Loss and sadness. Loss of relationship you once had. Loss of a friend, sadness at seeing a capable, lively person lose their appetite for life and abilities to do simple things. As the person deteriorates this may make it harder to cope.
Anger
When a family member is trying really hard to care, this can cause them to become aggravated because of lack of sleep and stress.
A family member may feel angry if they think there is not enough care in place or offered by the professionals for their relative. And this anger may be because they are crying out for help.
Uncertainty
Living or being around someone with dementia could make you feel nervous because of the unknown, not knowing how they are going to be or what is going to happen next. You would be also living with the uncertainty of the illness itself. Not knowing what the next stages will bring.
Exhaustion
It could be physically and mentally exhausting caring for a family member and difficult to keep up with.
Love, humour and compassion
Some family members may use humour to defuse the tension and anxiety that builds up.
It is normal to feel all or some of these emotions when a family member has dementia you are not alone.
Effects Dementia has on a person’s health and quality of life
Dementia shows to affect a person’s quality of life in many ways such as
Work- A person may have to leave work or need extra support while working. Or maybe take on another role at work that is not too much for the person. At least this way the individual still has a purpose and this may help to maintain their self- esteem while going through the symptoms of dementia.
Driving- Driving will be affected as dementia can affect the ability to drive safely. When a hazard arises a person with dementia may not be able to react as quickly as someone without dementia. Not being able to get out and about could stop the person from going out resulting in them feeling very lonely.
General advice- Assistance and support with paying the bills, benefits and just general advice.
Making decisions – as dementia progresses individuals are less able to make decisions. Yet some people in the early stages make decisions for later on.
Toileting and incontinence – an individual with dementia may lose their ability to recognise when they need to go to the toilet, what to do in the toilet and where it is. They may forget to wash and no longer understand the need for washing.
Socially this will affect the individual because of hygiene measures, friends and other people may not want to go near because of their smell, what they look like, and this negative impact that other people are showing towards the persons will make the person with dementia feel not good about themself and may stop them going out if they think people are judging in a negative way. This will result in them staying in the home, having no social life. This could worsen the symptoms of dementia as physically the person will probably be getting no exercise if they are around the home all day every day. They may just want to sleep if they are not feeling good about themself and intellectually the brain will be getting no stimulation. This will result in the person going downhill very quickly.
In groups discuss each of the points and develop one example of how a person’s quality of life will be impacted. This will then be used as part of your P2.
Look after your health
Eating well and exercising is important for everyone to live well
Living a healthy lifestyle is important for everyone, as well as people with dementia.
Regular, nutritious meals may become a challenge for people with dementia. As a person's cognitive function declines, he or she may become overwhelmed with too many food choices, forget to eat or have difficulty with eating utensils.
Proper nutrition is important to keep the body strong and healthy. For a person with dementia, poor nutrition may increase behavioural symptoms and cause weight loss.
The eat well plate shown below shows the different kinds of food that make up our diet, and in order to have a well-balanced healthy diet it shows the amount a person should be eating.
Based on the eat well plate, a person should eat,
Here is an example of a healthy diet for one day;
Breakfast – porridge oats with banana slices and a cup of orange juice
Lunch – mash potatoes chicken fillets, vegetables and gravy – water
Dessert – rice pudding and jam
Dinner – soup with bread – banana, water
Tea time– Horlicks, hot chocolate or tea.
As dementia progresses, a person may not want to eat, forget to eat or find it difficult to cook. Some people develop depression which then they do not feel they want to eat. With all these factors that can be occurring in a person could result in the person losing a vast amount of weight. If weight loss becomes a concern the doctor will need to be seen and may prescribe vitamins drinks to have during the day on top of meals to make up the loss of calories. Additionally in some serious cases a person may have to be fed through a drip.
It is important for a person with dementia to keep hydrated. Water and other drinks such as milkshakes and smoothies should be available and offered throughout the day, every day.
In order to help a person with their eating there are some strategies that a carer can do to try and make meals times better for an individual, for example,
- Give the person plenty of time to eat
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Serve only one or two foods at a time
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Check the food temperature.
A person with dementia might not be able to tell if something is too hot to eat or drink.
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Limit distractions. The TV may distract a person with dementia from eating.
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Keep the table setting simple. Just have on the table the things needed for the meal such as the utensils.
exercise
Leading a physically active lifestyle can have a significant impact on wellbeing. is beneficial for physical and mental health and can improve the quality of life for people at all stages of dementia.
As a person’s dementia develops it may affect their ability to do certain exercises as they may be frightened that they might fall as they find it hard to co-ordinate and judge spaces and also may be lacking motivation. Additionally a disabling environment can also stop a person from exercising for example, in some care homes, people are not persuaded or supported to do exercise, as it may be easier for the carer to leave the service users to sit around all day.
The benefits of exercise
There are many benefits to exercise and these include health, social and intellectual benefits.
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Exercise improves physical function, maintaining muscle strength and joint flexibility and can be a way of helping people for longer.
- Exercise helps to reduce the risk of osteoporosis and keeps the bones strong in addition physical activity can improve strength and balance, this could help to reduce the risk of falls as it may help to counteract the fear of falling.
- Reports suggests that exercise may slow down mental decline and improve memory.
- Exercising may reduce the feeling of isolation, as it opens opportunities for social interaction.
- Sleep is said to be improved.
- Exercise may make a person feel good about them self, giving them confidence about them self and what they can do. (A sense of achievement).
Below are some examples of exercises that you as the carer or the person can do them self with a little bit of encouragement.
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A person could do some simple stretches in the home for example, by using a couple of tins in each hands used as weights.
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Exercise DVDs such as ‘Tai chi’, this could help with a person’s balance and at the same time exercising.
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Going out for a walk, maybe a place where it is not too crowded.
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Gardening, simply pulling weeds can be a satisfying source of exercise.
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Swimming is not only good exercise but relaxing and may relieve stress that dementia may be causing.
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Cleaning in the home
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Exercise classes for people with dementia can be fun and a person can socialise at the same time, and maybe talk to each other about their dementia helping them to feel they are not alone.
To encourage a person to exercise, may be in a care home or daycentre there could be an exercise class that is not too strenuous with a persuading leader that everyone gets involved in.
Carer that go out to peoples home should try to do exercise with them whether it be sitting down exercise or just taking them for a walk on a regular basis.
- Abuse Explain why it is important to have an understanding of abuse.
- Give examples of how to involve family and friends in safeguarding individuals with dementia
- Give examples of assistive technologies available to minimise risk and explain how they are used
- Explain why individuals with dementia are at increased risk of falls.
Older people are vulnerable to abuse, especially those who are unwell, frail, confused and unable either to stand up for themselves or keep track of their affairs. Is it important to know the signs of abuse in order to give good care to the person with dementia.
Mentally ill people are four times more likely to be victims of violence.
Older people with mental health needs are at greater risk of abuse than other groups of older people.
References
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