Dementia refers to a loss of cognitive function (cognition) due to changes in the brain caused by disease or trauma. The changes may occur gradually or quickly; and how they occur may determine whether dementia is reversible or irreversible.
Cognition is the act or process of thinking, perceiving, and learning. Cognitive functions that may be affected by dementia include the following:
- Decision making, judgment
- Memory
- Spatial orientation
- Thinking, reasoning
- Verbal communication
Dementia also may result in behavioral and personality changes, depending on the area(s) of the brain affected.
Types:
Some dementia is reversible and can be cured partially or completely with treatment. The degree of reversibility often depends on how quickly the underlying cause is treated. Irreversible dementia is caused by an incurable condition (e.g., Alzheimer's disease). Patients with irreversible dementia are eventually unable to care for themselves and may require round-the-clock care.
Incidence and Prevalence An estimated 2 million people in the United States suffer from severe dementia and another 1 to 5 million people experience mild to moderate dementia. Five to eight percent of people over the age of 65 have some form of dementia and the number doubles every 5 years over age 65.
The prevalence of dementia has increased over the past few decades, either because of greater awareness and more accurate diagnosis, or because increased longevity is creating a larger population of elderly, which is the age group most commonly affected.
Risk Factors:
The greatest risk factor for dementia is advanced age. Inheriting the genes associated with Alzheimer's or Huntington's disease is a risk factor. Untreated infectious and metabolic disease and substance abuse also can lead to dementia.
Other risk factors include the following:
- Brain tumor
- Cardiovascular disease (e.g., hypertension, atherosclerosis)
- Head injury
- Kidney failure, liver disease, thyroid disease
- Vitamin deficiencies: B12, folic acid, B1 (thiamine)
Tips for dealing with dementia sufferers
- The basis of the relationship is the absolute and unconditional esteem for the patient, the love for him/her, the struggle for the acceptance of this person with his/her illness. This emotionally dedicated esteem has to be constantly renewed even in crisis situations and does not go without saying. Acceptance of the patient and the situation also means setting limits, taking responsibility and leadership, providing orientation. It is, however, necessary to react to their behavior in an adult manner and not to embarrass the patient.
- You will not succeed without empathy in gaining access to the inner frame of perception and behavior, in understanding the emotions and feelings of the patient. If the efforts to understand wane, there is a risk that people with dementia become objects of nursing and disappear as a person. There are limits here as well: we cannot understand everything and there is not a convenient theory for every anomaly of behavior. One must try to accept this as well, to accept what cannot be understood.
- Sincerity and truthfulness substantiate sensitive understanding and esteem. One has to be completely genuine provided this does not harm or hurt the patient. Pretending to have more esteem than one really feels undermines relationships. One reacts false using friendly facades, ambiguity, artificial role play, emotionally shallow encounters. People with dementia notice this and reject or retreat - caring for people with dementia means to make your own self available, the whole range of your ability for affection.
- It is important to understand the inner world of the care receivers, to foresee their plans, to supplement and to enable again and again a small feeling of success. Behave like a tennis coach who plays the ball to a pupil in a way that he can return it.
- Create a reliable daily routine with small rituals (from washing hands, saying prayers, preparing food, cleaning and singing to a little dancing before bedtime). Activate the patient in the framework of this routine without too little or too much demand. Existing capabilities should be used if possible because self-esteem relies on their use. Discreetly link into former habits, weave in memories, give the patient things to hold which represent parts of his/her life (christening candle, child's hat, wedding veil). Remember that the focus is always on the experience and not on the result. Feeling good preserves the feeling of being a person.
- As the disease progresses, the body very much becomes the focus. Physical closeness, touching hands, gestures and eye contact, firm grip of the other with your own body, showing your own feelings creates a warm sense of security, closeness and comfort.
- Try to communicate attentive calmness: allow unusual behavior, reduce your rejection of bizarre behavior and take care that your relative does not endanger himself. Resist the impulse to intervene and ask yourself from time to time what is the meaning of a particular type of behavior and what 'pleasure' is behind it.
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