Dementia has a number of causes. It is categorized as being caused by four subtypes: Alzheimer’s disease (the most common subtype, accounting for 50% of dementias); Vascular reasons (such as a stroke or hypertension, accounting for 9-15% of dementias); Substance abuse persisting dementias (accounting for 7-9% of dementias, with alcohol the major cause of most of these; and General medical conditions such as Parkinson’s disease, Huntington disease, and other neurological illnesses (accounting for 20-30%). Psuedodementia can also be caused by other mental illnesses such as Major Depressive Disorder and Psychosis. Regardless of the cause, the dementias all have common factors.
Initially in dementia, which begins benignly over months and years, there is memory loss for recent events such as stoves being left on, keys being misplaced, conversations forgotten. Later, people begin to get lost while driving roads that they once knew very well, and questions must be repeated because the questions and answers are quickly forgotten. The long-ago memories are retained and dwelled upon. Personality changes occur, and the person may manifest changes that are the complete opposite from their previous personality. Poor judgement and impulse control often go hand-in-hand. They may speak crudely, make lewd gestures and display their genitals.
The intellectual functions begin to deteriorate, with the patient having trouble naming objects, difficulties understanding language, and their speech can become stereotyped, slow, vague and filled with irrelevant details and they are unable to concentrate and follow a conversation and determine what is relevant and what is not.
They begin to have difficulty with motor tasks such as drawing a house, handling money, using tools to cook, assemble blocks. Patients often deny these problems vigorously, or become ashamed of them, and enter a phase of depression, anxious, and demoralized. They may then begin to show emotional incontinence: respond to situations inappropriately by crying, laughing, hostility, and immobility at inappropriate times. They may confabulate stories to make up for lost memories to conceal the degree of memory loss. Upon examination, these patients generally move slowly and deliberately or fidget, looking glum, bored or tense. On the other side, they may portray a mood of jocularity in which they make inappropriate remarks to members of the opposite sex.
Treatment of Dementia varies widely, and the general prognosis is poor. Cogentin is widely given, along with vitamin E. During the first year of abstinence from alcohol, for instance, there is a decline in dementia, to some extent, but not to a significant level. Alzheimer’s Disease is a progressive disease usually striking after age 65 with a stealthy but steady decline. They generally live 7-10 years, but may survive up to 15 years. There is no effective medication for this condition, although Aricept can slow the progression.
As far as psychosocial care goes, the goal is to make the person’s life as simple as possible, and to provide the best level of care possible for them. To this end, they should be allowed and encouraged to what they can, but ONLY what they can, without pressing them and causing frustration and anger. The decision to move them out of the home situation is one that eventually must be made in most cases, and is one not to be taken lightly. It needs to be a family decision, as it is a difficult choice to make. Family counseling can be useful in order to make sure that no one is “assigning blame” to any other family member and to clear the air. Often times one family member may feel they are performing all the workload with the person with dementia and they need help. This is the ideal time to ask for it.