The Tragedy of Dementia
A decline in cognitive functioning that disrupts life.
The reader needs to understand that many of the symptoms of dementia must be considered because we all occasionally misplace things like our keys, iPhones, eyeglasses, and other such items. The key word here is occasional.
During my career in mental health, I had a few clients who developed dementia. All of them were older. In two of the cases, the clients got lost on the way to my office after months or years of our meeting. In all cases, the work shifted to family therapy with the specific goal of planning the future of their loved one. It is always sad to see someone mentally vanish in front of your eyes.
In psychology, there is a concept known as remembering in context. It is common to remember wanting to do something while in one room, then walk into the next room and suddenly realize you forgot what it was you wanted to do. Walking back to the first room may help you remember, but it will eventually come to mind. None of these are symptoms of dementia. However, if you or your loved ones have any doubts, please consult your physician.
Dementia is a broad term that describes a decline in cognitive function severe enough to interfere with daily life. It is not a single disease but a general term that encompasses a wide range of specific medical conditions, including Alzheimer's disease, which is the most common cause of dementia among older adults.
Dementia affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. However, consciousness is typically not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation.
*From the Mayo Clinic, the Symptoms of Dementia
Cognitive Changes:
Memory loss, which is usually noticed by someone else.
Problems communicating or finding words.
Trouble with visual and spatial abilities, such as getting lost while driving.
Problems with reasoning or problem-solving.
Trouble performing complex tasks.
Trouble with planning and organizing.
Poor coordination and control of movements.
Confusion and disorientation.
Psychological Changes:
Personality changes.
Depression.
Anxiety.
Agitation.
Inappropriate behavior.
Being suspicious is known as paranoia.
Seeing things that aren't there is known as hallucination.
Risk Factors that Cannot be Changed:
Age. The risk of dementia rises as you age, especially after age 65. However, dementia isn't a typical part of aging. Dementia also can occur in younger people.
Family history. Having a family history of dementia puts you at greater risk of developing the condition. However, many people with a family history never develop symptoms, and many people without a family history do. There are tests to determine whether you have certain genetic changes that may increase your risk.
Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer's disease.
Risk Factors that Can be Changed:
Diet and exercise. Research has found that people at higher risk of dementia who followed a healthy lifestyle lowered their risk of cognitive decline. They ate a diet that included fish, fruits, vegetables, and oils. They also exercised, had cognitive training, and participated in social activities. While no specific diet reduces dementia risk, research shows that those who follow a Mediterranean-style diet rich in produce, whole grains, nuts, and seeds have better cognitive function.
Drinking too much alcohol. Drinking large amounts of alcohol has long caused brain changes. Several extensive studies and reviews found that alcohol use disorders were linked to an increased risk of dementia, particularly early-onset dementia.
Cardiovascular risk factors include obesity, high blood pressure, high cholesterol, and the buildup of fats in the artery walls, known as atherosclerosis. Diabetes and smoking are also cardiovascular risk factors. Diabetes can increase the risk of dementia, especially if it's poorly controlled. Smoking might increase the risk of developing dementia and blood vessel disease.
Depression. Although not yet well understood, late-life depression might show the development of dementia.
Air pollution. Studies in animals have indicated that air pollution particulates can speed up the degeneration of the nervous system. Human studies have found that air pollution exposure—particularly from traffic exhaust and burning wood—is associated with greater dementia risk.
Head trauma. People who've had severe head trauma have a greater risk of Alzheimer's disease. Several extensive studies found that in people aged 50 years or older who had a traumatic brain injury (TBI), the risk of dementia and Alzheimer's disease increased. The risk increases in people with more severe and multiple TBIs. Some studies show that the risk may be greatest within the first six months to two years after the TBI.
Sleep problems. People who have sleep apnea and other sleep disturbances might be at higher risk of developing dementia.
Low levels of certain vitamins and nutrients. Low levels of vitamin D, vitamin B-6, vitamin B-12, and folate can increase the risk of dementia.
Medicines that can worsen memory include sleep aids containing diphenhydramine (Benadryl) and medicines to treat urinary urgency, such as oxybutynin (Ditropan XL).
Also, limit sedatives and sleeping tablets. Talk to a healthcare professional about whether any of the medicines you take might make your memory worse.
*Information from the Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013
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Alzheimer's disease is characterized by the build-up of amyloid plaques in the brain, leading to the death of brain cells. Symptoms usually start slowly and worsen over time, including memory loss, confusion, impaired judgment, language deterioration, mood swings, and long-term memory loss.
Vascular dementia, the second most common type of dementia, results from damage to the vessels that supply blood to the brain. It can be caused by stroke or other conditions that block or reduce blood flow to the brain, depriving brain cells of oxygen and nutrients. Symptoms often overlap with those of Alzheimer's but may also include difficulty with problem-solving and concentration.
Lewy body dementia is associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain that can lead to problems with thinking, movement, behavior, and mood. Symptoms include visual hallucinations, sleep disturbances, and Parkinson's disease-like symptoms.
Frontotemporal dementia is a group of diseases characterized by the degeneration of nerve cells in the frontal and temporal lobes of the brain. This damage leads to symptoms such as changes in personality and behavior, difficulty in speaking and writing, and a decline in the ability to move or maintain balance.
It is important to note that while there is currently no cure for most types of dementia, there are treatment options that can help manage symptoms. Therapies can include medications to improve symptoms, as well as non-medical interventions such as cognitive therapy, lifestyle changes, and supportive services to help manage daily activities and improve the quality of life for both the person with dementia and their caregivers.
Recognizing the early signs of dementia can be crucial for early intervention and management. One of the earliest and most common signs is memory loss, which disrupts daily life. This is not just occasional forgetfulness, like misplacing keys, but more significant memory loss, such as forgetting important dates or events, asking for the same information repeatedly, or increasingly needing to rely on memory aids or family members for tasks they used to handle on their own.
Another early sign of dementia is facing challenges in planning or solving problems. Some people may need help with following a familiar recipe, keeping track of monthly bills, or taking longer to do these tasks because of concentration issues. Changes in completing familiar tasks at home, at work, or during leisure activities can also show dementia. This includes trouble driving to a familiar location, managing a budget, or remembering the rules of a favorite game.
Gradually, people with dementia experience confusion with time or place. They can lose track of dates, seasons, and the passage of time. They need help to understand something if it is happening after a while. They forget where they are or how they got there. Reading becomes a problem because the individual cannot remember what they just read.
Problems with words in speaking or writing are common. Someone with dementia may struggle with vocabulary, following or joining a conversation, finding the right word, or calling things by the wrong name.
Additionally, misplacing things and losing the ability to retrace steps is an early sign. A person with dementia may put things in unusual places, lose things, and cannot go back over their steps to find them again. This may lead them to accuse others of stealing, especially as the disease progresses.
Another symptom includes poor money handling, such as giving large amounts to telemarketers or paying less attention to grooming or personal cleanliness.
One of the most heartbreaking symptoms of dementia is the failure of the individual to recognize their loved ones. It is cruel when someone no longer recognizes their spouse, adult children, grandchildren, and many other well-known members of the family.
Caring for someone with dementia is a challenging journey that requires patience, understanding, and a network of support. Given the progressive nature of the condition, caregivers often navigate a range of emotions and responsibilities that can be both exhausting and depressing. These emotions become complicated when the caregiver and patient have a long history of contentiousness and conflict.
In my experience, it is usually the oldest daughter who becomes the primary caregiver. That happened when my grandfather became a dementia patient, and responsibility fell on her shoulders. While she had brothers, they did little or nothing to help.
Emotional support is vital for caregivers to help manage the stress and emotional toll that dementia care can demand. This can come from family and friends, as well as formal support groups where caregivers can share experiences, advice, and coping strategies. These groups, whether in person or online, offer a sense of community and understanding that can be incredibly comforting.
Practical support involves help with the day-to-day tasks of caring for someone with dementia. This can include respite care, which gives caregivers a temporary break from their duties. Community services may offer home health aides, adult day care centers, and meal delivery services to ease the practical burdens on caregivers.
Informational support is crucial in helping caregivers make informed decisions about care. This includes access to resources on dementia, understanding the stages of the disease, and learning about the legal and financial planning necessary to manage the person's care effectively. Healthcare professionals, dementia organizations, and online resources can provide valuable information and guidance.
Technology also offers tools that can help in caregiving, such as medication reminder systems, GPS devices to prevent wandering, and apps designed to improve communication with healthcare providers and manage medical records.
*Prevention
There's no sure way to prevent dementia, but there are steps you can take that might help. More research is needed, but it might be beneficial to do:
Keep your mind active. Mentally stimulating activities, such as reading, solving puzzles, and playing word games, might delay the onset of dementia and decrease its effects.
Be physically and socially active. Physical activity and social interaction might delay the onset of dementia and reduce its symptoms. Aim for 150 minutes of exercise a week.
Quit smoking. Some studies have shown that smoking in middle age and beyond might increase the risk of dementia and blood vessel conditions. Quitting smoking might reduce the risk and improve health.
Get enough vitamins. Some research suggests that people with low levels of vitamin D in their blood are more likely to develop Alzheimer's disease and other forms of dementia. Certain foods, supplements, and sun exposure can increase vitamin D levels.
More study is needed before an increase in vitamin D intake is recommended for preventing dementia. But it's a good idea to make sure you get adequate vitamin D. Taking a daily B-complex vitamin and vitamin C also might help.
Manage cardiovascular risk factors, treat high blood pressure, high cholesterol, and diabetes, and lose weight if you're overweight.
High blood pressure might lead to a higher risk of some types of dementia. More research is needed to determine whether treating high blood pressure may reduce the risk of dementia.
Treat health conditions. See your doctor for treatment of depression or anxiety.
Maintain a healthy diet. A diet such as the Mediterranean diet might promote health and lower the risk of developing dementia. A Mediterranean diet is rich in fruits, vegetables, whole grains, and omega-3 fatty acids, which are commonly found in certain fish and nuts. This type of diet also improves cardiovascular health, which also may help lower dementia risk.
Get good-quality sleep, practice good sleep hygiene, and talk to a healthcare professional if you snore loudly or have periods where you stop breathing or gasp during sleep.
Treat hearing problems. People with hearing loss are more likely to develop problems with thinking, known as cognitive decline. Early treatment of hearing loss, such as hearing aids, might help decrease the risk.
*From Mayo Clinic
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Last, caregivers should take care of their health. This means ensuring they have time for themselves, maintaining their medical appointments, eating well, exercising, and seeking mental health support when needed. Caregiver burnout is a real and serious issue, and addressing one's own needs is essential for being able to care for someone else effectively.
While the role of a caregiver for someone with dementia can be intense, there is a range of support options available to help manage the demands. Leveraging these resources can make a significant difference in the well-being of both the caregiver and the person with dementia.
One resource I can recommend is the Alzheimer's Association. They can be reached at 800-272-3900. They have a 24/7 Helpline.
I really don't know. Who knows, with all the environmental pollution today. I've stopped drinking any kind of cola and an kind of soda but, will that help me? Again, I don't know.
This article just might be the most important most comprehensive layperson "introduction to the dementias" article on the subject of dementia I've ever read! Thank you.
I've read many articles having had a Mom with early onset D, fronto-temporal and / or Pick's disease, a Dad with alcoholic D, a step-mom withe Lewy Body D, and a husband with Vascular D. Every single one of them had been a heavy smoker and my husband also had uncontrolled high blood pressure starting in his 30's because he did not like taking pills and hid that situation from me until too late and he had had many mini-strokes and a larger one. (By age 78 he also had chronic kidney disease and was bedridden and fully incontinent because of his decades of not controlling the pills for the ten years after his larger stroke helped, but not enough. He never was "out of it" and always knew who people were, but that did not make caregiving "easy". But I state that no matter who the caregivers are and no matter how far gone the one with dementia is, everyone in the immediate family suffers and has their lives, pockets, and careers affected in major and cruel ways.
It seems to me that since dementia is so prevalent that there should be a widespread public program of optional savings accounts for dementia care -- like HSA are an option but only for some employers-- and wide spread vetted and available caregiver helpers and that such care should not be limited to private "long term care" policies with many having onerous "deductibles" such as $25,000 deductibles.
Way too many people, employers, and families suffer from the inability to find and/ or afford proper D care and have to resort to ruined lives, ruined careers, lack of proper respite care, ruined employment situations when family medical leave is inadequate, etc. And long-term care policies as they exist now are unaffordable and community programs as they exist now are haphazard, some are of poor quality, and many proper affordable programs not available at all.
For the life of me I don't understand why any concepts such as "healthcare and caregiving are human rights"--and even Medicaid expansion is denigrated by the rich-- are anathema to too many MAGATS when heath conditions and dementias equally affect people too often irrespective of race and economic class to begin with and then may become more prevalent for certain racial and economic classes of groups of people over and above the basic numbers of wide spread dementias.
And it will be an even larger nightmare if Trump is elected and if politicians such as Rubio, Rick Scott and DeSantis are kept in power or allowed even greater political power. The last three have denied Floridians Medicaid expansion, for example. And we all know about the active talk, if not planning, by and in behalf of MAGATS to restrict or drastically cut the already inadequate Social Security and Medicare.
(Medicare does not help with the $500-600 a month for incontinency supplies, for example, and per accountants I've discussed it with, there are no tax deductions. Further, when a spouse with Social Security dies and leaves a Spouse with his or her own Social Security, the survivor loses one Social Security. One day a family may have $25,000 or more in a budget for either their own or future dementia, caregiving, non-emergency medical transportation* and incontinency needs and as of the first day of the month after the first spouse's death the survivor might have $25,000 or more less in the budget. * Just try getting a bed-ridden person to a doctor or hospital for non-emergency needs: Medicare does not pay and it can be $1,000 or more round trip for two large men and a gurney.)
Both dementia care --and even non-dementia chronic care--in the US is a nightmare and inhumane disgrace.