Used as a catchall term for a number of different conditions, dementia is a condition that affects some of the patients receiving palliative care from HospiceWits.
Dementia includes progressive and terminal conditions like Alzheimer’s disease, vascular dementia, frontotemporal dementia, Lewy body dementia, or a combination of these.
It is important to note that each type of dementia comes with a particular set of characteristic symptoms, which may overlap in some cases.
Perhaps the most widely studied form of dementia, Alzheimer’s disease starts in the brain many years before its symptoms are actually expressed. Although Alzheimer’s is sometimes diagnosed in younger people, 60% to 70% of cases appear in people who are older than 60 years of age.
Some of the symptoms associated with Alzheimer’s include:
- Memory problems: The ability to form new memories is usually the first to go, with memories from the recent past becoming fractured.
- Problems with executive functions: People with Alzheimer’s may have difficulty planning, organising, or thinking logically, finding themselves getting lost in time and space.
- General difficulties with regard to space and time, for example wanting a gin and tonic at 5:00 in the morning.
- Language difficulty: Patients may have trouble expressing themselves or comprehending what others are saying.
40% to 50% of patients with frontotemporal dementia have a strong genetic disposition towards the condition. Early-onset frontotemporal dementia may affect people under 60 years of age.
Some of the symptoms associated with frontotemporal dementia include:
- Behavioural changes: Patients may exhibit apathy, a loss of empathy with others, changes in diet, and impaired planning and judgement.
- Language difficulties: Patients may find themselves unable to understand language or produce speech.
Lewy body dementia
In cases of Parkinson’s disease, protein deposits called Lewy bodies occur in the part of the brain that is involved in movement. In the case of Lewy body dementia, these same protein deposits occur in the cells of the brain’s cerebral cortex.
Some of the symptoms associated with Lewy body dementia include:
- Fluctuating cognitive changes
- Loss of attention
- Changes in visual special awareness
- Sleep disorders
- Some of the physical or motor features of Parkinson’s disease, like tremors.
This condition stems from accumulated damage to the blood vessels in the brain – the nervous system is very sensitive to damage like this – caused by the blockage of small vessels or bleeds in the brain that lead to periods of oxygen depletion.
Vascular dementia can be characterised by periods of functional deterioration, interspersed with periods of relative stability.
The different stages of dementia, and how to provide care to patients
Dementia may progress in various stages, and understanding these stages allows carers and loved ones to make sense of the individual with dementia’s journey.
Stage one: Mild dementia
A person’s cognitive functioning or thinking is affected. This may include things like changes in memory, planning, judgement, mood, insight and communication. This is often the time when a diagnosis is made.
How to provide care and support: Focus on independence, autonomy, and planning for the patient’s future.
Stage two: Moderate dementia
One may see an increase in symptoms from stage one, as well as the onset of psychological and behavioural symptoms.
How to provide care and support: Safety considerations become vital, for example, not leaving the patient alone, putting security on gates and outside doors, and making sure that plugs and kitchen appliances are out of reach.
Stage three: Advanced dementia
Progressive impairment of nerve impulses starts affecting the working of the muscles. This can affect mobility, chewing, swallowing, continence, and other physical functions like contractures. During this stage, the patient will most likely require progressive assistance with daily living, and is at an increased risk of infections.
How to provide care and support: Comfort and the relief of the physical symptoms related with dementia become the focus now. Loved ones or carers may decide to use the arts as a means of communication when this becomes difficult for patients. For example, singing, dancing, tactile attention (touch) and hearing music or poems from the patient’s youth may help to settle them down.
To find out how HospiceWits can assist a loved one with dementia, please contact us here.