4 3778 June 1, 2021 at 21:48 Author of the publication: Yanina Burakova, designer Editor: Diana Kirss, doctor
According to WHO, there are approximately 50 million people with dementia worldwide. About 10 million new cases of the disease are detected every year. The proportion of the general population aged 60 years and over with dementia at any one time is estimated to be 5-8 people in every 100 people. The total number of people with dementia is projected to be around 82 million in 2030 and 152 million by 2050. (Source https://www.who.int)
As life expectancy increases, cases of this disease have become more frequent. Senile dementia, or senile dementia. The signs of senile dementia, causes and recommendations for caring for patients are repeatedly described on the Internet. Even how to treat senile dementia. At the same time, the question remains open: what should relatives do?
Forums where relatives share their observations and support each other help a lot. But everyone agrees on one thing - the patient is unpredictable, if you leave him for a day, you don’t know what kind of destruction you will find in the apartment.
What is dementia and what are its manifestations?
Dementia is the loss of cognitive, or, as experts say, cognitive abilities, that is, memory, attention, speech, spatial orientation and others.
Previously, this condition was called dementia, and the extreme degree of its manifestation - marasmus, but now these names are not used in medicine.
With dementia, cognitive abilities are permanently impaired, that is, we are not talking about a temporary deterioration in mental state, as, for example, during an acute illness. The diagnosis of dementia is established if memory and other functions are reduced for more than six months.
Some decline in memory for recent events is natural in old age, and this phenomenon is called benign forgetfulness. When impairment reaches the level of dementia, people have difficulty performing everyday tasks that were previously easy.
If normally a person can make his forgetfulness noticeable only to him, then with dementia the changes are visible first to close people, and then to everyone around him.
What happens if you don't get rid of dementia?
This condition is not congenital but occurs as a result of brain damage. Most often this happens in old age, when recovery processes are much slower and getting rid of dementia is most difficult. Cognitive decline in old age is considered normal. Dementia is said to occur when this process occurs excessively quickly. Dementia is considered one of the most serious diseases of our time, since it lasts quite a long time and causes a lot of trouble for the patient and his family. Researchers say that this disease is diagnosed in every tenth person over 65 years of age. At the same time, the frequency of brain damage increases with age. About 30% of people over 85 years of age are in this condition.
Causes of dementia
Dementia is not the name of a specific disease. We are talking about a combination of symptoms (syndrome) that can be caused by various reasons. Only a doctor after an examination can understand which disease led to dementia.
Most often (in 2/3 of cases), dementia in older people develops due to Alzheimer's disease, in which, for reasons that are not entirely clear, nerve cells in the brain steadily die.
The second most common cause of dementia is atherosclerosis of cerebral vessels (deposition of cholesterol plaques in them), and in this case dementia is called vascular.
Alzheimer's disease and vascular dementia are incurable. If the diagnosis is correct, do not believe those who promise recovery. There have been no such cases in history, and this fact must be accepted.
Photo from bestichilov.ru
Other causes of dementia are less common, and there are many of them: alcoholism, genetic diseases, traumatic brain injuries, lack of thyroid hormones, increased intracranial pressure and others. In some of these cases, it is possible to address the cause and cure the dementia.
Memory loss and loss of everyday skills are not normal at any age. It is always the result of illness or injury. It is very important to recognize dementia early and see a doctor.
How to behave with people with dementia: give up or try to fight?
Unfortunately, there is no magic cure that can cure dementia. However, nootropics and vitamin-mineral complexes should not be neglected: they promote blood circulation and stimulate brain activity. Experts recommend doing simple exercises for attention, memory, and fine motor skills every day. Working with cards, art therapy, solving crossword puzzles - all these activities can slow down the rapid development of dementia and support the patient’s mental activity.
How to recognize dementia in its early stages
With different types of dementia, symptoms may vary and appear in different sequences. Typically, dementia in Alzheimer's disease develops gradually, gradually, and often loved ones have difficulty remembering when the patient first showed changes.
Unfortunately, many people with dementia never receive modern medical care because their family considers their condition “normal.” Most often, a doctor is consulted at a time when it is no longer possible to slow down the process and the few medications that can temporarily improve the condition no longer work.
A person is likely to develop dementia if: • they constantly lose important things: keys, documents, etc.; • puts things in completely unusual places; • suspects that lost items are stolen and cannot be dissuaded; • asks the same thing over and over again, forgetting the answer; • finds it difficult to navigate on the street; • makes serious mistakes in things that used to be easy (for example, filling out receipts).
Even one of the listed signs is a reason to consult a neurologist or psychiatrist.
A person who develops dementia often feels weak and suffers from the fact that they cannot do things that were previously easy. He can hide problems and simply refuse difficult tasks, explaining that he doesn’t want to or doesn’t have time.
On the Internet you can find many tests that are used for diagnosis, including to assess your own cognitive abilities. It must be understood that a diagnosis is never made solely on the basis of the patient's performance of tests. The doctor evaluates many indicators, but tests are quite suitable as the “first call” that will force you to see a doctor.
One of the simplest and most reliable is the task of drawing a clock. A person is asked to draw from memory a round dial with all the numbers and hands so that they show a certain time, for example, four hours and thirty minutes.
A healthy person can easily cope with this task. With the development of dementia, errors in this test begin to appear very early: for example, the “mirror” arrangement of numbers, the numbers 13, 14 on the dial, etc. Usually, by this time, problems that can alarm relatives are already noticeable in everyday life. There is no need to wait for them to disappear: the sooner you see a doctor, the more treatment options your loved one will have.
How behavior changes with dementia
Memory and other cognitive abilities are gradually and naturally lost with any progressive dementia. Moreover, the behavior of two patients with the same diagnosis can be very different.
Some are passive and “don’t cause problems,” others are restless and even aggressive. All people with dementia experience behavioral changes, but the predominant impairments vary. Let's look at the most common and difficult behavioral symptoms of dementia for caregivers.
Gustav Klimt, fragment of the painting “The Three Ages of a Woman.” Photo from rfi.fr
Home care or nursing home?
How to care for an elderly person with dementia whose brain is affected by degenerative processes is up to the family to decide. It is worth considering that the patient, once wise and independent, turns into a child - rude, harsh, capricious and manipulative. But children develop, acquiring skills and abilities, and old people over 60 with dementia lose them. In this case, thoughts about a boarding house where an elderly relative will be surrounded with attention and care are not a betrayal. People in Russia, following Europe and America, are increasingly abandoning home care without specialized knowledge and skills, and are deciding in favor of specialized medical institutions.
Character changes
With the development of dementia, the character always changes. Already in the early stages of dementia, loved ones sometimes notice that a previously active person has become indifferent and lacking initiative. The patient can sit in front of the TV or look out the window all day without doing anything.
The fact is that certain parts of the brain are responsible for the desire for activity and planning, and with dementia their work is disrupted. It is useless to shame the patient or expect him to “pull himself together” and do something on his own.
With dementia, only healthy loved ones can encourage a person to be active, and they will have to support and control what he will do all the time. For some patients, the activity becomes constant and “stupid”, for example, they take things out of closets, sort through something, tear fabric.
With dementia, a person can become selfish, irritable, and impulsive. Sometimes the patient becomes like a child: he is impatient, his mood changes quickly, and “hysterics” occur.
Great grief is caused to loved ones by the fact that a person who is still alive loses his personality and changes irreversibly, but this is inevitable, because the disease destroys his brain.
Rave
We often use the word “delirium” in our speech, but, fortunately, few have encountered this mental pathology in their loved ones. Nonsense is not some absurd statement. In terms of content, it can be very close to reality: for example, after a legal battle, a woman develops a delusion that her ex-husband wants to take away her apartment, which was really the basis of his claims.
The point is not whether the ex-husband wants to take away the apartment, but that even if he changes his mind, this will not affect the woman’s thoughts. A person who has become delusional does not need real facts in order to draw conclusions.
So, delirium is a thought that is generated without relying on outside information. Normally, a person draws conclusions based on what he perceives and adjusts his thoughts taking into account what he sees and hears. In a state of delirium, a person, on the contrary, “adjusts” reality to his thought.
It looks like this: the neighbors didn't just trim the bushes, but to watch his windows; his relatives specially take good care of him in order to lull his vigilance and kill him, etc. The thoughts of a delirious person revolve around the same topic, and it is impossible to dissuade him.
Your words do not correct the picture of reality, because the point of nonsense is that it does not need confirmation. In the vast majority of cases, it is treated with special medications called antipsychotics or antipsychotics.
Delusions in dementia have their own characteristics: usually this is the so-called “delusion of harm”, and we are talking about the fact that neighbors or acquaintances are trying to harm (take away an apartment, poison, ruin life in other ways).
This is “nonsense of a small scale,” that is, the plot is tied to one’s own home and does not extend beyond its borders, for example, in a hospital the patient does not make any accusations against the staff, but once at the dacha, he “remembers” that the neighbors move the fence at night, to seize part of his land, and the situation does not change with the change of neighbors.
Sometimes delirium has virtually no effect on behavior: for example, the patient constantly loses things, is sure that the neighbor is stealing them, but, apart from grumbling, does not perform any actions. In other cases, for delusional reasons, patients become aggressive: they kick relatives and caregivers out of the house, write complaints to the police, etc.
Photo from psychcentral.com
What to change in the house
- If possible, furniture and curtains should be bright, but without patterns.
- If possible, highlight the doors to the bathroom and toilet with bright colors or large stickers - this will make it easier for the patient to remember them.
- The dishes should clearly stand out against the background of the kitchen - but, again, without small patterns, which often “confuse” patients, causing visual illusions.
- If a person gets nervous from the sight of mirrors (not necessarily, but it happens), hang them up.
- Some patients find TV soothing - the main thing is that the video and sound do not require constant, long-term attention. For example, videos with landscapes accompanied by music are suitable. It scares some people - then it’s better to remove it.
- Try to reduce noise in the room. Some patients are not able to realize and say that radio/music/TV shows tire them.
- Equip bathrooms with handrails (preferably in a contrasting color so that they catch the eye). If you are renovating, make anti-slip surfaces in the bathrooms. If this is not possible, install rubber mats.
Read separate article: DIY simple rearrangements in the home of a person with dementia.
Hallucinations
Hallucinations are perceptions without an object. For example, the patient sees non-existent people or animals, talks to them, tries to touch them. In addition to hallucinations, patients with dementia may have illusions (incorrect recognition of a real object) and false memories.
Deprived of a true picture of recent events, their memory is filled with what did not happen: for example, they say that yesterday long-dead acquaintances came to see them. These are not hallucinations, and the treatment tactics in these cases are different, so the doctor needs to tell you in detail how what you consider to be hallucinations manifests itself.
Also, a patient who, at the stage of severe dementia, is frightened by the mirror and swears at it, does not hallucinate. He just doesn't understand that it is his own reflection.
Hallucinations are not only visual, but also auditory, olfactory, tactile and auditory. It depends on which part of the brain is affected.
Most often, the patient is uncritical of hallucinations, that is, he is sure that they really exist. However, sometimes the patient perceives the arguments of others or, based on the properties of the hallucination, understands that the object does not exist.
Behind him, down the rabbit hole
I like to compare the reality of living with dementia to Alice in Wonderland. If you are familiar with this book, you know that little Alice fell down the rabbit hole and found herself in another world, where magical adventures awaited her with the Cheshire Cat, the White Rabbit and many other unusual characters. But when Alice wakes up and finds herself in the real world, all her new friends and amazing adventures remain on the other side. They simply do not exist in our world.
Some of the most difficult parts of caring for someone with dementia come from trying to get them back into the real world. These attempts can create anxiety, anger, fear in the patient, and make him aggressive and belligerent. It will be much easier to connect with him if we jump decisively into the rabbit hole, into his world, and allow him to become our guide - Alice, who will lead us through her Wonderland. Remember: facts are forgotten, but feelings remain!
Sexual disinhibition
This disorder causes many problems for the patient’s loved ones, but they are often embarrassed to tell even the doctor about it. It is especially difficult to cope with disinhibited behavior in men; it can spread not only to the wife, but also to caregivers, and even daughters, whom the patient may no longer recognize.
This is a natural manifestation of the breakdown of certain areas of the brain that make behavior restrained and conscious. A neurologist or psychiatrist should respond correctly to your story about such disorders and prescribe sedatives that reduce sexual desire.
