Dementia is a chronic or progressive disease of the brain in which memory, orientation, comprehension, learning, language, and judgment are impaired.The disease usually occurs in old age, but is not a normal sign of aging. In Austria, more than 130.000 people suffering from dementia. There are different forms of dementia such as z.B. Alzheimer's disease, the symptoms are similar, but the treatment options vary. The diagnosis of dementia is composed of different testing procedures (z.B. clock test).
Incidence of dementia
At more than 40%, dementia is now the most common reason for admission to a nursing home. As a result of increasing life expectancy, the number of dementia cases will also continue to rise. In the group of 60- to 70-year-olds, about 1 in 100 people suffers from dementia. In the 80- to 85-year-old age group, 1.5 out of 10 and in the 90-plus age group, 3 out of 10 are already affected.
Causes, symptoms& Progression of dementia
Dementia is an umbrella term for the pathological decline of mental abilities, which can have many causes. In the course of the disease, there is a loss of mental abilities. Today, there are about 50 known diseases that can lead to dementia. These include, for example, Alzheimer's disease, Parkinson's disease, Creutzfeldt-Jakob disease, epilepsy, multiple sclerosis, vascular diseases of the brain or brain tumors.
The causes of dementia are not clear, but some risk factors are known:
– Advanced age. – Women are affected more often than men. – People with lower levels of education have an increased risk of. – Depression is common at the onset of the disease. – People who live alone and those with little social contact are more likely to develop the disease. – Diseases such as obesity, hypertension, diabetes mellitus, kidney failure or stroke increase the risk of dementia. A distinction is made between primary. Secondary forms of dementia. Primary forms are caused by damage to the brain tie, secondary forms are triggered by events and disorders that are not primarily located in the brain. Primary dementias make up the majority of the diseases. Alzheimer's is the most common form with 6 to 8 out of 10 cases. 1 to 3 cases are vascular dementia or dementia with Lewy bodies. Less than 1 in 10 cases are diagnosed with frontotemporal dementia.
Video: Successful communication with people with dementia
M.Ed. M.A. Katharina Schoene, pastoral counselor and psychotherapist in training, gives tips for everyday life with people with dementia. How to talk to a loved one affected by Alzheimer's disease? How to help with care and support? (Baden, 29.6.2020)
Alzheimer's disease is often the cause of dementia, in 60 to 80% of cases. Alzheimer's disease most commonly occurs after age 65. from the age of. The causes of the disease are not yet clear. Vascular dementia is often characterized by a sudden onset. A gradual deterioration characterized. The cause is usually a cerebral circulatory disorder, for example, a cerebral infarction, stroke or arteriosclerosis. Because this interrupts the flow of blood in the brain, damage occurs to individual brain regions. This form of dementia, unlike Alzheimer's, affects more men than women.
Lewy body dementia
The term Lewy bodies stands for protein deposits in the brain. They can also trigger dementia. Typically develop with Parkinson's disease. In a few cases, Lewy bodies can occur even in the absence of Parkinson's disease. About 20% of dementia patients suffer from this form.
Frontotemporal dementia is when nerve cells in the frontal and temporal area, the fronto-temporal lobe, are degraded first. In this area of the brain, emotions and social behavior are controlled, therefore personality changes occur at the beginning of the disease. Aggressiveness, tactlessness, immoderate eating and apathy are early signs of frontotemporal dementia. It breaks out earlier than other forms, usually as early as the fifth or sixth decade of life.
Dementia can also be a secondary disease of another disease. In this case, it is called secondary dementia. It is not caused by changes in the brain and is the only form where there is a chance of recovery if the underlying disease is corrected. However, if the diagnosis is made too late, this is no longer possible.
– Medications such as antidepressants, anti-anxiety and anti-stress medications, antihypertensive medications, or anti-arrhythmic medications can cause secondary dementia. – Tumor diseases, such as brain tumors, lymph node cancer or blood cancer, can also be the cause. If the tumor is treated, the dementia symptoms usually disappear as well. – Metabolic disorders, such as hyperthyroidism or hypothyroidism, kidney or liver failure, hypoglycemia, can cause secondary dementia. – Infections caused by bacteria, viruses or fungi that spread to the brain and underlie dementia. – Head injuries, z.B. as a result of an accident or a fall, can later lead to dementia.
Dementia manifests itself on different levels. There are symptoms in the intellectual and cognitive area, effects on mood and state of mind, behavior and also on physical functions.
INTELLECTUAL AND COGNITIVE RANGE
MOOD AND STATE OF MIND
– Spatial and temporal orientation disorders with loss of the day-night rhythm – Problems with speech comprehension and linguistic expression
– Lack of interest – Affective withdrawal (no longer recognizable emotions) – Anxiety – Restlessness – Mood instability – Tendency to diffuse moodiness
– Apathy (listlessness) – Irritability and aggressiveness
The course of dementia is divided into 3 stages:
The affected person is slightly impaired in everyday life, but can still master it alone and largely lead an independent and autonomous life. Sometimes it is difficult for him to follow a conversation. There are also word-finding disorders and repetitions. The patient is better able to remember things that happened a long time ago. In complex actions, the first incorrect actions occur.
Independent living becomes increasingly difficult. Assistance and supervision become necessary to a certain extent. Even simpler tasks such as choosing clothes or shopping become difficult for the patient. Personal hygiene is often neglected. Psychological symptoms such as anxiety, delusion, restlessness and other behavioral disorders appear, the patients are disturbed in their orientation, wander aimlessly and are restless. If you try to correct the patient, he often reacts in an irritable and aggressive way. Disturbed day-night rhythm and cognitive urinary incontinence (not visiting the toilet in time or using chairs or trash cans) are other possible symptoms.
Independent living is no longer possible at this stage. Even simple activities can no longer be performed by the affected person, and motor disturbances, e.g., the use of a computer, are no longer possible.B. when walking, occur at this stage. Patients become bedridden. Forgetting to eat frequently. Eventually, urinary and fecal incontinence also occur. Progressive speech disorders make it increasingly difficult to communicate with the patient.
Diagnosis of dementia
The diagnosis of dementia is difficult, especially in the early stages. The first signs are noticed by the affected persons themselves. Their relatives are often not aware of them or downplay them. For this reason, the diagnosis is often only made when there are already impairments in everyday life.
At the beginning of the diagnosis there is a detailed discussion with the doctor. This involves talking not only to the patient himself, but also to relatives or other close persons.
Relevant points are:
– Previous illnesses – Illnesses of family members – Events that have affected the patient's body or psyche – Perceived changes, signs of disorders – Course of disorders – Mood swings – Personality changes – Medications
It is essential for the diagnosis of dementia to determine the cognitive decline, z.B. with the help of the Mini-Mental-Status-Test or the Clock-Test. In early stages, extensive neuropsychological testing is necessary. In the event of abnormal results, imaging procedures such as computer tomography (CT) or magnetic resonance imaging (MRI) are used for further clarification.
Therapy of dementia
Early detection is an important factor. The earlier dementia is detected, the better it can be treated. Depending on the form and symptoms, different medications are used. An important group of medications is that of anti-dementia drugs. The aim is to preserve mental abilities and delay the progression of the disease. Neuroleptics, antidepressants, antipsychotics and sleeping pills can also be administered to treat accompanying symptoms.
The treatment of dementia is individual for each patient. In addition to drug therapy, there are a number of other options available, which are suitable as therapy depending on the symptoms and the form of the disease. Psychological and psychotherapeutic methods, memory training and occupational therapy are suitable for improving the cognitive performance and quality of life of the person affected and slowing down the course of the disease. However, therapy should be stage-related.
Psychotherapy is suitable for the treatment of affective disorders such as anxiety, depressive states, helplessness or aggressiveness, behavioral and drive disorders, social withdrawal and regression, mortification due to perceived losses and deficits, and also functional disorders such as urinary incontinence. Psychotherapeutic methods are manifold.
Dance therapy is also suitable for patients with limited mental and cognitive abilities, because the work with the body is in the foreground. Dance therapy promotes body awareness, social contacts, positive moods, self-esteem and helps maintain mobility.
Music therapy works with sounds, rhythms, harmony, melody and noises. The patient is given z.B. familiar songs are played. This helps to jog the memory, sometimes the patient spontaneously remembers a situation that is connected with the song. In active music therapy, those affected are also encouraged to make music or sing themselves. Music therapy is usually held in groups, which creates a group feeling and promotes communication skills. Patients appear more agile and oriented.
The goal of memory training with people with dementia is to maintain and train mental capacity. It is important to keep in mind that in advanced stages, short-term memory often no longer functions as well. Questions about current events can put prere on the patient. It makes more sense to choose exercises that address the long-term memory, i.e. activate memories. The exercises should be fun for the patient. Conveying a sense of achievement. Tasks such as talking about the past when looking at a photo album together or proverbs such as "The early bird gets the worm…" The following are examples of what memory training can look like.
The aim of occupational therapy is to strengthen the person in activities of self-care, productivity and leisure activities, and to improve the quality of life and state of mind of the patient. Functional and skills training is an important component. Occupational therapy reduces mental decline and behavioral problems and increases social behavior and daily activities.
Dementia: What the person with dementia can do for him/herself
If dementia is suspected, a doctor should be consulted as soon as possible. Early diagnosis. Treatment can slow the progression of the disease.
Studies have shown that dementia is less likely to occur in people who exercise regularly and lead an active mental and social life. Cardiovascular diseases or diabetes mellitus increase the risk of the disease. Other risk factors are smoking or obesity. So, if you pay attention to a healthy lifestyle, your risk of dementia can also be reduced.
However, there are also risk factors that cannot be influenced. These include increasing age, gender, but also a family history of dementia.
Staying mentally active can not only slow the progression of dementia, but also reduce the risk of developing the disease. Reading, learning, practicing foreign languages, writing, making music and singing, being involved in a community (z.B. Exercise. Sports help.
Dealing with dementia patients – tips for relatives
If a family member develops dementia, this also affects the relatives. Pain, pity, helplessness, anger, sadness and despair accompany them. There are many challenges to overcome. Caring for a person with dementia requires a lot of time, energy and perseverance, so it is important to get support in time. Family members should keep in mind that the person's behavioral changes do not happen willingly. They are the result of an organic disorder in the brain. The patient does not want to intentionally annoy or provoke anyone. When caring for a loved one, it is especially important to also keep an eye on your own well-being, to find space for your own interests and a balance.
Validation is a helpful concept in dealing with people with dementia. The aim is not to criticize or correct the behavior of the person with dementia, but to declare it to be true and to accept it, i.e. to validate it.
Routine is helpful for dementia patients – processes that are the same every day are beneficial for those affected. Patience, composure, respect and understanding in dealing with the sick person are important in nursing care. Patients should not be overburdened, but at the same time have the chance to do as many things as possible themselves. That slows down mental decline.
More than 80% of all dementias are attributable to Alzheimer's disease. Depending on the stage, a distinction is made between a mild, moderate and severe form.
Dementia is a challenge, especially for family members. In the free "DEMENZ UND ICH-Online training teaches you how to deal with the situation in the best possible way.
How to tell from yourself or from the outside if a person is merely "forgetful"? or there are signs of dementia?