Understanding Dementia: Types, Effects On Individuals And Families, Legislation And Frameworks

Types and signs of dementia

1. The term dementia refers to a group of neurological disorders encompassing a gradual and long-term reduction in the ability to remember and think. Thus, it affects the daily functioning of the affected person. Dementia can be attributed to progressive degeneration of the cerebral cortex, the part of the human brain responsible for controlling emotions, thoughts, memories, actions and personalities (Prince et al. 2013).

The different types of dementia and their signs and symptoms are as follows:

• Alzheimer’s disease- Accountingfor more than 50% of dementia disorders, the hallmark abnormalities observed in this disorder occurs due to deposition of beta-amyloid plaques and tau proteins in the neurons. Common symptoms include difficulty in reasoning, insight and judgment (Stern 2012).
• Vascular dementia- The second most common type of dementia primarily involves damage to the blood vessels thereby affecting the blood supply to the brain.Common symptoms are associated with impaired judgment, lack of ability to make decisions, and difficulty in organizing and planning (Iadecola 2013).
• Fronto-temporal dementia- The disease ischaracterized by sudden language difficulties and personality changes (Rademakers, Neumann and Mackenzie 2012).
• Dementia with Lewy bodies- Deposition of abnormal aggregates of alpha-synuclein protein in the cortex contributes to development of Lewy bodies. Most common symptoms are associated with visual hallucinations, gait imbalance, slowness and parkinsonian movement (Abeysuriya and Walker 2015).
• Creutzfeldt-Jacob disease- This group of fatal disorders affects several humans and other mammals, due to misfolded prion protein that leads to ‘domino effect’. It is characterized by memory impairment and lack of coordination (Sikorska et al. 2012).

2. Dementia directly exerts a negative influence on the individual suffering from it and his carers. The impacts are not restricted to the practical effects. Upon diagnosis of the disorder, a huge negative impact is observed on the individual. Patients who have been recently diagnosed with dementia often experience a wide range of emotions including loss, shock, anger, grief and disbelief. Most people struggle while dealing with their emotions and feel afraid about the impending future (Matthews et al. 2013). The confirmation of dementia also triggers anxiety and depression in some people. Commonly observed psychological effects are associated with mood swings, frustration, anger with self and with people surrounding them, loss of motivation and irritability. Failure to accomplish everyday tasks often results in inappropriate responses and aggressive behaviour (Barnes et al. 2012).

Individuals, playing the role of carers for patients suffering from dementia, are also affected due to dementia. Recalling ways of treating the patient in the past often results in guilt feelings in the carers, thereby contributing to embarrassment. Previously exhibited temper or odd behaviour towards the patient often makes the family feel guilty. Grief occurs as a response to loss of the loved person who develops dementia (Aguirre et al. 2014). The family members often get angry and frustrated with their role of being a caregiver. Anger and frustration also arises due to the difficulty in managing abnormal behaviours demonstrated by the patients (Romero-Moreno et al. 2013). The obstacles that arise while balancing care-giving with career, child rearing and relationship usually increase the risk of depression, burden and stress on the family members. Therefore, caring for a dementia patient is more stressful than for an individual with physical disability (Kim et al. 2012).

3. Owing to the fact that dementia is a progressive neurological disorder, the loss of brain function does not occur at one instance. The patients gradually lose the ability to stand, walk and get up by themselves. Medication effects, vision loss and balance problems are responsible for these disabilities among the patients. This increases the risk of pressure ulcers or bedsores, which if not prevented in the early stages, can result in infection and worsen the health. The patients demonstrating a decrease in mobility are at an increased risk of developing blood clots and infections (Pitkälä et al. 2013). Problems associated with memory, attention, learning and concentration also leads to social withdrawal. Patients are also at an increased likelihood of developing problems in verbal communication. They face difficulty in comprehending speech and are often found repeating phrases or sounds (Klimova and Kuca 2016). Lack of speech coherence is another commonly observed effect. The intended feelings and thoughts are usually communicated using facial expressions, sounds and appropriate gestures. Dementia patients also forget the process of swallowing (dysphagia) and chewing food, which in turn contributes to dehydration and worsens their physical symptoms (Sato et al. 2014). Loss of appetite and pain leads to drastic weight loss that increases the risk of infections and other chronic illness.

Effects of dementia on individuals and families

Quality of life (QoL) generally refers to the perception of an individual on their position with regards to value system, culture, goals, concerns and standards. Research evidences suggest that dementia results in a decline in the QoL, with a progress of illness. Decrease in the quality of life is statistically correlated with increased levels of psychological and behavioural disturbances among dementia patients (Cooper et al. 2012). Patients who adhere to medications show increased QoL with respect to their mood patterns, feelings, social interactions and enjoyment of activities. Increase in problems related to depression, agitation, disinhibition, anxiety and irritability also impairs quality of life (Beerens et al. 2013).

4. Poor mental health is considered by the government as the primary reason that contributes to disabilities. The Mental Capacity Act (2005) clarified the legal position of the individuals who provided services to people incapable of caring and deciding for themselves. Its major provisions illustrated the importance of supporting individuals in decision making, acting in the best interest of the person, and using the least restrictive options (Manthorpe and Samsi 2015). The NHS plan developed in 2000, provided funds to support the National Service Framework for Mental Health (1999), for funding a comprehensive and evidence based care for mental disorders. The National Dementia Strategy (2009) was further established by the government for setting new standards for dementia care (McGorry, Bates and Birchwood 2013). The Dementia Challenge was further launched in 2012, with the aim of creating dementia friendly communities, bringing improvements in care services and improving research on the neurological disorder.

In addition, the Dementia Friends campaign was also launched by the Alzheimer’s society and the Public Health England in May 2014, for improving understanding of the disease and changing the attitudes of carers and surrounding people towards the patients (Alzheimer’s Society 2012). The Care Act (2014) also intends to create a single law that introduced new duties on the local authorities, thereby creating a major impact on the life of the patients and the carers (Legislation.gov.uk 2018). Therefore, the aforementioned policies have created significant impact on awareness regarding mental health.

References:

Abeysuriya, R. and Walker, Z., 2015. Dementia with Lewy bodies. British Journal of Neuroscience Nursing, 11(3), pp.146-149.

Aguirre, E., Hoare, Z., Spector, A., Woods, R.T. and Orrell, M., 2014. The effects of a Cognitive Stimulation Therapy [CST] programme for people with dementia on family caregivers’ health. BMC geriatrics, 14(1), p.31.

Alzheimer’s Society., 2012. Dementia 2012: A national challenge. Retrieved from- https://www.alzheimers.org.uk/download/downloads/id/1389/alzheimers_society_dementia_2012-_full_report.pdf

Impact of dementia on quality of life

Barnes, D.E., Yaffe, K., Byers, A.L., McCormick, M., Schaefer, C. and Whitmer, R.A., 2012. Midlife vs late-life depressive symptoms and risk of dementia: differential effects for Alzheimer disease and vascular dementia. Archives of general psychiatry, 69(5), pp.493-498.

Beerens, H.C., Zwakhalen, S.M., Verbeek, H., Ruwaard, D. and Hamers, J.P., 2013. Factors associated with quality of life of people with dementia in long-term care facilities: a systematic review. International journal of nursing studies, 50(9), pp.1259-1270.

Cooper, C., Mukadam, N., Katona, C., Lyketsos, C.G., Ames, D., Rabins, P., Engedal, K., de Mendonça Lima, C., Blazer, D., Teri, L. and Brodaty, H., 2012. Systematic review of the effectiveness of non-pharmacological interventions to improve quality of life of people with dementia. International Psychogeriatrics, 24(6), pp.856-870.

Iadecola, C., 2013. The pathobiology of vascular dementia. Neuron, 80(4), pp.844-866.

Kim, H., Chang, M., Rose, K. and Kim, S., 2012. Predictors of caregiver burden in caregivers of individuals with dementia. Journal of advanced nursing, 68(4), pp.846-855. 

Klimova, B. and Kuca, K., 2016. Speech and language impairments in dementia. Journal of Applied Biomedicine, 14(2), pp.97-103.

Legislation.gov.uk (2018). Care Act 2014. [online] Legislation.gov.uk. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents [Accessed 14 Jan. 2018].

Manthorpe, J. and Samsi, K., 2015. Care professionals’ understanding of the new criminal offences created by the Mental Capacity Act 2005. International journal of geriatric psychiatry, 30(4), pp.384-392.

Matthews, F.E., Arthur, A., Barnes, L.E., Bond, J., Jagger, C., Robinson, L., Brayne, C. and Medical Research Council Cognitive Function and Ageing Collaboration, 2013. A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. The Lancet, 382(9902), pp.1405-1412.

McGorry, P., Bates, T. and Birchwood, M., 2013. Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. The British Journal of Psychiatry, 202(s54), pp.s30-s35.

Pitkälä, K., Savikko, N., Poysti, M., Strandberg, T. and Laakkonen, M.L., 2013. Efficacy of physical exercise intervention on mobility and physical functioning in older people with dementia: a systematic review. Experimental Gerontology, 48(1), pp.85-93.

Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C.P., 2013. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s & Dementia, 9(1), pp.63-75.

Rademakers, R., Neumann, M. and Mackenzie, I.R., 2012. Advances in understanding the molecular basis of frontotemporal dementia. Nature Reviews Neurology, 8(8), pp.423-434.

Romero-Moreno, R., Losada, A., Marquez, M., Laidlaw, K., Fernández-Fernández, V., Nogales-González, C. and López, J., 2013. Leisure, gender, and kinship in dementia caregiving: psychological vulnerability of caregiving daughters with feelings of guilt. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(4), pp.502-513.

Sato, E., Hirano, H., Watanabe, Y., Edahiro, A., Sato, K., Yamane, G. and Katakura, A., 2014. Detecting signs of dysphagia in patients with Alzheimer’s disease with oral feeding in daily life. Geriatrics & gerontology international, 14(3), pp.549-555.

Sikorska, B., Knight, R., Ironside, J.W. and Liberski, P.P., 2012. Creutzfeldt-Jakob disease. Neurodegenerative Diseases, pp.76-90.

Stern, Y., 2012. Cognitive reserve in ageing and Alzheimer’s disease. The Lancet Neurology, 11(11), pp.1006-1012.