Dementia slowly and inexorably attacks the nerve cells in various parts of the brain. However, all dementias do not have progressive deteriorating course. Some dementias that are caused by tumors, infections, metabolic/circulatory disturbances, adverse drug reactions or as a result of alcoholism are usually treatable and reversible up to some extent. It is mostly in cases of Alzheimer's disease or severe Vascular or Multi-infarct Dementia that the decline is gradual and takes a deteriorating course. Our discussion here focuses on the irreversible forms of dementia—Senile Dementia and Alzheimer's disease.
Causes: We are far from a clear understanding of its exact etiology. What we do know definitely is that certain changes in the nerve endings and the brain cells themselves referred to as 'tangles' and 'plaques', lead to an accumulation of abnormal fibers, that are characteristic of the disease. The larger the number of plaques and tangles, the greater the disturbance in intellectual function and memory. Theories about why this happens range from genetic influence to biochemical imbalance, to abnormal proteins and slow viral infections.
Treatment: Most progressive dementias such as vascular or Multi-infarct Dementia as well as Alzheimer's disease have no cure or time tested preventive strategies. Hence treatment centers around making the patient feel more comfortable and alleviating discomfort and secondary symptoms. In many cases, the person may require hospitalisation or custodial care in the final stages.
Drugs: Medication that helps to reduce a patient's anxiety or depression such as minor or major tranquilisers or antidepressants may be prescribed. These help to stabilise the mood, angry or violent outbursts and restless behaviours. However, careful monitoring is required as these drugs can produce unpleasant side effects also, especially in the elderly. These may also interact with other medication for other illnesses as well.
Exercise: Exercise can be an ideal antidote to the anxiety and agitation that manifests as aimless, restless behaviour in these patients. Walking, simple dance movements and basic calisthenics can be fruitful, enjoyable activity.
Diet: A nutritious diet at regular intervals can provide resistance to infections and other illnesses by improving immune functioning. They can also help to prevent or relieve digestive problems (diarrhea and constipation), dehydration, malnutrition, anemia and vitamin or mineral deficiencies. Nutrition supplements can be taken if indicated on doctor's advice.
Psychosocial Management: During the early stages of illness, the caregivers have to learn to manage the volatile mixture of emotions in the patient. Confusion as to what is happening to him, frustration about inability to carry out routine tasks and the resultant anger, fear about failing memory, uncertainty about what lies ahead and depression/mood swings have to be dealt with patience, ingenuity and gentle persuasiveness.
During the later stages the patient may require 24-hour attention and outside help may be necessary. Problems such as passing urine and stools in bed or clothes, difficulty in eating, swallowing, inability to walk or make coordinated movements, painful bedsores are frequently encountered and drains the resources and stamina of the caregivers. Here are some practical tips for caregivers:-
- Approach the patient slowly. Listen well. Stand in front and speak clearly in short sentences. Give stepwise instructions.
- Reassure him, give feedback about his actions.
- Do not push or pull if he is in an aggressive mood. Be gentle and distract him if necessary.
- To check wandering, keep doors locked from outside and sew name and address on his clothes for identification.
- Keep soft lights on at night. Discourage naps during the day and avoid stimulants if sleep difficulty is present.
- Provide quiet entertainment, avoid loud, violent TV.
- Accompany him for a walk or an outing.
- Engage him in simple routine chores to provide a sense of purpose.
- Do not allow him to bathe or shave alone. Take him to toilet at regular intervals; provide
clothes with elastic instead of buttons or hooks.
- Driving has to be totally avoided.
- Do not change around the furniture or have too many visitors.
- In general give guidance, reassurance, limit choices and breakdown talks into manageable steps.
Caring for a dementia patient can be a truly exhausting, confusing and frustrating job and can tax the entire resources—physical, psychological, financial and spiritual. Yet, in a way this caring is like a process of giving back the love and care one has received from the person having dementia. Hence caring for the caregivers and helping them in dealing with their own stress and negative emotions along with their health are an equally important issue in dealing with dementia management. That is why perhaps more than any other disease, dementia is a disease of families that challenges the might of all the pooled resources. |
