Dementia Needs, Types and Treatments

Dementia Needs, Types and Treatments Specific needs of the older person INTRODUCTION MAIN BODY Dementia is a term used to describe symptoms such as loss of memory, language, motor skills, judgment and other intellectual functions caused by permanent damage or death of the brains nerve cells. (Alzheimer’s foundation of America, 2014) Most dementias are reversible. Reversible dementias are caused by nutritional deficiencies or infection or from a bleed on the brain or the side effect of a medication; the symptoms of these dementias can be stopped or reversed as long as the underlying causes can be treated. Dementia consists of 3 stages: Early stage (difficulty concentrating, poor orientation, decreased memory, withdrawal from friends and family, poor socializing skills and denial of their symptoms) This stage usually lasts up to two years. Mid stage (major memory loss, client needs help carrying out their activities of daily living (ADLS), they can lose control of their bowels or bladder, ability to speak declines, agitation occurs, compulsions or anxiety) This stage lasts up to two and a half years. Late stage (people in this stage lose the ability to communicate or speak, they need assistance with nearly all their ADLS, they often lose the ability to walk) This stage usually lasts up to two and a half years. There are many types of dementia but I have listed the four major ones below and have given the physiological and psychological changes that occur for the older person with these dementias. Type of Dementia Physiological Psychological Client’s needs Alzheimer’s Problems with speaking. Decreased judgement. Difficulty solving problems or puzzles. Disorientation in familiar surroundings. Depression. Psychosis. Agitation. Sleep disorder. Resistance to care. Memory loss. Assess and reverse agitation factors. Memory therapy. Language therapy. Vascular Difficulty finding the right words. Confusion and disorientation. Aggressiveness. Memory loss. Depression. Slowness of taught. Hallucinations. Memory therapy. Speech therapy. Lewy body Confusion followed by alertness. Tremors. Shuffling gait. Rigidity. Fainting-loss of consciousness. Hallucinations in touch and feelings. Visual hallucinations. Sleep disorder. Aggression. Depression. Speech therapy. Physical therapy which includes gait training. Front temporal Language comprehension declines. Tongue tie occurs. Ability to read or write is impaired. Lack of co-ordination. Shaking. Balance problems. Eye twitching. Muscle spasms and rigidity. Inability to relate to people. Personality changes. Speech therapy. As a carer it is very important to understand the Lewy body dementia disease and its symptoms so that the appropriate treatments can be implemented. The carer should also act as an advocate to ensure the client with dementia Due to word limitations I will only be discussing Lewy body dementia in detail below. LEWY BODY DEMENTIA In the early 1900s scientist FREIDERICK H. LEWY discovered that the brains activities was disrupted by deposits of abnormal protein while he was researching Parkinson’s disease. The Lewy body proteins were found in the brain stem where they kill off the neurotransmitter Dopamine causing symptoms similar to Parkinson’s symptoms. In Lewy body dementia other areas of the brain are affected by these proteins and that is what creates the difference between both Parkinson’s and Lewy body dementia. When the protein attacks the brain chemical acetylcholine it causes the client to suffer disruption in their thinking, behaviour and perception. Lewy body dementia can be its own disease or it could act in conjunction with brain changes in Alzheimer’s disease and Parkinson’s disease. This is why Lewy body disease can be miss diagnosed and the client ends up been told they have Parkinson’s disease instead. When diagnosing Lewy body dementia an experienced member of the multidisciplinary team should carry out a diagnostic evaluation of the client. This evaluation should include both physical and neurological examinations. The client should also be examined on their language skills, memory skills and their functioning skills. The client’s family should also be interviewed as they might have noticed changes in the client which would be helpful in their diagnosis. The client should also undergo a MRI or CT scan to determine what areas of the brain are affected. Blood tests may also help in the client’s clinical diagnosis. Lewy body dementia can only be conclusively diagnosed when the client has passed, through a post-mortem autopsy. Unfortunately there is no known cure for Lewy body dementia and treatment only relieves symptoms. People live up to seven years with the disease but some have lived up to twenty years with the disease. Medication is not always the best option for clients with Lewy body because what works with one client might not work for another client. It is also important to know that clients with Lewy body are extremely sensitive and may react negatively to medication. If using medication then there are different medications for the different symptoms. Cognitive symptoms Cholinesterase inhibitors (Aricept, Exelon, and Raza dyne) are used as they are drugs that increase the level of acetylcholine in the brain. Acetylcholine is a chemical which helps in memory and learning functions. These were developed to treat Alzheimer’s clients but it has been discovered they work better on Lewy body clients. Movement symptoms Levodopa is a drug which is also used on Parkinson’s clients. This medication is only used if the symptoms are severe. Visual hallucinations Antipsychotic medication (haloperidol) which are tranquillizers that block the dopamine receptors in the brain are used but only if the hallucinations are upsetting or disruptive as the side effects can be severe. Rem sleep behaviour disorder Melatonin or clonazepam medication can be used and have been proven to be very effective. â€Å"50% of clients with lewy body dementia who are treated with any antipsychotic medication may experience severe neuroleptic sensitivity, such as worsening cognition, heavy sedation, increased or possibly irreversible parkinsonism, or symptoms resembling neuroleptic malignant syndrome which can be fatal.† (Lewy body dementia association, 2014) Non-medical treatments Speech therapy This may help the client with their voice volume. It is also helpful in clients who have swallowing difficulties and may improve their facial muscular strength. Physical therapy This includes strengthening, flexibility and cardiovascular exercises as well as gait training. Occupational therapy This may help the client in promoting his independence and maintain their skills. Individual and family therapy This can be useful in managing emotional and behavioural symptoms and help with any concerns the family might have for the future. Support groups These are helpful for the client and the carers as they can help in day to day frustrations and provide emotional support for all.