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Summary DEMONSTRATE KNOWLEDGE OF THE PROCESS AND EXPERIENCE OF DEMENTIA
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DEMONSTRATE KNOWLEDGE OF THE PROCESS AND EXPERIENCE OF DEMENTIA
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UNIT 33 DEMONSTRATE KNOWLEDGE OF THE PROCESS AND EXPERIENCE OF DEMENTIA.Part 1.
1. Dementia is caused by various diseases that can affect the brain. It can be affected in different ways with
varying degrees, each set of circumstances being unique to the individual. There are 4 of the most common
types of dementia; Alzheimer’s disease, Vascular dementia, Dementia with Lewy Bodies and Pick’s disease
(Frontotemporal dementia).
Alzheimer’s disease, named after Dr. Alois Alzheimer, and the most common form of dementia, is caused by
a build-up of proteins in the brain which forms structures known as ‘plaques’ or ‘tangles’, causing a loss in
connections between the nerve cells and imminently causing the death of the nerve cells and brain tissue.
There is also a shortage of important chemicals in the brain which interferes with the ‘message-sending’
processes in the brain.it is a progressive disease and as it progresses more symptoms appear. Symptoms
include forgetting recent events, being unfamiliar with surroundings, repetitive speech, difficulty in
organising or planning tasks, aggression and mood swings.
Vascular dementia is the second most common form of dementia. This is caused by diseased blood vessels
which reduce the amount of blood to the brain. When the vessels are damaged they become weak or
blocked causing insufficient blood being carried to the brain cells, which eventually die. Symptoms include
urinary incontinence, hallucinations, increased aggression and difficulty in finding the right words, short term
memory loss, changes in mood, slow responses, attention difficulties and mixed up words.
Pick’s disease is a name given to Frontotemporal dementia and is less common. This involves the two frontal
lobes of the brain becoming damaged when nerve cells in the frontal and temporal lobes die and the
pathways which connect them change, causing, in time, the frontal and temporal lobes to shrink.
Lewy Bodies (DLB) shares symptoms with Alzheimer’s disease and Parkinson’s disease and can be difficult to
diagnose because of the similarity in symptoms. Although it is not fully understood why it happens, tiny
deposits of protein appear in the nerve cells in the brain causing low levels of important chemicals and a loss
of connections between nerve cells which will begin to die. These can be anywhere in the brain.
Other causes of dementia may be:
Mixed dementia – where there is more than one cause occurring simultaneously,
CJD – Creutzfeldt- Jakob disease,
Huntington’s disease – which involves a defective gene,
Wernicke-Korsakoff syndrome – a chronic memory disorder.
2. Memory impairment may initially begin with short-term memory loss, an inability to remember recent
events. This may cause a lot of confusion for the individual, affecting their day-to-day activities such as being
unable to follow TV programs, forgetting names and places, misplacing objects or leaving them in unusual
places, losing conversations i.e. forgetting what is was they were trying to say. This slow decline in memory
will become very frustrating for the individual, as the decline will be in memory, reasoning and
communication, causing changes in behaviour such as loss of skills and abilities and difficulties in movement,
which may fluctuate. It may fluctuate greatly but will become more apparent as the condition progresses
and worsens. This, in effect, will lead to changes in the individual’s behaviour. Communication will become
more difficult because of the inability to remember and the individual will become limited in their
understanding. There will also be a lack of reasoning as the confusion and frustration sets in. Planning
activities or simple tasks will become more challenging as they may not remember anything about the plans
or may not feel motivated to continue with the plans or tasks. As the dementia progresses, the individual’s
behaviour will change and they will need support to manage these changes and adapt to them in order to
live an independent and fulfilling life as much as possible.
3. How information is processed is a very complicated process. A simple way of understanding this is that the
eyes receive visual images which are then ‘coded’ into electrical neural activity. It is then fed to the brain
through our neurotransmitters where it is stored and coded and decoded. The information is then processed
, into areas such as memory, perception, attention etc.. in the relevant areas of the brain. The result, for
example, is that you may be able to ‘read what you can see’. The information may be stored in our ‘internal
warehouse’, if you like, and retrieved when it is needed. This information can be sensory, as in sight, sound,
touch, hearing or taste/smell. Information is stored and processed in much the same way in all the senses. If
you now imagine that somewhere down the line the nerve cells have become diseased or damaged causing
a loss to the ‘neural feed’, the information cannot carry on it’s journey or cannot be retrieved because there
is a break in the neural flow. This is what happens with dementia. The affected nerve cells die off or become
blocked and the information process is interrupted. This, in turn, will affect attention. In order to take in
information we need to pay attention. We are usually selective in how and what we pay attention to and if
the information process is interrupted, so too is our attention. As the dementia progresses, the attention
span will decrease also. Although dementia affects people in different ways, it is very common for the
individual to experience short-term memory loss, though long-term memory loss will be more apparent as
the dementia progresses. They may remember distant events in great detail, but may falter when it comes
to remembering recent events, the more recent the more apparent. They may be unable to take in new
information, may not recognise people or places or even separate fact from fiction. They may appear to be
living in the past, revisiting their childhood, relating to when they were much younger. I had an uncle who
suffered from dementia and he would never accept that he was ill, to the point where family had to hide his
car keys as he was constantly searching for them to go for a drive, but his condition had progressed to a
point where he was no longer safe to drive. The ability to retain new information is difficult which may cause
the individual to become anxious, confused or both. The changes in processing the information causes
changes in the individuals behaviour and may affect their view of reality, often finding it difficult to separate
reality from non-reality.
4. There are some medical conditions that can mimic the symptoms of dementia such as; Head Trauma,
Normal Pressure Hydrocephalus, problems with vision or hearing, Heart and Lung disorders, Liver and Kidney
disease, Infections such as UTI’s, Cancer, Depression, Medications. Also, experiencing loss and bereavement
can have such an impact on an individual as can environmental changes such as moving house etc.. With
intense medical screening all these may be distinguished from dementia symptoms with diagnostic tools
such as blood tests, xrays and scans etc. An individual suffering from depression may have poor
concentration and poor memory, finding it difficult to remember details or plan everyday tasks. An individual
with a UTI may experience confusion, not being able to think clearly or remember things. Certain drugs or
medications can have an effect of dementia symptoms such as Anxiety medications, Corticosteroids,
Chemotherapy drugs, Statins and even pain relief medications. So as you can see, it is not easy to diagnose
properly without eliminating other causes through medical screening.
5. The abilities and needs may fluctuate because of the physical environment. There will be changes such as
moving home, attending a Day Centre. They may become more isolated and confused with changes to the
social environment, changes in carers and coping with the carers being stressed and many personal changes
such as historical events such as being abused, changes in treatment and medication, risks of bacteria and
infections as well as the vascular changes.
6. Early diagnosis and follow up can have a huge impact on the quality of life of the individual and their
families. Initially, fear will be a dominant factor. The feeling of not being in control, losing identity, the
impact it is going to have on the family and friends and the loss of dignity and privacy. I feel one of the
biggest hurdles to overcome is the common feeling of being dependent on others which also links to denial.
Early diagnosis means that we can prepare more and develop a care package with agreed ways of working
and best practices to suit the needs of the individual. For the individual, it means that cognitive
understanding and communication may not be as impaired in the early stages. The family and friends will
also experience fear and denial and early diagnosis can help them to overcome their varying emotions by
providing the support they need from GP’s, social services etc.. and to provide as much information as
possible so that they understand the changes that will affect themselves and the individual. The care
package needs to be ‘person centred’ and include involvement from family and friends as much as possible.
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