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During the summer, I had the opportunity to undergo work experience at the local dementia services in my hometown. Although it only lasted for a week, this experience allowed me to gain insight into what dementia is – of which I had no prior knowledge.
Dementia is an umbrella term for a wide range of symptoms that relate to a decline in memory, cognitive abilities, and communication skills. It is known as a ‘major neurocognitive disorder’ and there are many different types of dementia. Some of these include:
- Alzheimer’s disease
- Frontotemporal dementia
- Parkinson’s disease
- Dementia with Lewy bodies
- Vascular dementia
All these types vary in presentation and each one differs in the treatment strategies needed.
Unfortunately, there are many myths surrounding dementia. One of the most prominent is that it is a normal part of ageing. This is false as dementia is a medical condition and therefore not inevitable. There are, however, certain risk factors that can increase the likelihood of dementia occurring. Age is a risk factor, as the likelihood of developing dementia doubles every five years after the age of 65. But it is estimated that dementia only affects 5% of the population older than 65, even though the rates do increase as you get older. Another myth is that there is nothing you can do to lower your risk of dementia. Yet it has been found that smoking, high cholesterol, and high blood pressure are all risk factors – therefore emphasis is put on exercising and eating healthily.
During my time with my local NHS Dementia Service I had the chance to go along to a few house visits to see the identification, assessment, and treatment processes given by various health professionals to those with dementia and also the support provided to them and their families. The latter is paramount. Often it can be very difficult for the relatives to understand and accept that their loved one has dementia. Particularly, the younger the carer, the more they are affected by a loved one having dementia, and it has been found that they are more likely to develop psychological problems (around 75% children). Therefore, support needs to be provided to relatives. Whether that is through genetic counselling or generally just by providing the right kind of information about dementia to help families understand it better.
In order to diagnose somebody with dementia, certain steps are taken. For instance, early identification of dementia could express itself through mild cognitive impairment, learning difficulties, and a history of stroke or Parkinson’s disease. An initial assessment with your GP could rule out any other explanations, and the GP could perform a basic memory function test such as the General Practitioner Assessment of Cognition (GPCOG). If the GP believes there could be a possibility of dementia, they could refer the patient to a specialist to have a CT or MRI scan for further assessment.
In the service, often psychologists or nurses would perform a clinical interview with those who think they might have dementia and perform an Addenbrooke’s Cognitive Examination (ACE-III).This tests for attention, memory (including recall), fluency and language skills, and also visuospatial abilities. The health professionals who carried out the clinical assessments then relayed their observations of the patient’s performance to the consultant psychiatrist within the service, who formally diagnosed the patient. Often this follows the Clinical Dementia Rating (CDR) for dementia diagnosis, or the Diagnostic and Statistical Manual (DSM). To be diagnosed as having dementia, you must qualify for the following criteria:
- One or more declining symptoms of: learning and memory, language, executive function, complex attention, perceptual motor, and social cognition skills.
- If these interfere with independence in daily activities.
- If cognitive deficits do not occur exclusively in the context of a delirium
- If it cannot be explained by another mental disorder
Along with dementia, sometimes other mental health problems such as anxiety or depression can be present. Anxiety disorders diagnoses have been found in 5–21% of dementia sufferers, and general symptoms of anxiety have been found within 71% of dementia sufferers. There has also been found high rates of depression in those with Alzheimer’s Disease. Therefore, the possibility of other mental health issues presenting alongside dementia needs to be considered. Often Cognitive Behavioural Therapy (CBT) is provided to treat anxiety disorders and depression.
However, there is no cure for dementia (although it is often thought that there is – another myth), there are some pharmaceutical drugs available such as donepezil, rivastigmine, and galantamine which are essentially cholinesterase inhibitors which work by increasing levels of a chemical messenger involved in memory and judgement. These drugs are used to treat symptoms of mild to moderate Alzheimer’s disease. Interventions like cognitive rehabilitation and cognitive stimulation also attempt to improve (or at least maintain) functioning of some skills. For instance, the service provided a support group which consisted of a small community of dementia patients attending each week. I sat in on two of the sessions and the patients took part in quizzes, discussions about the news, and even looked at things from their past (e.g., adverts and ration booklets). The aim was to allow them to recall their memories and also engage in social discussions – all to keep their minds active. Another group played cards and board games, which gave them a strong sense of community and support. I think it is very important to provide support groups such as these, after all one of the risk factors for dementia is social isolation.
Nevertheless, I think following a ‘person-centred’ treatment plan is the best. Tom Kitwood came up with this idea, which looks at the dementia sufferer holistically and involves both the patient and carers at all stages. With regards to helping the patient be comfortable and safe in their own home, this is where occupational therapists come in. I managed to speak to the occupational therapist working with the service and managed to find out more about their roles.
Occupational therapists usually aid in the evaluation of how the patient is coping and functioning in the daily life. They look at their strengths and impairments and look at the areas needing intervention, and will subsequently help the person with dementia to adapt to these. As we get older, we tend to lose our sense of depth perception, spatial awareness, visual acuity, and generally just perceive our surroundings differently. With dementia, these impairments can be more intense. Therefore, care is needed to modify the environment the patient is living in in order to make it safer. Research has supported that colour and contrast plays an important part in this. In the patient’s home environment, things like doorways and stair rails need to be contrasted against the rest of the walls to make it easier for the patient to notice. Having patterns on the floors also needs to be avoided as it could appear to the individual that they are uneven which could cause hesitation and unsteadiness and could lead to falls. Therefore, lots of different factors need to be accounted for to enable the comfort and safety of the person suffering with dementia.
There are various societies which provide much information about dementia, if you are interested. Some of these include: Alzheimer’s Research UK, Dementia UK, and Alzheimer’s Society which are all worth taking a look at.
I think it is necessary to educate yourself on what dementia is for I certainly had no clue before I turned up to my work experience, and I’m so glad I was offered the opportunity to learn and share my experience. There are a host of research currently looking into dementia – we know so far of the different types, risk factors, and how such treatment such as medication, cognitive stimulation, and how support groups and modifying the environment play a huge role in aiding somebody suffering with dementia. Hopefully in the years to come we will know even more about it – and potentially find a cure.
Alice Allen is a third year psychology student at Manchester Metropolitan University. She began as a combined honours student studying philosophy as well as psychology.
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