Caring for Dementia with Respect and Dignity.
A patient of mine who is about 75 years of age has been attending one of my regular general health check clinics for the last fifteen years. During the last year she lost her partner who she used to cycle with regularly and during my last clinic requested a follow up appointment which she wished to attend together with her solicitor because she told me that she wanted to put her financial affairs in order as she had noticed that her memory is rapidly failing.
The first thing I did was to complete a mental state and cognitive assessment specifically looking for sign of depression. I also completed a full physical examination and then agreed to see her one week later with her solicitor.
Fear and anxiety about memory failure and dementia is not uncommon in primary care. Every one of us needs to be aware about how to recognize early signs of dementia so that those conditions that are treatable can be dealt with and people with dementia and their carers can be well supported.
What we know about dementia
I read a very useful report published by the Alzheimer’s Association in 2014 which I would like to recommend to others. It states that dementia is caused by damage to nerve cells (neurones) in the brain which means that they can no longer function properly and can lead to the death of these nerve cells. As a result people with dementia show a decline in:
- Memory or other thinking skills
- The ability to perform everyday activities
Over time other bodily functions such as walking and swallowing also decline and dementia ultimately causes death.
There are many types of dementia but the commonest is Alzheimer’s Disease
Millions of Americans have Alzheimer’s Disease and other dementias and the prevalence is rising because people are living longer. There are about 5 million people aged 65 and over with a diagnosis of dementia in the USA and about 3.2 million are women. This does not mean that women are more likely to have dementia than men and the reason so many women are affected is because they live longer than men.
ALZHEIMER’S ASSOCIATION (CREATED FROM DATA FROM HERBERT ET AL 2013)
Things that might make you suspect that your friend or relative may be suffering from Alzheimer’s Disease
The Alzheimer’s Association report also suggested ten things to look out for if you suspect that your friend or relative may be suffering from dementia. These symptoms do not always occur at the same time and may include:
- Memory loss that disrupts daily life
- Challenges in planning or solving problems
- Difficulty completing familiar tasks at home, at work or during leisure time
- Confusion with time or place
- Trouble understanding visual images and spatial relationships
- New problems with words in speaking or writing
- Misplacing things and losing the ability to retrace your steps
- Decreased or poor judgement
- Withdrawal from work or social activities
- Changes in mood and personality including apathy or depression
If family or friends notice any of these symptoms they should seek early help from their family doctor because if this is dementia you need extra help because things may get worse and if the problem is due to depression or other treatable conditions the memory loss can be reversed.
What we can do to prevent dementia
Keeping your heart and blood vessels healthy is associated with a healthy brain and decreases the risk of dementia so we can all do our bit to reduce the risk. Things that work include:
- Stopping smoking
- Preventing and managing obesity especially in mid-life
- Reducing cholesterol levels
- Reducing blood pressure
- Regular physical activity
- A healthy diet low in saturated fats and rich in vegetables and vegetable based oils
Other things that you can do to decrease the risk of dementia include:
- Keeping mentally active
- Keeping socially active
What should happen in suspected dementia
Once a doctor suspects that their patient may have dementia it is very important that they rule out other treatable conditions that mimic dementia such as depression, delirium, thyroid problems, vitamin deficiencies, alcohol misuse and side effects of some medications.
Carers are important
People with dementia have much of their care provided by relatives and loved once and we don’t thank them enough. Cares provide many different aspects of support including medication management, personal hygiene, legal issues, end of life care to name but a few. This means that we also need to care for carers. This can be through psycho-education, counselling and respite and means that people who plan the delivery of services should always include caring for carers in service design. Family doctors can also do a lot to co-ordinate and provide many of these services.
The global response
I attended a mental health forum (mhGAP) at the WHO in Geneva Switzerland on 10th October 2016 and the draft WHO global action plan on the public health response to dementia 2017-2025 was discussed as part of a consultation process. I was very pleased to see that many Ambassadors and NGO’s who attended have been making active plans to develop a global strategy.
The vision presented was for the people of the world to be able to live well, with or without dementia and receive the support they need to fulfill their potential with dignity, respect and equality. We cannot ask for more.
Once the final WHO global action plan on the public health response to dementia is agreed we must all work together to ensure that we meet the targets set. If not we will let ourselves and the general population down.
We can do a lot to reduce the risk of dementia and to support our loved ones with dementia. Carers matter and these unsung heroes should be kept in mind, supported and celebrated. Most importantly the individual matters and is entitled to dignity in care.
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