Understand the neurology of Dementia

Understand the neurology of Dementia
Describe a range of causes of dementia syndrome
Dementia syndrome is a combination of conditions, which are sometimes called a mixed dementia.

Causes of dementia are:

• Specific diseases; Alzheimer’s, Parkinson’s disease.
• Cerebral vascular accident such as stroke of the brain
• A group of conditions/brain disorders

Alzheimer’s is caused by broken signals within the brain leading to the death of brain cells, this can also lead to a shortage of some important chemicals, these chemicals control the transmitting of messages to the brain. Parkinson’s disease is a progressive neurological condition which occurs when the brains nerve cells that contain/produce dopamine die, without the chemical dopamine Parkinson sufferers will find their movements become slower as well as taking longer to do day to day activities Vascular dementia is caused when the blood flow to the brain becomes blocked which often occurs when an individual has a stroke. If the vascular system becomes damaged and blood flow is unable to reach brain cells then the cells will eventually die leading to early onset vascular dementia. Picks disease is a rare disorder that causes the frontal/temporal lobes of the brain to slow down, this is a direct result of protein in the affected areas of the brain.

Describe the types of memory impairment commonly experienced by individuals with dementia

• Frontal lobe: higher intellectual functioning, planning, judgement, controlling behaviour.
• Temporal lobe: auditory processing, language, words and memory
• Parietal lobe: body movement, language, words and memory.
• Occipital lobe: visual processing.

The brain is a complicated group of systems and if any one part of the brain is not functioning at an individual’s normal level this may cause: confusion, hallucinations, delusions, false beliefs or a false sense of reality.Explain how other factors can cause changes in an individual’s condition that may not be attributable to dementia An individual’s age or gender can create changes to their bodies that are not a direct result of suffering with  dementia, such as women between the ages of 40-60 who may have to deal with emotional/physical changes associated with the menopause. Or a diabetic with visual/dietary complications. An individual that relies on mood adjusting medication for a condition such as depression may already display behavioural/physical changes that are challenging for them and others in direct contact with them.

Explain why the abilities and needs of an individual with dementia may fluctuate Each person suffering with dementia should be viewed as an individual, and treated accordingly. From the initial diagnosis of dementia a person’s attitude, physical/mental needs will change as the condition progresses. Dependant on the level of dementia that the individual has the brain will deteriorate in terms of mobility requirements, memory loss and a lack of independence. Having to accept support on a daily basis may lead mental health concerns or erratic frustrating outbursts that are out of character.

Understand the impact of recognition and diagnosis of dementia

Describe the impact of early diagnosis and follow up to diagnosis Early diagnosis of dementia and follow up care can help in many ways, as well as being able to look into and access physical/emotional support services at an earliest opportunity it can also give time to research financial aid and dictate any future legal implications such as power of attorney or next of kin arrangements. Having an early diagnosis can also give a sufferer every chance of being made aware of their condition and how it may effect themselves and their family/friends.

Explain the importance of recording possible signs or symptoms of dementia in an individual in line with agreed ways of working It is extremely important that accurate records are kept regarding an individual with dementias health on regular basis. The facts required include:

• Monthly weight record; this allows for any weight loss/gain to be recognised
• A personal care plan; to record any personal assistance that the individual may require daily as well as who is providing the necessary care
• Diet/fluid chart; to ensure nutritional need are being met
• Mobility assessment; required by law to protect individuals/carers
• Behavioural chart; used to record any change in attitude or behaviour
• Regular reviews with multi agencies

Explain the process of reporting possible signs of dementia within agreed ways of working Within my own work place reporting possible signs of dementia will involve looking at the individuals care plan which holds information on previous/currant illness, observations recorded regarding emotional/physical changes and whether their symptoms fit with a profile of a dementia sufferer. Upon having suspicions a healthcare assistant may inform their manager/matron who in turn will refer to the individuals Gp or other medical professional as cognitive investigations or other tests may be required as well as involving multi agencies for guidance/support.

Describe the possible impact of receiving a diagnosis of dementia on

1. The individual
2. Family/friends

Individual: in the first instance an individual may experience a mixed range of emotions such as confusion, fear, anger and shock as many people receiving life changing news would feel. Suddenly their outlook for the future may become unclear, will their diagnosis impact on their hopes/dreams, how will it affect their working life, will they have to retire early and can they afford to? The individual may also begin to worry about the effect that their illness will have on those around them and their social life.

Family/friends: when an individual is given a diagnosis of dementia it impacts on their friends and family too, they may feel angry or guilty but may also have an overwhelming fear of what they can do to support the sufferer and each other at present and in the future. Will they be able to cope with the level of commitment to the individuals needs on top of their own daily trials? Not to mention the added financial/emotional stress. Support services are available for care givers alongside the person suffering with dementia via Gp, social services or online forums.

Understand how dementia care must be underpinned by a person centred approach Compare a person centred approach with a non-person centred approach Person centred approach
This involves looking at the person as a unique individual while building the care package required just for them, they should have choices available on what they eat/drink, when they like to wake/sleep or which activities they may enjoy being involved in. choices on medications or who will become their advocate when the individual no longer has the mental capacity to make decisions their selves. Giving an individual options can help them feel valued, listened to and often empowered therefore encouraging positive mental wellbeing.

Non person centred approach

Is the complete opposite to the above! This involves ignoring or not considering an individual for who they are when taking into consideration the level of care required, by taking away their own choices, options or opinions the individual may become isolated/excluded from important decisions. Taking away a person’s right to choice or not allowing them to participate in decision making is considered abuse, this could lead to upset, fear or depression. Comparing both approaches, I would consider a person centred approach to be the most beneficial/positive way of helping and supporting an individual with dementia.

Describe a range of different techniques that can be used to meet the fluctuating abilities and needs of the individual with dementia It is important for an individual with dementia and their family to write a brief history including memorable events, dates and periods of time to aid reminiscence. This will help interaction with the individual as and when cognitive ability starts to fail. Continuity of care is also fundamental for the wellbeing of the individual, getting to know the same group of names and faces is re assuring in a confusing situation it is also a positive step when having to deal with episodes of challenging behaviour •Completing a health profile

• Carrying out a life at the moment profile
• Describe the myths and stereotypes related to dementia may affect the individual and their carers

To someone unaware of what dementia is or how to treat a person who has the condition it is very easy to stereotype them , it used to be believed that there was no place in society for someone who is losing their mind or shows a mental disability. A young dementia sufferer may struggle to be accepted more than an older individual as many believe dementia is an old person’s disease. at first a dementia sufferer at any age will be capable of performing daily tasks and holding down a job or raising a family, with no more real concerns than that of a considered normal person and without prejudice. As symptoms develop then employment issues, social acceptance issues and the ability to deal with daily family life may become a concern to the individual and those around them. Friends and family may at first be around or on hand to offer support to the dementia sufferer and any appointed carers but with time and the progression of the illness, support often decreases.

One of the effects of dementia can be aggression/agitation and the lack of coping with physical/emotional changes. A stranger may fear the individual and what they could do to themselves or others should these occasions arise. Those who have dementia may feel that people want to pity them or that they are becoming a burden to those around them, maybe they could feel inadequate, isolated/alone and start to suffer from low self-esteem. the truth is that mental health problems until recently were stigmatised and sufferers faced discrimination by society in many areas but with strong efforts to educate society via the media where a prime time soap opera on tv showed the struggles of a middle aged Alzheimer’s suffer, or on the internet as resources are now at a touch of a button. Attitudes are changing for the better.

Describe ways in which individuals and carers can be supported to overcome their fears A dementia suffer and their appointed cares can access support from close family/friends or neighbours when worried or fearful over their changing circumstances, professional support is also available through a gp or health visitor/social worker who can offer advice and information about agencies that specialise in dementia care. From leaflets, telephone advice lines or web pages. Social services can arrange respite/short-term care to
give carers/family a chance to take time out and look after themselves which will in turn aid the dementia sufferers well-being.

References:

• Miller, Bruce L. The behavioral neurology of dementia. Cambridge University Press, 2016.
• Petersen, Ronald C., et al. “Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology.” Neurology 56.9 (2001): 1133-1142.
• Doody, Rachelle Smith, et al. “Practice parameter: Management of dementia (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology.” Neurology 56.9 (2001): 1154-1166.