Case study-
Mike, is a retired banker and played professional soccer for over 2 decades. He takes his dog for a walk everyday and meets with his friends for golf every Sunday at 10am.
His wife, Julia, rather found it funny that mike had filed an electricity bill in her cookbook on his 74th birthday but she was increasingly concerned as he frequently lost his spectacles, repeatedly asked her the day of the week or if she locked the porch door, lost his turn to their home after walks returning late, got clumsier with pouring coffee and fumbled when buttoning his shirt.
Mike’s physician noted in the history that he used to be a chain-smoker until his early 40s and had a paternal cousin who had Dementia. After a series of blood tests and Brain CT, MRI scans, a diagnosis of Alzheimer’s disease was established.
Julia actively made adjustments around the house to help mike’s condition like fixing a chain for his spectacles so he could wear them around his neck, get a digital calendar that displayed the time, date and day in big bold lettering, labelled every shelf with his belongings. She set his phone with frequent reminders and GPS to direct him home after walks.
She also made a checklist everyday for him to read the newspaper, feed the dog, water the grass and take out the trash. Sudoku, chess and word puzzles seemed to keep him well engaged, occupied and happy along with the medications prescribed by his psychiatrist.
Over the next years, the medication doses needed to be increased and Mike progressed to losing bladder and bowel control, refused to eat much as he seemed to forget how to swallow until one day, little after his 84th birthday he asked Julia “who are you?” when she patiently replied, “I am your wife, Julia”.
Dementia, a disease mostly diagnosed in the elderly, above 65 years, is an umbrella term to describe loss of thinking ability, memory, attention, logical reasoning with other mental functions.
Though it is frequently recognized among the public as “short term memory loss that sets in with old age”, Dementia is not a sequence in the natural aging process. It is caused by organic damage to the brain and the symptoms depend on the particular part of the brain involved.
The following are the commonest mechanisms of dementia and a patient diagnosed with one of it could have simultaneously co-existing multiple pathologies.
Alzheimer’s disease – this, the commonest type of dementia, is a gradually advancing neurological disorder typically seen in old age due to an abnormal protein accumulation in the brain which can lead to nerve cell death and destruction of neurological pathways.
Alzheimer’s shows a genetic predisposition and is invariably progressive but can be treated symptomatically.
Vascular Dementia-
Vascular Dementia is caused by interruption of the flow of blood and oxygen supply to the brain, mostly seen in patients with comorbid conditions and risk factors to develop a stroke like high blood pressure, cholesterol and smoking.
Risk factor modification being the key to prevention of this variable of dementia, physiotherapy and brain stimulating activity has proven to improve quality of life by “re-teaching” “forgotten” activities.
Lewy-body Dementia-
This type of dementia is the most difficult to diagnose, and is also caused by abnormal protein deposits in the brain.
the person’s short-term memory doesn’t seem to be very affected but can elicit symptoms similar to Parkinson’s disease like muscle rigidity, stiffness, tremors and loss of balance along with hallucinations, fluctuating cognition, with a day-to-day variability.
Early detection of Dementia symptoms is important, as some causes can be treated and it can help with managing the condition with simple life style modifications and medication.
Quoting long term caretakers of patients with dementia, you agree, never argue. You redirect, never reason. You distract, never shame. You reminisce, never say remember. You repeat, never say, “I told you so” and you ask, never command.
