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Friendly Print preview .. 2 page pdf link THE DEMENTIAS: MEMORY LOSS AND CONFUSION Prepared By: ALZHEIMER'S ASSOCIATION VICTORIA Do you have a friend or relative who is becoming very forgetful? Someone, for example, who gets lost in familiar surroundings? Or makes serious mistakes over simple matters at work? Or does things around the house like turning on the gas and forgetting to light it? Has this started happening to you? This is a different thing from the ordinary forgetfulness that everyone has from time to time. If it seems to be affecting you or someone else close to you - your spouse or an elderly parent, for example - then you may find this pamphlet useful. Serious loss of memory may be a sign of dementia. As used by doctors, this word refers to a group of illnesses that affect the brain physically and cause the person's mental abilities to decline. About 100,000 people suffer from dementia in Australia today - most of them are over 60 years of age. "Senility" has been the common term for it, as if dementia were a normal part of ageing and as if only elderly people suffered from it. But dementia can come on when people are still in their 40's or 50's or younger, and many people live long lives without any sign of it. In the over 65 age group, more people have cancer than dementia, yet no one would say that cancer is a normal part of growing old. The task of caring for someone whose brain is affected in this way often falls on close relatives. This pamphlet is written mainly for people in that role, but it is also meant to provide information for others who may be less directly involved. WHAT CAUSES IT? Nearly half the cases of dementia are caused by Alzheimer's disease (pronounced alt-sigh-mer's), an illness which is 40 times more common than multiple sclerosis. It is a disease in which brain tissue degenerates in a characteristic way. At present we don't know what causes it and there is no medical treatment which will cure it or even slow it down. However, there are some promising research developments. For example, the brains of sufferers from Alzheimer's disease have been found to have low levels of an enzyme which produces the chemical acetyl choline. This is one of the chemicals used by the brain to transmit messages between nerve cells. A deficiency of it may be the key cause of memory loss. Researchers are now working on ways to increase the level of acetyl choline in the brain. Dementia can also result from a series of small strokes - this is called multi-infarct dementia. Excessive alcohol over a long period of time, and severe head injury are other causes of dementia. Three are a large number of less common causes (such as Huntington's Chorea, a rare inherited disease). When it's curable: Serious forgetfulness is sometimes caused by a condition which can be cured. When such a condition is treated appropriately, the memory improves. Conditions of this sort include some vitamin and hormone deficiencies, brain tumours and hydrocephalus ( in which the fluid-containing chamber of the brain expands). Sometimes, too, a person who is suffering from depression may be incorrectly thought to be suffering from dementia. Treatment of the depression can cure this so called "pseudo-dementia". As there are many treatable dementias, it is important for anyone with worsening forgetfulness to seek thorough assessment in order to find the cause. This can be done by your own doctor, by a specialist (psychiatrist, geriatrician or neurologist) or at a hospital with an assessment centre. No one should accept "going senile" as an explanation. WHAT HAPPENS? Alzheimer's disease, for example, may progress rapidly or may take a number of years. In general, there are three stages in its progress. The first stage often passes unnoticed as the symptoms can be ignored or written off as unimportant - the person becomes increasingly forgetful, finds it difficult to take in new information, loses her or his way or sense of time occasionally and becomes less spontaneous. In the second stage, the memory and ability to take in new information continue to deteriorate. This may lead to serious mistakes, such as turning on the gas and forgetting to light it, and the person may need supervision. A sufferer may forget what he or she was saying mid-sentence, forget the meaning of words, have trouble calculating or making plans or decisions, and becoming much slower in speaking and understanding. Other problems in this may include changes in personality, such as becoming paranoid, obsessional or even violent; wandering and becoming lost; and difficulties with personal hygiene. In the third stage, sufferers generally become apathetic, fail to recognise people and even their own reflection and can no longer control their bladder and bowel functions. Finally, they seem unable to make any sense of the world or to manage even simple tasks such as dressing or washing. By now, full time professional care is usually needed. Some types of dementias do not have the relentless progression of Alzheimer's disease. For example, alcohol dementia will not get worse from the time the person stops drinking alcohol - it may even improve slightly. WHAT CAN BE DONE? For people with Alzheimer's disease or a similar (as yet) incurable condition, much can be done to help, and to meet the needs of those caring for them and living with them. It often takes people a long time to realise something is happening when a relative is affected by dementia. Many people find that it makes a lot of difference when they finally recognise that the person has a disease and that the person's mental abilities will never return to normal. This may be hard face, but once relatives and friends can accept what is happening, they tend to find that they can take more appropriate action. At home: Looking after someone with Alzheimer's disease or a similar disorder becomes difficult and exhausting as time goes by. People with dementia may try fiercely to remain independent but may need supervision in case they do something dangerous. Some sufferers realise that their driving or cooking has become hazardous, and stop trying to do them. Others keep on trying! Rather then struggling by yourself to try and work out what to do, ask for advice from your family doctor, welfare staff at the local Council, the nearest Community Health Centre or Alzheimer's disease and Related Disease Society (see address at the end of this pamphlet). Experience shows that it is better to remind disoriented people constantly of the reality around them rather tan to play along with their mistakes and fantasies. This is best done in a low key way, by repeatedly slipping basic information into the conversation:
There is information available to help you take this approach further. The general name for it is "reality orientation". There are many ways of cheering someone up with dementia; singing old songs together, affectionate physical contact, outings to familiar places, visits from old friends and the companionships of pets are examples. How well and how long you are able to cope with the effects of dementia on your family life depends on a number of things, such as your own age and health, what kinds of help and support are available, and whether you are a wage earner, looking after a family or living on a pension. There are some service in your community which can help relieve the strain:
Some areas have day care centers especially for people with dementia. The carer can have some time off and at the same time know that the affected person is receiving valuable stimulation. Some hospitals, hostels and special accommodation houses provide holiday care, sometimes known as family relief. Families can take advantage of this service in order to have an extended break from the constant demands of caring. The affected person will be cared for and there is an added advantage, if a person is admitted to hospital, of a medical assessment. Ask about these services through your local doctor, Council social worker, community health center or regional Geriatric hospital. WHAT HAPPENS NEXT? Some places are better able to meet the needs of people with dementia than others. It is often helpful to speak with a community nurse or social worker when placement is being considered. Separation is almost always painful for all concerned, even though it may also feel like a relief. When you go to visit them, you may meet with reproach. In the last stages of the disease, the affected person may treat you as a stranger. YOU ARE NOT ALONE The people who are most likely to know how to help you and who can understand how you are feeling are those who have had similar experiences. For this reason, all over the world, people are setting up support groups for the friends and relatives of people with dementia. In Victoria, the Alzheimer's Disease and Related Disorders Society (ADARDS) has been formed. For more information about the Association contact: ALZHEIMER'S ASSOCIATION VICTORIA
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East Valley Division General Practice, Victoria,
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