The most prevalent mental disorder associated with aging is dementia, a term used to describe a broad syndrome of brain diseases which cause people to progressively lose their ability to think and reason clearly. Since it is a degenerative neurological disease it eventually impacts on a personâ€™s physical being as well, including problems with balance, mobility, continence and swallowing. Nearly half of all people over the age of 85 display some form of dementia.
In Australia, one in ten people over 65 have dementia compared to three in ten over the age of 85. There are currently around 350,000 Australians living with dementia and this number is expected to increase to 900,000 by 2050. Every week approximately 1,800 people in Australia are newly diagnosed with dementia, which equates to a new diagnosis every six minutes.
Dementia is the single greatest cause of disability in Australians over 65, the third leading cause of disability overall, and the second leading cause of death in Australia. Dementia is caused by damage to brain cells which affects the brain’s ability to think, reason, and remember clearly. The most common affected areas include: memory, visual-spatial, language, attention, and problem solving. The underlying causes of damage to the brain may include:
- Traumatic brain injury (such as experienced in boxing or football);
- A temporary reduction in the supply of blood or oxygen to the brain (due to stroke or infection);
- Chemical impact, such as excessive use of alcohol; or
- Neuro-degenerative disease.
Around 75% of all dementia is caused by Alzheimer’s 6 which is a neuro-degenerative disease. With Alzheimer’s disease, proteins damage the ability of the brain to continue functioning properly leading to memory loss, language problems, trouble with visual-spatial areas, loss of direction, and a decline in reasoning and judgement.
Dementia typically has a long, slow onset (except in the cases of a stroke or trauma), accompanied by a slow progressive decline of mental functioning. By the time the person shows obvious signs of the disease, the process in the brain has been happening for a long time.
In the early stages, people with dementia may have problems with short-term memory which affects their ability to keep track of a purse or wallet, pay bills, plan and prepare meals, or remember appointments. In this stage, patients have trouble organizing, may repeat things, can experience personality changes, and even lose their sense of direction. While they can usually still take care of themselves, they may need prompting and reminders along the way.
As dementia progresses, the early symptoms get worse. While the rate of decline is different for each person, generally all need help functioning and shouldnâ€™t be left alone. And in the late stages of dementia, patients need 24 hour supervision. They may wander, have hallucinations, or lose their ability to control their bladder and bowels (incontinence). Generally, the most severe patients need assistance with all aspects of daily life for often they lose the ability to eat or swallow, have severely decreased appetites, could become agitated easily, and may no longer recognize familiar people.
Typical Symptoms of dementia include the following:
Depression and anxiety
Depression and anxiety are frequently associated with dementia and worsen in direct relation to the degree of cognitive and behavioural impairment. Anxiety often manifests itself in agitated, disruptive, and aggressive behaviour as well as wandering and restlessness.
Along with mood changes, dementia is associated with other behaviour changes. One typical type of behavioural change seen with dementia is a shift from being shy to outgoing. Dementia patients may become less inhibited, more impulsive, and show a lack of social judgement: They may say rude things, expose themselves, make inappropriate or sexually explicit comments, and may openly start using pornography.
A common symptom of early dementia is social withdrawal accompanied by a general listlessness or apathy. People with dementia lose interest in hobbies or activities. They may not want to go out anymore or to do anything fun. They may lose interest in spending time with friends and family and may seem emotionally flat.
Difficulty doing normal tasks
Dementia patients struggle to complete normal tasks. In addition, they may struggle to learn how to do new things or follow new routines.
In the early stages of dementia, patients start showing signs of forgetfulness. As dementia progresses, they often show signs of memory distortion. They may start developing â€œmemoriesâ€ of things that never happened, combining memories, or confusing the people in a memory. They may struggle to remember faces or find the right words.
Failing sense of direction
Memory problems accompanied by a decline in spatial orientation causes patients to forget once-familiar landmarks, regularly used directions, and easy step-by-step directions.
Difficulty following story-lines
Memory confusion makes it hard to follow a story-line. In addition, people with dementia forget the meanings of words they hear which causes them to struggle to follow conversations or TV programs.
Repetition is common in dementia because of memory loss. The patient may repeat daily tasks obsessively. They may also repeat the same questions in a conversation even if the question has already been answered for them.
Struggling to adapt to change
For someone in the early stages of dementia, the experience is frightening. Suddenly they canâ€™t remember people they know, or follow what others are saying. They canâ€™t remember why they went to the store or get lost on the way home. Because of this, they crave routine and may not want to try new things. Having difficulty adapting to change is a typical sign of early dementia.
In addition to their obvious cognitive decline, patients with dementia may display a range of physical symptoms such as tremors, trouble with balance, rigid muscles, jerky movements, numbness and tingling of the limbs, and muscle contractions causing involuntary repetitive movements.
Dementia patients often develop speech and language difficulty. Apart from difficulty finding the right words and naming things, they also have problems producing speech because they have difficulty coordinating the muscles they need to speak. Many patients show a marked decline in speech, using only one-syllable words. Some become totally mute.
Trouble eating and swallowing
Patients with dementia often have difficulty eating and swallowing because they struggle to coordinate the muscles they need to accomplish the task.
Most distressingly, patients exhibit a range of psychoses. They may experience delusions, persecution paranoia (believing people are stealing from them or intend to harm them), or experience vivid visual hallucinations.
Seniors with dementia experience the same prevalence of conditions likely to cause pain as seniors without dementia. Yet those with dementia usually become incapable of informing others that they’re in pain. Persistent pain can lead to decreased mobility, depressed mood, sleep disturbances, reduced appetite and worsening of cognitive impairment.
While there are drug treatments to address the symptoms of dementia, there is no cure to slow or stop the progression of dementia. As a result, therapies generally include aromatherapy, massage, music therapy, reminiscence therapy, cognitive reframing, and mental exercise.