DEMENTIA

DEMENTIA

By: Laurence T. Gayao MD

Dementia is not a specific disease. It is rather a general term for the impaired ability to remember, think, or make decisions that interfere with doing everyday activities. Alzheimer’s disease is the most common type of dementia.

When I started my medical practice as primary care physician, I had to take care of nursing home residents. Many of them were having some degree of dementia. There was not much we could do for the dementia other than address their other medical problems.

As we got older, I and wife Edith have been involved dealing with family members with this illness. Just recently, we had to deal with a family member and her husband who progressed to advance dementia and could not manage living on their own.

First, we notice they stopped taking trips. They lived two hours’ drive away from us and they stopped visiting us. As a couple, they had a wide circle of friends and were active in church and they gradually just withdraw from activities and contacts. We later noted that when we visit them, they had all their window blinds always close the glass opening in their door covered. Their mental condition just gradually deteriorated.

It got to where we had to hire someone to take care of them and a member of the family to handle their finances and help take care of their home. They both stated they did not want to stay in a nursing home. Finally, their mental and physical state were such that they needed 24/7 assisted care.

So my wife suggest for them to move to the Philippines, where we have an apartment for them to stay, and they could have 24/7 assisted nursing and domestic assisted care. To transport them to there, my wife, her brother and his wife accompanied and assisted them in their travel to the islands.

My wife said the travel was very difficult, and stressful because it was like dealing with two toddlers in adult bodies. They needed help for their toilet needs, help in feed them, and to occupy their attention so as not to bother other passengers. At one point, the husband threw food at some passengers, because he got paranoid that they were after him. The travel took almost 20 hours. My wife said, she had to be awake the entire trip because of the unpredictable behavior of the couple.

Lately, I run into a friend at a party. She told me his older brother had multi-infract dementia (multiple mini-strokes), and just passed away after 5 years from the time of diagnosis. He wanted to go back to the Philippines so he could get round the clock assisted care. His children, who were all in the United States, wanted him not to do it because it would be too far for them to visit him regularly. They admitted him to Alzheimer’s facility, which cost $7,500.00 per month for the last three years of his life.

What causes dementia?

Dementia is caused by structural abnormalities in the brain tissue. Multiple biological factors (e.g. plasma tau protein, amyloid plaques build up in the brain tissue) and environmental factors (e.g. repeated head trauma, drug abuse) contribute to dementia. Diseases such as Alzheimer’s, Parkinson’s, AIDS, Syphilis, brain tumors, and metabolic disorders are causes of dementia. Excessive alcohol and drug consumption, severe vitamin deficiencies, as well as multiple head traumas such as repeated concussions can also contribute to dementia.

The 7 stages of Dementia

• Normal Behavior. …
• Forgetfulness. …
• Mild Decline. …
• Moderate Decline. …
• Moderately Severe Decline. …
• Severe Decline. …
• Very Severe Decline.

 

How long can you live with dementia?

The average life expectancy figures for the most common types of dementia are as follows: Alzheimer’s disease – around eight to 10 years. Life expectancy is less if the person is diagnosed in their 80s or 90s. A few people with Alzheimer’s live for longer, sometimes for 15 or even 20 years.

Is dementia is Hereditary?

Many people affected by dementia are concerned that they may inherit or pass on dementia. The majority of dementia is not inherited by children and grandchildren. In rarer types of dementia there may be a strong genetic link, but these are only a tiny proportion of overall cases of dementia.

Who is most likely to get dementia?

The biggest risk factor for dementia is ageing. This means as a person gets older, their risk of developing dementia increases a lot. For people aged between 65 and 69, around 2 in every 100 people have dementia. A person’s risk then increases as they age, roughly doubling every five years.

The number of Americans living with Alzheimer’s is growing — and growing fast. More than 6 million Americans of all ages have Alzheimer’s.

An estimated 6.7 million Americans age 65 and older are living with Alzheimer’s in 2023. Seventy-three percent are age 75 or older.

• About 1 in 9 people age 65 and older (10.7%) has Alzheimer’s.
• Almost two-thirds of Americans with Alzheimer’s are women.
• Older Black Americans are about twice as likely to have Alzheimer’s or other dementias as older Whites.
• Older Hispanics are about one and one-half times as likely to have Alzheimer’s or other dementias as older Whites.

Can dementia be prevented?

Dementia is hard to prevent, because what causes it often is not known. But people who have dementia caused by stroke may be able to prevent future declines by lowering their risk of heart disease and stroke. Even if you don’t have these known risks, your overall health can benefit from these strategies:

• Don’t smoke or abuse drugs or alcohol.
• Stay at a healthy weight.
• Get plenty of exercise.
• Eat healthy food.
• Manage health problems including diabetes, high blood pressure, and high cholesterol.
• Stay mentally alert by learning new hobbies, reading, or solving crossword puzzles.
• Stay involved socially. Attend community activities, church, or support groups.
• If your doctor recommends it, take aspirin

How is dementia treated?

Medicines may slow down dementia, but they don’t cure it. They may help improve mental function, mood, or behavior.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It’s different from care to cure the illness. Its goal is to improve a person’s quality of life—not just in body but also in mind and spirit.

Care may include:

• Tips to help the person be independent and manage daily life as long as possible.
• Medicine. While medicines can’t cure dementia, they may help improve mental function, mood, or behavior.
• Support and counseling. A diagnosis of dementia can create feelings of anger, fear, and anxiety. A person in the early stage of the illness should seek emotional support from family, friends, and perhaps a counselor experienced in working with people who have dementia.

Treatment as dementia gets worse

The goals of ongoing treatment for dementia are to keep the person safely at home for as long as possible and to provide support and guidance to the caregivers.

The person will need routine follow-up visits every 3 to 6 months. The doctor will monitor medicines and the person’s level of functioning.

At some point, the family may have to think about placing the person in a care facility that has a dementia unit.

Why plan ahead?

We learned some important things being personally involved in the care and management of family members with dementia.

Making legal plans in advance is important for several reasons: Early planning allows the person with dementia to be involved and express his or her wishes for future care and decisions. When the family where still able to make decisions we had them have medical and financial power of attorney. We also made sure they had their medical will all set up.

This eliminates guesswork for families, and allows for the person with dementia to designate decision makers on his or her behalf. Early planning also allows time to work through the complex legal and financial issues that are involved in long-term care.

Legal planning should include:

• Preparing for long-term care and health care needs.
• Making arrangements for finances and property.
• Naming another person to make decisions on behalf of the person with dementia.

It can be difficult to talk about dementia with a friend or family member, especially when you have to talk about legal and financial issues. Dementia Conversations: Driving, Doctor Visits, Legal & Financial Planning, a free online course, prepares you to have these tough conversations.

“With something like cancer, there is a feeling that you can fight it in some way or control your response to it, but with dementia there is the fear of losing control of your mind and your life.” Kevin Whately