Dementia

Dementia tends to get worse over time and creates serious problems for both the person experiencing it and their loved ones. Its progress is different in every case. Eventually, many people with dementia can no longer live independently or make major decisions on their own. Your chances of having dementia rise as you get older, but this does not mean that everyone will get it. Many older adults never get it.

If you or a loved one is experiencing worsening memory loss, see your doctor. It may be nothing to worry about, but if it is dementia, treatment could help.

Symptoms
The most common and noticeable symptom of dementia is usually memory loss. If your memory is impaired, your family and friends will often be the first to notice. As dementia progresses, you may experience other symptoms. People with dementia often have challenges with completing tasks that require planning and organization, such as shopping. You may have difficulty using language properly and comprehending certain words. Sometimes, you may find that you get lost in places you were once very familiar with.

Subtle or blatant personality changes can occur. You may become frightened easily or aggressive, overly possessive of others, or act out in an emotionally immature manner. As well, people with dementia often neglect self-care activities, such as combing hair, brushing teeth or showering. As dementia becomes more severe, you lose the ability to care for yourself. You may become disoriented and unable to recognize family members or friends.

Causes/Risk Factors
Dementia is caused by damage to or changes in the brain, such as strokes, tumours, head injuries or Alzheimer's disease. Alzheimer's disease is the most frequent cause (60-80 per cent of cases), followed by strokes (10-20 per cent of cases). When a stroke causes dementia, the resulting condition is called vascular dementia. Other forms of dementia or conditions associated with it are Parkinson's disease and other illnesses.

In some cases, dementia may be caused by a treatable condition. Examples of these conditions include under-active thyroid glands (hypothyroidism), a vitamin B12 deficiency, and the build-up of fluid in the brain (normal-pressure hydrocephalus). In some cases, depression can also lead to memory loss that may be mistaken for dementia but which disappears upon successful treatment.

Rarer causes of dementia include Huntington's disease, Leukoencephalopathies, long-term high blood pressure or atherosclerosis, Creutzfeldt-Jakob disease, certain cases of multiple sclerosis and amyotrophic lateral sclerosis, multiple-system atrophy, infections like mad cow disease and late-stage syphilis.

Certain combinations of medicines can produce symptoms that mimic dementia. Ensure your doctor knows all the prescription and non-prescription medications you are taking, including vitamins, minerals, supplements, herbal remedies and other substances with medicinal properties.

What You Can Do
There are many things you can do to help ease the impact of dementia on loved ones:

• Talk with your loved one about handling major decisions before their condition worsens. This may include creating a personal directive and naming a substitute decision-maker.
• Improve home safety by installing handrails in bathrooms and along stairs to help prevent falls, lock up the medicine cabinet and remove any dangerous appliances. Remove all throw rugs to prevent tripping or slipping that can lead to a fall.
• Put a list of important numbers by the phone and post reminder notes where they can easily be seen.
• Establish regular routines, particularly at night, when symptoms may be worse. Consider keeping a light on at night.
• Maintain good nutrition. Offer food more often, including healthy mid-morning and mid-afternoon snacks. If the person has trouble using a spoon or a fork, serve finger foods. Serve one food at a time; choices can be confusing. If the person is losing weight, consider offering a liquid nutrition drink, such as Ensure.
• If your loved one is on their own, prepare meals for them and store them in the fridge in microwaveable containers.
• Help your loved one stay awake and active in the daytime and give them warm milk or a non-caffeinated tea before bed.
• Encourage your loved one to visit the washroom regularly during the day. You might also consider purchasing disposable undergarments in case the person has accidents during the day.
• Keep things in the same place around the house to provide continuity and familiarity.
• Consider strange or disruptive behaviour in terms of past activities. Your loved one may be trying to do something they did in the past.
• Keep noise levels down to avoid over-stimulation and/or agitation.
• Lock outside doors, and use alarms and other devices to alert you when the person wanders.
• Communicate in simple language and explain what you are doing while doing it.
• Try to be patient when responding to repetitive questions or behaviours.
• Help keep your loved one socially, physically and mentally active by going places or on walks and playing board games or cards together.
• As the dementia worsens, your loved one will require even more support. Eventually, they may need help with the simplest tasks, such as eating, getting dressed and using the washroom. You may want to consider a long-term home where your loved one can get round-the-clock professional care to help them maintain their daily routine.

Know that there is support for you, as well. Many people have family members who suffer from dementia. Consult your doctor and the Internet to find out about local support groups, such as the Alzheimer Society of Canada. Ask family members to share the responsibilities, sign up for homecare support or seek respite care, such as the Just Like Home Program.

What You Can Take

There are medicines you can take for dementia. They cannot cure it, but they can slow it down for a while and make it easier to live with.

If the underlying cause of the dementia is hypothyroidism, vitamin B12 or antibiotics for infection can be helpful.

Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon) are used to treat Alzheimer's disease and may help to enhance or stabilize mental functioning in people with dementia. Common side effects for Rivastigmine are nausea, vomiting, and weight loss.

Memantine (Ebixa) can slow the progress of later-stage Alzheimer's disease. It may also help people with mild to moderate vascular dementia. More research is being done on this drug.

Medication for high blood pressure and high cholesterol, which are risk factors in vascular dementia, can prevent strokes and heart disease that can increase damage to the brain.

Antidepressants help relieve the symptoms of depression, a typical problem associated with dementia. Their use should be carefully monitored, as they can cause delirium in those with dementia. Antidepressants with the least side effects are preferable.

Risperidone (Risperdal), olanzapine (Zyprexa) and similar medicines may help treat behavioural problems and psychosis in those with dementia.

If your loved one is taking antidepressants, watch for increased anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, suicidal behaviour, hostility, and mania. If you have concerns about any of these symptoms, don't let your loved one stop taking prescribed medication without first consulting their doctor.

Further Resources
Contact the Alzheimer Society at www.alzheimer.ca or 1-800-616-8816.