The Impacts of Dementia (Research Paper Sample)

Dementia
Introduction
It is normal for people to become absent minded, forgetful and experience mild cognitive impairment as they grow older. This is often described as age associated memory impairment that causes people to experience gradual memory loss in daily activities like remembering names, phone numbers or misplacing objects. Although a certain degree of memory decline is associated with normal aging, their intellectual functioning will still remain intact. Normal memory loss due to aging is also not an indication for onset of Alzheimer’s disease. However, when people start to get lost in familiar place, begin repeating the recent conversations and experiences difficulty to perform familiar tasks it could signal the beginning of more serious problems like dementia or Alzheimer’s disease. Dementia will cause memory loss and a decline of cognitive abilities in patients. Although the prevalence of dementia increases with age, young people are also known to be affected by problems of dementia. A medical professional can help by accessing the cognitive impairment in a patient and recommend the type of treatment. The available drugs cannot repair brain damage or cure dementia but they can help to slow down the dementia progress and improve its symptoms. This aim of this article is to use current literature for describing the best practices and multidisciplinary approach for identification, assessment and management of dementia. The article will first begin by offering a brief explanation about what is dementia. It will then proceed to discuss about the processes involved in the identification of dementia in patients. This will be followed by a discussion on how the assessment of dementia is being performed. The article will then proceed to discuss on the best approaches for managing the behavioral and psychological symptoms shown by patients with dementia.
About dementia
Dementia is a condition that is characterized by memory impairments and multiple cognitive deficits. It occurs when degeneration of brain cells takes place in the region of the brain called cerebral cortex. This is the part of the brain that is responsible for our memories, thoughts, personality and actions (Sue et al., 2008). The most common cause for dementia is Alzheimer’s disease. Between 50% and 75% of dementia cases are found to be cause by Alzheimer’s disease. Other common causes for dementia are Lewy body dementia caused by the presence of abnormal protein chunks in the brain and vascular dementia that is caused by reduced blood flow to the brain (Sue et al., 2008). Dementia is also caused by fronto-temporal dementia, Huntington’s disease, brain injury and Creutzfeldt-Jakob disease (Weiner and Lipton, 2008). Dementia is an incurable progressive condition that affects the functional ability and the quality of life of a person (Chang and Johnson, 2008). People with dementia gradually lose their ability to think well which results in being unable to perform normal activities like eating or getting dressed. They also experience personality change, hallucinate, become easily agitated and experience mood disturbances (Miller, 2009).
About 4.5 million people in US had been diagnosed with Alzheimer’s disease in 2003 and this figure was estimated to reach 14 million by 2050 (Sue, et al. 2008). Similarly the prevalence of dementia in Australia is also expected to be increasing by four-fold over the next 40 years (Terpening, Hodges and Cordato, 2011). There had been 210,000 cases of confirmed diagnosis for dementia in Australia during 2006 (Chang and Johnson,2008).This could be attributed to the fact that Australia’s aging population of people over 65 years is expected to double by middle of this century (Kohsaka, 2012.). Incidence of dementia is known found to double every five years between the ages of 65 and 90 years. Prevalence of dementia in people who live beyond 90 has also been found to rise exponentially (Corrada, Brookmeyer, Paganini-Hill, Berlau and Kawas, 2010). This condition is expected to produce a growing burden on public healthcare for coping with incidence of dementia in an aging population.
Identification of dementia
From a clinical perspective, the identification of dementia has shifted from the diagnosis of a full-blown dementia to an early diagnosis of dementia causing illnesses so that they could be treated before it causes the irreversible state of dementia (Weiner and Lipton, 2008). Early diagnosis of dementia will help the patients to plan for their future by making necessary arrangements with their caregivers and preparation of legal matters like authorizing power of authority to a trustworthy person. Although it has been found that more than two thirds of the people who have noticed symptoms of their cognitive decline will consult with a physician to be evaluated, over 90% of mild dementia cases had been missed during primary care assessment (Terpening, Hodges and Cordato, 2011).
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a standard that is published by American Psychiatric association to help standardize the criteria and categories for psychiatric diagnosis. The DSM-IV-TR helps to list major etiological categories that cause dementia into general medical conditions, substance-induced persisting dementia, multiple etiologies and unspecified dementia (Sue et al., 2008). General medical conditions that are described will include Alzheimer’s disease, Parkinson Disease, cerebro-vascular disease or brain trauma. DSM-IV-TR uses clusters of symptoms to meet threshold levels to identify specific subtype of mental disorder. This is important because it enables guided prognosis and appropriate treatment plan. However its minimal threshold level can reduce the sensitivity of the diagnosis which can cause failed early detection and delayed disease modifying treatment (Weiner and Lipton, 2008).
A reliable diagnosis for dementia needs full mental assessment, comprehensive history record and physical examination. A detailed neuropsychological test may be the best tool for diagnosis but it is only available to specialist psychologists, will be time consuming and costly (Terpening, Hodges and Cordato, 2011). Brief screening instruments like mini-mental state examination (MMSE) can be used to evaluate patients with cognitive complaints but it is also reported to have many shortcomings like lacking in diagnostic specificity, being unsystematic and unable to detect milder cognitive impairment (Zarit, Blazer, Orrell and Woods, 2008). It may be unrealistic to rely on brief screening tools for diagnosing dementia but it can become a more accurate instrument when used alongside a reliable clinical history. Screening tools like Addenbrooke’s MMSE help to detect mild cognitive impairment and it is already being used in Australia (Lonie, Tireney and Ebmeier, 2009). Other tools used for diagnosing dementia in Australia are Addenbrooke’s Cognitive Examination–Revised (ACE-R), General Practitioner Assessment of Cognition (GPCog) and Rowland Universal Dementia Assessment Scale (RUDAS) (Terpening, Cordato, Hepner, et al., 2011). These tools contain statements that are systematically developed as being best practice guidelines for identification of dementia and achieving better health outcomes.
Assessment of dementia
The diagnosis of dementia will need to identify two deficits consisting of memory impairment and a functional disability (Ham, 2007). Therefore the assessment of patients with symptoms for dementia will include examining their cognitive status, functional status, medical condition, behavioral issues and other forms of regular assessments. These assessments must also consider the capacity of a patient for decision making, address the support system available to the patient and identify a primary caregiver.
The assessment of cognitive status by a clinician will begin with a review of the patient’s attentiveness and alertness (Ham, 2007). If any deficit is found, a further assessment of cognitive status for a suspected dementia patient can be done using the MMSE (Zarit, Blazer, Orrell and Woods, 2008) and for mild cognitive impairments the Addenbrooke’s MMSE can be used by physicians (Lonie, Tireney and Ebmeier, 2009). The MMSE will test for five domains consisting of the patient’s orientation, memory, attention, language and praxis (Ham, 2007).
Assessment of a patient’s functional status will include domains of psychological, physical and socioeconomic status. It is used to determine if the patient is having any functional disability that is being caused by a cognitive impairment (Ham, 2007). This assessment can be more difficult to perform in a primary care environment because it requires information from someone close to the patient to determine their baseline for comparing with the present functional performance. It helps determine the capacity of the patient for living independently and self care.
The suspected dementia patient should also be assessed for other medical conditions that can begin with a structured interview with the patient or a reliable informant to understand their past medical history. Laboratory tests can be done to find for medical illnesses that can contribute to cognitive impairment. Physical examination is also done to determine presence of neurological conditions that can suggest disorders like Alzheimer’s or Parkinson’s disease. The types of medications taken by the patient should also be examined to identify drugs that are sedative or having anti-cholinergic side effects (Ham, 2007).
Patients are also assessed for physical and psychological behavioral problems. Their physical behavioral changes can include aggression, restlessness and wandering. Psychological changes associated with dementia are hallucinations, delusions, anxiety and...