Recently, I have noticed an ever growing presence of articles, research and development of memory related conditions such as Dementia and Alzheimer’s, all devastatingly underestimated and something that effects so many indirectly and directly each year. As I’ve mentioned before my posts are full of my own opinions, I aim to educate and raise awareness on topics I find relevant and interesting. So what actually is dementia? we all hear the word bounced around but do we really have a clear idea of what is involved? The term “dementia” is used to describe the gradual deterioration of “intellectual” abilities and behaviour that eventually interferes with customary daily living activities. “Customary daily living activities” include balancing the check book, keeping a household going, driving the car, involvement in social activities, and working at one’s usual occupation. There may also be changes in personality and emotions. Contrary to popular belief, dementia is not a normal outcome of aging, but is caused by diseases that affect the brain. Dementia influences all aspects of mind and behaviour, including memory, judgment, language, concentration, visual perception, temperament, and social interactions. Although dementia symptoms are eventually obvious to everyone, in the early stages special evaluations are necessary to demonstrate the abnormalities. Dementia is not a single disease, but a set of symptoms and signs related to multiple diseases or brain injuries often devastating for not only the person, but family members as they are perhaps more aware of the seriousness of the outcome than the person, they carry the emotion of seeing a loved one slip in an incapable state, heart-breaking. Although dementia symptoms are eventually obvious to everyone, in the early stages special evaluations are necessary to demonstrate the abnormalities. In people over the age of 65, the most common cause of dementia is Alzheimer’s disease. Alzheimer’s disease is a form of brain degeneration in which abnormal particles called neurofibrillary tangles and neurotic plaques form in the brain and destroy healthy neurons (brain cells).
These abnormalities tend to settle in brain areas that control the ability to learn a new fact and remember it 30 minutes, or a day later, a skill we refer to as “memory”. Years of studying dementias have shown that Alzheimer’s disease is not the only type of brain degeneration. There are other forms of brain degeneration, many of which can affect people in their 50’s or even 40’s! Many treatments are being evaluated, but as of yet, there is no cure. There are a number of medications currently approved by the Food and Drug Administration (FDA) for the treatment of mild to moderate Alzheimer’s Disease. Donepezil (Aricept), Rivastigmine (Exelon) and Galantamine (Razydyne) are medications which block the enzyme, acetylcholinesterase, which is one of the enzymes responsible for degrading acetylcholine. Acetylcholine is a neurotransmitter in the brain, which is crucial for the formation of memories. Drug trials with these medications show that cognitive abilities can be improved over baseline for up to 6-12 months after starting a cholinesterase inhibitor. These medications have also been shown to improve some of the behaviours associated with Alzheimer’s disease. Common side effects seen with all of the cholinesterase inhibitors include nausea, diarrhoea, and dizziness.
Another medication with a different mechanism of action has been approved by the FDA for the treatment of Alzheimer’s disease. Memantine (Namenda) is a medication which helps improve cognition by blocking the over stimulating effects of excessive glutamate, a mechanism which appears to be a major factor in cell injury and death in Alzheimer’s disease. Common side effects seen with memantine include dizziness, confusion and headache. Researchers are also trying to develop other methods of blocking the product of amyloid plaques or enhancing their clearance from the brain. There are also a number of psychiatric medications, which are used to treat the behavioural disturbances which commonly develop in the later stages of Alzheimer’s disease such as depression, apathy, aggressive behaviour, delusional thinking ect.. Medications used to treat these behavioural and psychiatric symptoms include antidepressants, antipsychotic and mood stabilizing medications. In addition to medication, treatment for Alzheimer’s disease involves a wide range of other measures and treatments to help people with dementia live as independently as possible. For example, an occupational therapist can identify problems or unsafe areas in their everyday life and help people to develop strategies or use alternative tools to manage these. Prompting items may be calendars, diaries, phone reminders ect.also, adding grab bars and handrails to the home to help them move around safely.
Perhaps what I find most interesting is the cognitive approach to therapies: psychological treatments, such as cognitive stimulation, may be offered to help improve your memory, problem solving skills and language ability, music and art therapy, reminiscence and relaxation therapies may also be offered. These may help with managing depression, anxiety, agitation, hallucinations, delusions and challenging behaviour that can occur with Alzheimer’s disease. Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave, it’s pretty interesting really. I will explain a little more into this therapy: CBT cannot remove your problems, but it can help you deal with them in a more positive way. It is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle. CBT aims to help you crack this cycle by breaking down overwhelming problems into smaller parts and showing you how to change these negative patterns to improve the way you feel. I have included below a link to a site called ‘mind’ it is in bold, it explains CBT in more detail but in a straight forward however not patronising manner. I find it so helpful not only for research into dementia but also topics such as depression and anxiety it is so worthwhile reading if anyone is struggling. It offers tips, links to other helpful sites and phone numbers should anyone need it. Definitely recommend!
references and useful websites: