Dementia refers to the appearance
of mental symptoms with implications for the social, professional, and
intellectual functioning of people who have a process of rapid and irreversible
damage to the brain by destroying neurons. This neurodegenerative phenomenon's
progression translates into a slower or faster deterioration of functional,
cognitive (memory, attention, language, thinking, planning, organization, etc.)
and behavioral abilities. There are several forms of dementia, but the most
common of these is dementia in Alzheimer's disease, responsible for almost 60%
of diagnosed cases. Unfortunately, science has not yet been able to provide
effective treatment for this terrible disease, making it all the more important
to identify the first signs of the disease as early as possible.
Could it be Alzheimer's disease?
Everyone knows that with age, it
is normal to become a bit more "forgetful". Therefore, how can anyone
distinguish an embarrassing moment when one of our seniors forgets a detail
from the onset of Alzheimer's disease?
It should be noted that about 1
in 8 people over the age of 65 have this devastating form of dementia. In its
early stages, the disease can go undiagnosed even by a specialist, let alone
friends or family members. However, some alarm signals can lead to the correct
and early diagnosis of your disease that we can follow.
WHAT ARE THE ALARM SIGNALS?
1. Memory and speech
In the early stages of the
disease, long-term memory of information from the patient's distant past
remains unaltered, while short-term information of recent and very recent
information may show signs of weakness. The affected person may forget a
discussion they had recently, may ask the same thing several times or may have
trouble remembering certain words or names.
2. Behavior
In addition to impairing memory
and speech, Alzheimer's disease can cause confusion, disorientation, and
behavioral changes. The affected person may get lost in well-known places. He
may start not taking care of himself, neglecting his hygiene, wearing dirty
clothes, not washing his hair. It can present sudden and inexplicable changes
of mood, mistakes of judgment.
Most often, frightened by these
disturbing states, patients begin to show irritability, a tendency to social
isolation, marked anxiety, or even depressive episodes.
DO NOT IGNORE THESE SIGNS!
It is very difficult to face the
thought that a dear person, a parent, could have this disease, and denial is
the first reaction of most people undergoing this bitter test, but it is much
better to consult a psychiatrist sooner rather than later.
First of all, because the
diagnosis could be different from what we suspect, it can be the effect of a
Major Depressive Episode, endocrinological disorders (e.g., hypothyroidism),
metabolic, cardiovascular, or neurological disorders, many of them being
treatable if they are correctly and quickly diagnosed. And if there is still
dementia in Alzheimer's disease, treatment is most effective in the early
stages of the disease.
HOW IS ALZHEIMER'S DISEASE DIAGNOSED?
Until now, there is no single and
generally valid method for diagnosing this disease. Therefore, once this
suspicion is raised, the psychiatrist you need to see will perform a series of
multidisciplinary evaluations to confirm or refute the diagnosis.
Step 1: it is necessary a careful
mental examination, which must, with the help of close family members and the
patient, determine the degree of damage to the patient from several points of
view, compared to the level before the onset of symptoms. Professional, social
functioning, attention, memory, thinking, and affectivity are evaluated.
Step 2: Perform a clinical psychologist's
psychological examination, who will determine the degree of cognitive and
functional impairment, using clinical scales such as MMSE and GAFS.
Step 3: consultations that exclude the possibility of
having a different cause for the symptoms presented. There will be, if
necessary, neurological, endocrinological, cardiological examinations, but also
a brain imaging examination, such as computed tomography of the brain or,
preferably, a brain MRI. These examinations will bring additional information
about the patient's brain, eliminating the risk of having a brain tumor or a
stroke.
In some cases, it may be
advisable to perform a lumbar puncture to collect a sample of cerebrospinal
fluid (CSF) and dose-specific compounds for this disease, called Tau protein
and beta-amyloid.
Immediately after confirming the
diagnosis and a deeper understanding of the implications of the doctor's
information, a series of natural questions arise for those affected. Here are
some of the most common:
Q1. What to expect?
R1. The prognosis of Alzheimer's
disease is almost impossible to establish from the beginning. In each case, the
disease will follow different paths and will generate a variety of problems.
Sometimes the symptoms are more focused on the psychic area, other times, they
are complicated in the neurological sphere, but it is impossible to know from
the beginning. In some cases, there is a rapid and brutal worsening of
symptoms, which lead to confusion and severe memory impairment in a few years,
regardless of the therapeutic approaches. In other cases, the disease has a slow
and predictable evolution, which allows long maintenance of autonomy and patient
quality of life. Under these conditions, it can be estimated that this disease
can evolve from onset to death between 10 and even 20 years. Unfortunately,
statistics show that, from the time of diagnosis,
Q2. How
is the disease treated?
R2. Because so far it has not
been possible to obtain a drug treatment that can cure this disease, hope is
placed in those treatment schemes that seem to slow the progression of the
disease and the mental and social damage affected. The existing treatments'
objectives are to maintain as long as possible the autonomy and quality of life
of the affected persons.
Q3. How will Alzheimer's affect our lives?
R3. In the early stages of the
disease, our loved ones may have trouble taking care of themselves, cooking,
shopping, paying bills, and learning new things (how to use a cell phone or
modern home appliance). Patients may have increasing orientation and memory
problems in the more advanced stages, get lost in familiar places, or may no
longer recognize close people, sometimes even their children or life partners.
In the most advanced stages, there are serious problems of motor coordination,
the inability to hug, to move, there are problems of balance, and frequent
falls with major risks of serious fractures (fractures of the upper limbs,
fracture of the femoral neck, skull fractures, etc). There may also be moments
of psycho-motor agitation with physical aggression,
Q4. Is the ability to drive cars affected?
4. Unfortunately, this disease
involves impaired coordination, reflexes, memory, the ability to orient, which
are strictly necessary at the wheel. If you see these signs and fail to
persuade the patient to stop driving, seek medical attention. The social risks
involved in these cases are considerable. In more severe cases, when patients
refuse to comply with family or medical instructions, an official reassessment
of driving ability or driver's license may be requested.
Q5. Are exercises useful?
5. Everyone knows that a normal
life should contain as much exercise as possible, and Alzheimer's patients are
no exception. Recent studies have shown the usefulness of physical activity in
combating cognitive impairment. Involvement in group sports activities, adapted
to the medical condition, is even more useful, providing the patient's
necessary social gear.
Q6. What are
the role of family and loved ones?
6. If you are in the situation of
caring for a patient who has Alzheimer's dementia, you must be very well
informed about the evolution and particularities of this disease. It will be a
big responsibility on your shoulders, and it will take much effort. You will
have to deal with both the patient's manifestations and your reactions to the
stress you will be subjected to. Often, the informed decision-making capacity
of Alzheimer's patients deteriorates rapidly, and you have to fill that role by
establishing guardianship in court. You will also have to struggle to give the
patient "on the tray" everything he needs without asking him to get
involved in any activity, which will lead to hastening and increasing his
dependence on you.
Q7. What are the challenges for those who care
for a person with Alzheimer's?
7. If in the early stages of the
disease patients know and understand what is happening to them, as it
progresses, extremely disturbing situations may arise. Patients can become
suspicious, paranoid, even violent, they can accuse you of all sorts of things
- that you steal their money, that you poison them, that you keep them locked
up, they can try to "escape". In all these cases, you should seek the
help of a psychiatrist.
Q8. How do we manage the advanced stages of the
disease?
8. In the more advanced stages of
the disease, problems may require institutionalization of the patient in a
specialized medically assisted care unit, where patients are supervised and
cared for by qualified personnel. You have to keep in mind that often in these
phases, patients no longer recognize their closest relatives and raise major
problems due to sphincter incontinence, balance problems, maintenance of
hygiene, or swallowing problems. It indicates the hospitalization of patients
in-hospital palliative care departments to ensure adequate physical and mental
comfort.
If you have any regular mental
illness and want the treatment, join the recovery
groups in Louisville, Kentucky.
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