Wednesday, July 4, 2012

Dementia: Early Identification for Early Intervention

What is dementia?
Dementia is a psychiatric condition characterized of certain major changes in a persons’ ability to remember things and other day to day behaviors.

What causes dementia?
Dementia is a common term used to indicate a group of conditions characterized of similar manifestations but having different etiologies in different people such as due to Alzheimer disease, vascular degeneration etc. The major cause behind the condition is the gradual degeneration (death) of brain cells, which are the building blocks of brain and are responsible for the regular day to day behaviors and abilities of a person.

What are the major changes in the behaviors of such patients?
Dementia is mainly characterized of following symptoms
·      Gradual loss of memory leading to inability to remember names, relations, faces, where things were kept,
·      The person may forget the way to home and may get lost at the place which was very familiar to him/her,
·       Person may get lost even in his own home or office,
·       Inability to dress-up oneself, shave oneself, tie shoelaces, bathe properly, combing etc,
·      Complete change in the personality such as increased jocularity, disinhibition,
·      Sudden anger outbursts, irritability, risk taking behavior,
·      Urinating in cloths or at inappropriate places,
·      Inability to recognize things of daily use,
·      Inability to understand commands or to express what they want to say,
·      Inability to coordinate the simple body movements (such as picking up cup, use knife)

Is it aging or illness?
Though after the age of 60 or above anyone may have some of gradual deterioration of memory functions but in cases where the problems increase rapidly and start having major problems in day to day life may require immediate psychiatric consultation.

What to do if some of your known person has any of the above mentioned symptoms?
If any of your known has any of the above mentioned problems you must seek consultation from a psychiatrist who may help the patient by prescribing the medications which may slow down the process of gradual death of brain cells and thus resulting in slowing down the process of behavioral problems.

“He forgets his way and gets lost” what to do for this?
To help the person who loses his way when gone out
·    Should not be allowed to travel very far alone, but he should be given freedom to move out for a small walk (if required under supervision)
·       When going out a paper slip/diary indicating the address, name, and the name of the person whom to contact in case of need should be kept in his pocket,
·        The person can be given a location guide or map which can help the person in case of confusion about directions, etc.
If the person gets lost even within the house
·        In such cases certain arrow marks towards toilet, bedroom etc can be placed,
·        Name of the place in bold letters can be written and pasted at different places,
·        In case the person leaves home as he sees the door a mirror can be placed over the door’s back so that the person gets distracted as he reaches the door.
·         A night bulb must be lit up in night.
·        There should be adequate lighting in the room of the patient, etc.

What can be done if he forgets names, dates, people etc?
·           Person should be shown his old photographs, letters, videos etc frequently,
·        Whenever anybody comes to meet him/her he should be introduced by name and relationship rather than asking patient to identify him (such as “Look your daughter Seema has come to meet you with her husband Amit, they have come after a week to see you would you like to meet them?”),
·           Keep large calendars, clock and pictures of family members in patient’s room,
·           Indicate in bold letters about what is kept here, such as “MEDICINE” over the cupboard where medicine is kept,

What if he gets angry or remains irritable unnecessarily?
·           Try to understand the patients confusion and avoid arguments with him,
·            Do not blame patient for his condition,
·            Try to keep the activities structured,
·             Keep less articles (distractions) in the room of patient,
·            Use audible but polite voice while interacting with him,
·            Allow him/her to walk around and engage in activities that he likes to do, etc.

What to do if he urinates in bed/clothes?
·             Try to track the time of the day when he urinated for a few days and then make it a habit to ask patient to use toilet before that identified time comes,
·              Patient can be reminded to use toilet even if does not feel the need after every two hours,
·              Give him a privilege if he remains dry for the whole night,
·      Train patient to hold the urine for longer duration gradually increasing time between liquid intake and elimination of urine, etc.
Can dementia be cured?
In some cases where the cause is not the degeneration there the condition can be reversed with right treatment. Mostly dementia is often a result of gradual degeneration of brain building blocks thus once it has been started it can only be slowed down but cannot be reversed. It puts a big onus on the caregivers, as it requires constant care.

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