Alzheimer’s disease is the most common degenerative brain disorder. A history of familial incidence is considered to play a role in the development of the disease, which is incurable at present. The age of onset is between 45-65 years of age; both males and females are equally affected. The frontal and temporal lobes are most affected but gradual progressive atrophy (shrinkage) of the entire brain occurs and microscopically there is a wide spread loss of nerve cells.
It is generally accepted in the Bio-Medical model that people with dementia progress through three stages of the disease; mild, moderate and severe.
The first stage lasts 2 – 4 years and is characterised by subtle changes initially which may be dismissed as inattention or carelessness; eventually there are recognizable changes in personality, loss of memory for recent and remote events, apathy, loss of spontaneity and initiative, neglect of personal hygiene and appearance, and a suspiciousness of others motives with a tendency to blame them for one’s incapacities. Loss of special orientation is seen in the inability to put on a garment without confusion as to top and bottom and sleeve and neck. Weakness, muscular twitching or seizures may occur. The person cannot recall words he or she wishes to say and speech slurring may become evident. Indifference to social customs and graces develops.
In stage two of the disease, the changes of the first stage intensify. Disorientation is complete; emotional lability increases and there may be restlessness at night. Memory loss becomes so severe that even close friends and relatives are not recognised and the person may not recognise himself or herself in the mirror. Movements are slow, and simple writing, reading and mathematical skills and reasoning deteriorate seriously. Other deficiencies such as inability to recognise objects by way of the senses become obvious. Motor dysfunction may progress from unsteady gait to inability to stand or walk. The person loses weight due to poor nutrition and shows no or little interest in meals.
In the third and final stage of the disease, movements become repetitive and stereotyped, there is inability to use language, urinary and bowel incontinence, abnormal reflexes and muscular rigidity develop and eventually, the individual becomes bedridden and totally helpless. There is a marked tendency to grasp objects and put them to the mouth. The disease may last for several years. Death usually results from bronchopneumonia or infected pressure sores.
Treatment for early-to-moderate stages of dementia and also for accompanying anxiety, depression and or psychosis is drug related which may carry various side effects.
The Psycho-Social approach does not deny that drugs are an important aspect of care however; drugs should not be the only form of care. This approach asserts that the medical diagnosis of Alzheimer’s disease only tells part of the story, and that something other than the pathology of the brain also contributes to the development of dementia.
A person who has dementia is going through two kinds of change, going on side by side. First, there is the gradual advancing failure of mental powers such as memory, reasoning and comprehension. Much here can be attributed directly to the brain being less efficient; its function has declined and usually there is degeneration in its structure. Second, there are changes in the social-Psychological environment – in patterns of relationship and interaction:
EG: Mary, who used to be extremely polite and kind, shows great confusion at times, and on occasion says things that her former friends find offensive. Some of these friends do not know how to deal with Mary’s apparent rudeness and unpredictability, and so begin to behave differently towards her; she now has to find ways of coping with their changed behaviour … and so on.
It is impossible of course to distinguish clearly between the two types of change – the one neurological and the other social-psychological; however, the dementing process, as it actually occurs, is a consequence of them both.
The scientific disciplines related to Psychiatry have devoted intense and detailed attention to the first kind of change, while subjecting the second to almost total neglect. As a result there has been much progress in elucidating the neuropathology, biochemistry and genetics of dementia; while Naomi Feil and especially Tom Kitwood through their research, has furthered the Psycho-social understanding of dementia and its holistic method of care. This model of dementia has proposed that those affected progress through 4 stages of the disease; (1) Malorientation (at time of diagnosis person is aware of what is occurring and may suffer depression and/or anxiety), (2) time confusion, (3) repetitive motion and (4) vegetation. With each stage physical deterioration and psycho-social withdrawal inwards worsens. (The first two stages of this model correspond to the first stage in the Bio-medical model of dementia). There is no clear dividing line between each stage and a person may fluctuate between one or two stages on a daily basis.
EG: A person in the moderate to severe stage of dementia may have the delusional believe that their mother is still alive (even though they them-self are 86 years of age and their mother died 15 years ago), therefore when feeling anxious or afraid may call out or cry for their mother. The carer validates the emotions and feelings that the person is experiencing with interactions such as:
‘You love your mother very much don’t you, you must miss her’.
The carer is not colluding with the beliefs (incorrect facts) of the dementia sufferer ie; not pretending their mother is still alive; but is empathically acknowledging how the dementia sufferer feels; tone of voice and body language are all important. Communication between dementia sufferer and carer is on an emotional level rather than a cognitive one.
The confused, disoriented person with dementia may not remember spoken words from one minute to the next; some may not remember the care worker from day to day; however, they will remember a genuine touch, warm eye contact and a nurturing caring voice. The person with dementia will respond to an empathic validating carer; from empathy stems trust which provides safety and strength; through validation the individuality of the person with dementia is recognised and their value as a person is respected.
Dementia care … or lack of it, has been criticised recently (and in some cases rightly so!) however, In hospitals and care homes, medical, nursing and care staff are (or should be!) trained to care for people with dementia holistically in terms of medication (when required) and Psycho-Social therapies such as those previously mentioned. If Dementia care is lacking then professionals need to reassess the training provided.
I hope this is useful for those wanting or needing to understand Dementia in a little more depth.