Mental Health Condition Dementia - Case Study Example

Dementia Dementia is a general for a variety of cognitive disorders whose symptoms include long-term memory impairment; difficulty in areas of language, motor activity, object recognition; and disturbance of executive function (McNamara 2011). According to Cantley (2001), dementia is the deterioration in brain performance to a level at which social and personal functions are affected. What this means is that those with dementia eventually lose brain function to the extent that they cannot perform everyday tasks as noted by Prince, Bryce, Albanese, Wimo, Ribeiro and Ferri (2013). Apart from long-term memory loss, other symptoms of dementia include disorientation; behaviour mood, and judgement changes; difficulties in coordination and recognition, loss of skills that are applied in daily life as well as decline in communication skills (Social Care Institute for Excellence 2014). Some of the brain diseases that fall under the remit of dementia include: Lewy Body dementia, Creutzfeldt–Jakob disease, progressive supranuclear palsy, and Alzheimers disease (AD) (Biernacki 2007). This paper will discuss dementia in light of its signs and symptoms, epidemiology, prognosis, effects on caregiver and family, and treatments, and will focus on Alzheimers disease. The paper will specifically focus on Alzheimer’s disease because it is more prevalent compared to its counterparts. The paper will further discuss the policies that impact of the interventions applied with respect to dementia. Alzheimers disease Alzheimer’s disease (AD) is a type of dementia that is more prevalent compared to other types of the condition. The condition results when damaged tissues build-up in the brain resulting in the emergence of plaques and tangles that cause brain cells to die (Knopman 2014). The existence of plaques has a negative impact on the brain as they affect the chemicals that play a role in transmitting information to different parts of the brain. Alzheimer’s disease is commonly defined based on the age levels and cortical dimensions. With respect to age, there is senile and pre-senile dementia (Knopman 2014). An individual who shows signs of dementia in their mid-sixties or beyond is said to be affected by senile dementia. On the other hand, an individual is said to have re-senile dementia if they exhibit signs of dementia before reaching their mid-sixties. Generally, experts note that the chances of showing signs of dementia rises the older an individual gets (McGilton 2004). According to the ICD-10, Alzheimer disease (AD) is a primary degenerative brain disease (WHO 2014).Those who have Alzheimer’s disease commonly experience a severe effect on their short-term memory first. According to Roberts and Wolfson (2004), the person may not have the capacity to remember the names of familiar objects and the names of friends and relatives. As a result, the individual loses their capacity to make serious plans and decisions. This is closely followed by their experience of fear or paranoia. As the condition gets worse, the affected person may lose their short and long-term memory rendering them unable to cope with normal daily life (McGilton 2004). Signs and Symptoms Dementia is associated with behavioural and psychiatric systems including sleep disturbanceand wandering, agitation, aggression, and psychotic symptoms (Haw, Yorston & Stubbs 2009). The most common symptom of Alzheimer’s disease is memory loss, with recent memory being worst affected (Prince, Bryce, Albanese, Wimo, Ribeiro & Ferri, 2013: 64). As brain facets such as nerves and cells slowly deteriorate, the affected person exhibits behavioural changes. They may withdraw from public settings so as to lower their likelihood of suffering from their loss of memory when in situations that appear to be dangerous (Bourgeois & Hickey 2011). They may refrain from participating actively in social activities and sometimes show lack of initiative to take part in normal life activities. This may be owing to their embarrassment relating to their inability to remember things and fear of other people’s responses. Some people experiencing AD are concerned that their memory loss may be interpreted by others as lack of intelligence (Cantley 2001). The affected person may experience stigma when people fail to understand their problems and make negative statements about them. Another major cause of stigma for those with AD results from the feeling that they are a burden to their loved ones who have to attend to their very basic needs. As a result of the stigma they experience and inability to communicate effectively, they may get verbally hostile to family members, care providers, and even strangers when they get overwhelmed, without provocation (Bourgeois & Hickey 2011). Some people have trouble in terms of understanding visual images and spatial relationships, this can lead to people falling over (Graff, Vernooij-Dassen & Thijssen 2006). They can have difficulty in reading, determining colour and contrast, and judging distance. This might cause problems around meal times. Older adults may not have adequate nutrition due to confusion arising from seeing food patterned plates (Talerico, Miller & Swaffor 2006). Some people experience problems with language, such as in speaking or writing (Cantley 2001). They have trouble when trying to join and follow conversations; and they may suddenly stop or repeat themselves (Woods, Aguirre, Spector & Orrell 2012). Epidemiology of Alzheimers disease Alzheimers disease is most prevalent among those aged over 65, with women being slightly at a higher risk of suffering from the disease than men. The risk of Alzheimer’s disease is high the older one gets. It affects one out of six people above 80 years and one out of every 20 people between the ages of 40 to 65 suffers from the disease as noted by Biernacki (2007). Over 25 million people in the world today suffer from Dementia with a good number of them having Alzheimer’s disease (Kivipelto & von Strauss 2009: 112). According to the Woods, Aguirre, Spector and Orrell (2012), there are roughly 800,000 individuals with dementia in the U.K. Its prevalence in both developed and developing countries has had a tremendous effect on the lives of the patients, caregivers, and the whole society. Aetiological factors that are the main cause besides old age and genetic vulnerabilities are not yet established. Based on increased evidence nevertheless, there is growing belief that the cause could be related to vascular risk factors and disorders. Psychosocial factors from activities such as high education, active social engagement, physical exercise, and mentally stimulating activities are beneficial in the pathogenetic process and clinical visibility of dementia diseases. A long-term intervention aimed at maximum control of multiple vascular risk factors and socially integrated lifestyle maintenance and activities that are mentally stimulating are expected to lower the risks if not postpone clinical beginnings of dementia such as Alzheimers disease (Woods, Aguirre, Spector & Orrell 2012). Neurodegeneration and cognitive deficits have the ability to increase the chances of co-morbid disorders and their ability to influence mortality (Huena, Schoepf, Potluri & Natalwala 2011). Studies show that those elderly patients suffering from AD have more eating disorders, infections, brain diseases, and neck of femur fractures as compared to other elderly patients (Prince, Bryce, Albanese, Wimo, Ribeiro & Ferri 2013). Though patients with AD had different co-morbidities, they still die from the same diseases as those without them (Huena, Schoepf, Potluri & Natalwala 201: 49). Prognosis In the approach to the treatment of Alzheimer’s disease, two critical crossroads are reached. First, recognizing Alzheimer’s disease as a distinct disease from normal aging, and secondly, the realization that in the development of therapeutic and social interventions, the idea of care is as important as that of cure (Strock 2013). Factors such as patient, environment and stress from family have the capacity to exaggerate disability of a patient and increase burden on the family when Alzheimer’s disease is in the clinical stage. Other factors such as depression or delusion have the potential to aggravate dysfunctions of a patient with Alzheimer’s disease. These factors sometimes come up during the course of the disease lead to memory impairment, leading to the patient doing worse than they would if only they had just the dementia disease. This causes a clinical condition known as excess disability (McNamara 2011: 49). The immediate environment of a patient can cause interference to the patients coping abilities leading to increased impairment (Rafii & Aisen 2009). If the surrounding is modified, it helps reduce the stress brought about by environmental factors. Safety is key, and may come in the form of protecting the patient from wandering to the staircase and falling off in the process. Also important is reducing the patient’s frustration level such as placing different hints in the environment to deal with memory loss and reduce resultant stress levels and disorientation. It is also important to find the most protective but least restrictive environment for care. Effects on caregiver and family Those with Alzheimer’s disease may become completely dependent on other people for even the most fundamental of personal needs (OConnor, Ames, Gardner & King 2009). Caring for such individuals can be quite challenging for family members. With the progression of the disease comes increased anxiety and stress on the family and pain from seeing disturbing changes taking toll on the loved one (Rafii & Aisen 2009). This normally couples with guilt of not being able to do enough for the loved one. Those giving care may suffer reaction depression, chronic stress and consequent depression that is level higher than that of a normal person. Forced retirement on the caregiver away from the environment leads them to feeling unproductive in society. Other effects include depression on caregiver and stress that can lead to them to abuse the patient (Shah 2014). Treatments and Interventions Alzheimer’s disease patients commonly display behavioural and psychological symptoms of dementia (BPSD). Such symptoms are extremely distressing to the patient and the caregiver. Presently there are no specific treatments for the disease. While this is the case, experts agree that the best way of treating the condition is by identifying and treating underlying symptoms. Underlying causes may be hormonal, nutritional, smoke-related, tumour related, or drug related (OConnor, Ames, Gardner, &King 2009: 226). The other thing that is presently unknown is the reason for high incidence of BPSD in Alzheimers disease patients since patients experience the symptoms because of their susceptibility (Passmore 2014). Risk factors related to BPSD can be put into two categories; modifiable and non-modifiable. Risk factors that are modifiable include lack of caregiver preparedness, multiple medication, and chaotic living conditions. Non-modifiable conditions are multiple co-morbid conditions, degree of dementia, and pre-existing personality disorder (Passmore 2014).Some studies indicate that the use of approaches such as game pet therapy, recreational therapies such as using crafts, and therapies such as art and dance lead to improved behaviour and mood (Rafii & Aisen 2009). New methods such as music therapy, massage, and simulation of presence have come alongside those that have undergone trial and testing such as cognitive therapy, occupational therapy and positive reinforcement. Each symptom may have a specific therapy that goes along with it (Grossberg & Kamat 2011: 72). Medications administered to the pathologies in neurotransmission related to the disease have been done cautiously. A study conducted by DSM revealed that Quali®-E Vitamin E helped delay the functional decline of those suffering from Alzheimer’s disease by roughly 20% (Kaiseraugst, 2014).There is evidence that a low dose of antipsychotics supports the QIPP medicines used as an intervention against dementia (NICE 2013; Haw, Yorston & Stubbs 2009). Some of the medications that are administered to patients with Alzheimer’s disease include Tacrine and Donepezil. The National Institute for Health and Care Excellence recommends the early diagnosis and treatment of dementia (NICE 2014). The organisation also recommends that proper diagnosis and assessment of the disease should be conducted by well trained professionals to establish the subtype of the condition that a person is suffering from. During treatment, the choice of the person with dementia should be promoted much as they together with their families should be supported. In general, NICE calls for an integrated and coordinated approach to providing person centred care to those with dementia. Depression Methods of combating depression that are nonpharmaceutical include cognitive therapy and emerging methods such as music therapy and therapeutic physical activities. Behavioural intervention on both the caregiver and the patient shows decreased depression on both (Grossberg & Kamat 2011: 83).Cognitive therapy for adults that experience mild dementia is meant to challenge the negative ideation of the patient. This has proved to be effective in reducing patients’ depression levels. On the other hand, as recommended by NICE pharmacological treatment mainly targets cognitive impairment, behavioural symptoms such as agitation and aggression, and psychological symptoms such as anxiety, depression, and psychosis. Pharmacological treatment involves the administration of ChEIs, rivastigmine and galantamine. These should only be recommended by a dementia specialist after thorough discussion with the family because of the cholinergic side-effects involved (Talerico, Miller, & Swaffor 2006). Anxiety and Agitation The use of music and cognitive group therapy shows improvement against anxiety by patients with AD (Woods, Aguirre, Spector & Orrell 2012). According to Smith, Robinson and Segal (2014), agitation can be divided into three groups. Spontaneous agitation which most likely occurs during the evening can be reduced by avoiding caffeine, increasing activity during the day, and avoiding naps during the day. Reactive agitation occurs due to changes such in routine and an argument with a caregiver. Uninhibited agitation takes the form of manic behaviour; it is normally unpredictable and unrelenting as noted by Roberts and Wolfson (2004). An environment with limits that are set can best help improve such situations. As a result of the agitation that old persons with Alzheimer face, they are prone to being given more medications that ordinarily necessary in a bid to keep them under control (Talerico, Miller, & Swaffor 2006). Prevention There are six pillars related to the prevention of AD (Smith, Robinson & Segal 2014) as outlined hereafter. Regular exercise reduces the chances of suffering from AD by 50 percent and can slow further damage for those who have already started showing symptoms. A healthy diet is also key in the prevention of the disease. Mental stimulation through consistent learning helps keep Alzheimer at bay as noted by McNamara (2011). Failure to continue learning exposes the brain to the risk of AD. Quality sleep that is regular and restful helps the brain function optimally. Chronic stress puts a heavy burden on the brain which leads to shrinkage of the hippocampus, preventing nerve cell growth. This increases the chances of getting Alzheimer’s disease. A socially active life is equally quite essential. Key Policies Related to Alzheimer’s In all the countries of the world, dementia is under-diagnosed in primary care as noted by Edwards, Voss and Iliffe (2013). It also remains a challenge to family physicians due to its insidious onset and growing prevalence. The current diagnosis level in the U.K. stands at 45 percent, which is lower than both Scotland and Ireland. This is possibly the case due to people’s lack of knowledge about the condition. The government is putting measures to improve diagnosis rate through the provision of adequate information as part of memory services for doctors to those who are 65 to 74 year old Grossberg & Kamat 2010). The U.K. government is prioritizing early diagnosis of the condition as a policy measure with the aim of facilitating timely intervention against the disease and support for families of those affected by the condition (Johl, Patterson & Pearson 2014: 2). Person-centred care is advocated by NICE when dealing with persons suffering from dementia. Person-centred care is dedicated to improving the condition of the person affected by focusing on their particular situation and condition. In particular, it stresses the formation and maintenance of relationships. With regard to individuals with AD, person-centred care is vital because their particular condition undermines interconnectedness (Talerico, Miller & Swaffor 2006). Yet another policy that is dedicated to reducing the prevalence of dementia or delaying its onset is encouraging people to remain physically and mentally active even as they advance in age and avoiding negative behaviour such as smoking Kivipelto, Qiu, von Strauss, 2009). Yet another policy that is dedicated to fighting dementia is encouraging people to consume balanced diets and keeping a check on their blood pressure (Department of Health 2013). Besides these policies there is also the Mental Health Act designed to protect the people of England and Wales who are diagnosed with mental health disorders. This covers areas such as detention, care, and treatment given to them (Alzheimer’s Society 2014). The application of different policies toward the creation of greater awareness about the condition, its diagnosis and interventions as proposed or instituted by the U.K. government are bound to bear positive fruits given that they target the root causes of the problem. Communication Communicating with patients needs to be handled with care, whether it is through speech, listening, or body language (Alzheimer’s Society 2012). Clarity and calmness should be observed and reducing the speed of speech should be considered. Voices should not be raised and long sentences should be avoided. Humour helps to create a bond with the patient (Kerr & Cunningham 2004). Being positive goes a long way in improving the relationship between the care giver and the affected person. Listening carefully goes together with speaking to the extent that the patient is to be given plenty of time when speaking. Sudden body language movements and facial expressions may upset the person affected by AD and so should be avoided as noted by Hulme, Wright and Crocker (2010). The body language should match what is being said to the patient. Conclusion In conclusion, Alzheimer’s disease is one of the brain diseases under the umbrella term, dementia. Symptoms that characterize this disease include memory loss, difficulty when it comes to planning and solving problems that entail dealing with numbers, understanding visual images, and spatial relationships among others. Prevention of the disease calls for some change in habits, adequate exercise, healthy diet, brain stimulation, stress management, adequate and quality sleep, and improved social activity. Treatment involves therapies such as cognitive therapy and behavioural therapy. The other treatment method involves the use of pharmaceuticals. References Alzheimer’s Society (2012), Communicating, [Online], Available: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=130 [24 July, 2014]. Alzheimer’s Society (2014) The Mental Health Act 1983 and guardianship, [Online], Available: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=117 [24 July, 2014]. Biernacki, C. (2007) Dementia: Metamorphosis in Care, London: John Wiley & Sons. Bourgeois, M.S. & Hickey E. (2011) Dementia: From Diagnosis to Management - A Functional Approach, London: Taylor & Francis. Cantley C. (2001) A Handbook of Dementia Care, London: Open University Press. Department of Health, (2013) Policy: Improving care for people with dementia, [Online], Available: https://www.gov.uk/government/policies/improving-care-for-people-with-dementia [24 July, 2014]. 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Appendices Appendix 1: Excerpt from DSM DSM’s Quali®-E Vitamin E slows functional decline in Alzheimer’s disease Kaiseraugst, CH, 10 Feb 2014 10:15 CET DSM’s Quali®-E Vitamin E delayed functional decline in patients with mild to moderate Alzheimer’s Disease (AD) by 19% or a clinically meaningful delay in progression of 6.2 months over the follow-up period compared to placebo. Further, daily high dose (2000 IU/day) supplementation of Vitamin E for a long period of time (2.3 years) did not raise safety concerns. DSM is the world’s largest manufacturer of Vitamin E for use in human nutrition - dietary supplements, food & beverage and infant nutrition, and animal nutrition markets. DSM’s Quali®-E is backed by the Quality for Life® seal offering manufacturers and their customers Peace of Mind.   Appendix 2: Excerpt from ICD-10 Version:2010 F00*Dementia in Alzheimer disease (G30.-+) Alzheimer disease is a primary degenerative cerebral disease of unknown etiology with characteristic neuropathological and neurochemical features. The disorder is usually insidious in onset and develops slowly but steadily over a period of several years. F00.0*Dementia in Alzheimer disease with early onset (G30.0+) Dementia in Alzheimer disease with onset before the age of 65, with a relatively rapid deteriorating course and with marked multiple disorders of the higher cortical functions. Alzheimer disease, type 2 Presenile dementia, Alzheimer type Primary degenerative dementia of the Alzheimer type, presenile onset F00.1*Dementia in Alzheimer disease with late onset (G30.1+) Dementia in Alzheimer disease with onset after the age of 65, usually in the late 70s or thereafter, with a slow progression, and with memory impairment as the principal feature. Alzheimer disease, type 1 Primary degenerative dementia of the Alzheimer type, senile onset Senile dementia, Alzheimer type Read More