Signs, Symptoms and causes of Dementia - Case Study Example

Case Study: Dementia Introduction Different types of mental disorders such as dementia can affect old people because of various reasons. “Dementia isthe progressive deterioration in cognitive function - the ability to process thought or intelligence” (MNT, 2015). Many people have the belief that Alzheimer’s and Dementia are different diseases. In fact Alzheimer’s is a type of dementia in which the patient struggles because of loss of memory and other intellectual abilities. Dementia appears in four different forms: Alzheimer’s disease, vascular dementia, diffuse Lewy body disease (dLbd), and alcohol-induced dementia (Theories Of Neurological Aging And Dementia, n. d, p.1). In fact Alzheimers accounts for 60 to 80 percent of dementia cases (ALZ.org, 2015). “Psychiatric disorders are diagnosed when a defined group of symptoms is present” (Harrison et al., 2013, p.3). When people are getting old, their cognitive abilities and memory will also face age related problems and they may show symptoms of mental disorders. In other words, old age can affect physical as well as mental abilities. As a result of the dementia like mental problems can occur during the latter periods of one’s life. Even though age has definite relationships with dementia, modern studies have proved that there are many other reasons for the causes of dementia. In other words, dementia can affect even younger people at times. In any case, dementia related problems may cause immense problems not only to the patient, but also to his family, relatives and the society. “Dementia has significant social and economic implications in terms of direct medical costs, direct social costs and the costs of informal care. In 2010, the total global societal costs of dementia were estimated to be US$ 604 billion. This corresponds to 1.0% of the worldwide gross domestic product (GDP), or 0.6% if only direct costs are considered” (WHO, 2015). One of my relatives is currently a victim of dementia. She is 82 years of age at present. Her family is currently facing a lot of problems in treating and caring her. In this paper, I analyses the above case in order to know more about dementia. For convenience, I use the letter X to represent the above mentioned patient hereafter. Signs, Symptoms and causes of Dementia According to Whalley (2002) the non-pathological relationships between brain ageing and the dementias are unclear and controversial. He argued that even though late-onset of Alzheimers disease is clinically proved, yet a clinical history of dementia is absent. At the same time many other studies have shown that ageing plays a significant role in contributing to dementia. For example, the article written by the Alzheimer Society of Canada (2015) argues that “Almost 40 per cent of people over the age of 65 experience some form of memory loss. When there is no underlying medical condition causing this memory loss, it is known as "age-associated memory impairment," which is considered a part of the normal aging process” Aging of the brain normally starts around the age of 50. Rapid changes can be observed in the physical and mental activities and abilities of a person when he/she crosses the age of 50. It is believed that many changes taking place in the brain when a person getting old. Age related changes such as apoptosis, telomere loss, neuroendocrine alterations, autoimmune changes, oxidative stress and others are common in most of the people when they approach their end of life period. Accelerated brain aging may begin after the age of 50 (Theories of Neurological Aging and Dementia, n. d, p.1). Head injury, stroke, brain tumour, Prion diseases - from certain types of protein, HIV infection, reversible factors such as medication interactions, depression, vitamin deficiencies and thyroid abnormalities can cause dementia (MNT, 2015). In the case of X, head injury, depression and thyroid abnormalities seem to be the major reasons that caused dementia. X had no problems until she reaches 60 years of old. However, she met an accident when she was 60 and suffered a serious head injury. She was admitted the intensive care unit for two weeks. In fact she was in the comma stage for 3 consecutive days. After a month long treatment in the hospital, she returned home. Her relatives had noticed signs of dementia in her during this period. She has started to show signs of mental problems also. She started to show little attention even in completing her routine jobs such as brushing, bathing etc. Moreover, she had shown little interests even in taking foods. Another important incident that took place in the life of X during this period is the death of her husband. She lost her husband immediately after her return from the hospital. Since then, she started to show signs of depression. At times, she gets agitated because of silly reasons and many other times she has seen to be staying away from others. In other words she disliked to socialize with others after the loss of her husband. She hated even her beloved children and stopped the habit of going to the church on every Sunday. She started to speak frequently about the end of this world and end of her life. In short she started to show the signs of Post Traumatic Disorder and depression after the accident and the death of her husband. “PTSD is an anxiety disorder that follows exposure to life-threatening experiences such as war, sexual assault, homicide, motor vehicle crashes, and natural disasters. The sufferer vacillates between the intense distress associated with unwanted trauma-related memories and psychic numbness”(Sayer, 2009, p. 704). The major symptoms of PTSD are intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms” (DSM Criteria for PTSD, 2011). Some of the other symptoms of PTSD are; impaired concentration, tension headaches, mental slowness, and indecision (Ruff et al., 2010). X had majority of the above mentioned symptoms of PTSD. Also, X started to show the symptoms of depression after the accident and the subsequent loss of her husband. In fact, she had developed suicide tendency after the loss of her husband. According to Klein, &Wender (2005, p.1), “somewhere between 10 and 30 percent depressives and manic depressives kill themselves”. Many people have the illusion that depression is only a minor psychological problem. In other words, depression has the ability to develop suicide tendency among the victims. Some of the major reasons of depression are; unpleasant life experiences, frustrations, failure to fulfil personal, social and professional commitments etc. Feelings of helplessness and hopelessness, loss of interest in daily activities, appetite or weight changes, sleep changes, irritability or restlessness, loss of energy, self-loathing, concentration problems, unexplained aches and pains etc. are some of the signs and symptoms of depression (Understanding Depression, 2011). Above all, X had developed thyroid problems at the age of 61. It should be noted that thyroid disease has the ability to cause severe mental problems and mood changes. In short, the causes of dementia in X can be attributed to various things such as PTSD, depression, head injury and thyroid problems. X had no memory problems before she faces the accident. In fact, many people were of the view that she had more memory power than ordinary people before the unfortunate accident occurs. However, she started to lose memory immediately after the accident and the loss of her husband. Biological, psychological and social needs Currently, there is no effective treatment available to cure dementia even though many researches are currently going on to identify a suitable treatment option for this disease. Since no effective medicines are available for this disease, the caring of dementia patients is extremely difficult. It should be noted that this type of patients have many biological, psychological and social needs. It is the duty of the caregivers to identify these needs and look after the patient properly and to improve the life standards of these people. Patients with dementia may have different biological needs. They may develop pain, illness and physical discomfort (including being constipated or thirsty, or from sitting for too long) (Alzheimers Society, 2015). Since X is taking medications for depression, PTSD, high BP, Cholesterol, and Thyroid problems, a lot of side effects have been developed by her. X has the habit of complaining about constipation most of the times. Even though she is taking medicines for avoiding constipation, she never stays away from complaining about this problem. At times, her complaints appear to be genuine since many of the medicines taken by her for depression problem contribute constipation. However, most of the times, her complaints related to constipation are baseless. Moreover, X has the habit of complaining about back pain leg pain and shoulder pain even though she is not undertaking any physical hard works. In fact she is reluctant to do even some physical exercises. Moreover, she has the habit of sitting for a longer period in the site out area of her house. She has no problems in sitting there alone even for many hours. X dislikes too much hot or too much cold climatic conditions. Too bright or noisy environment is also unbearable for her. Moreover she often complains about poor eyesight and hearing. As a result of that she has developed a lot of misunderstandings and misperceptions. Hallucinations and delusions are common in her life. Her family members are struggling to manage these biological and psychological problem developed by her. “The physical effects of dementia may have affected her judgement and self-control. She may have lost her inhibitions or have a decreased awareness of what kind of behavior is appropriate (Alzheimers Society, 2015). Social problems developed by X include, Lack of social contact and loneliness, Boredom, inactivity and sensory deprivation, Not liking or trusting a particular carer and Trying to hide their condition from others (Alzheimers Society, 2015). X has a tendency to stay away from others. Whenever some visitors come her house, she closes the door of her room and stays alone inside. If somebody asks her to come out, she comes out with an unhappy face. She has the habit of disliking some carers. She identifies many mistakes in the behavior of the carers who are disliked by her. At the same time, if a carer was replaced by another, she describes the previous carer as the best than the present. The person with dementia may have a perception that their rights are being infringed or that they are being ignored. This may be due to misperceptions, memory difficulties or problems processing information, but it may also be true. The person may become frustrated at not being able to complete tasks, eg making a cup of tea. A carer’s intentions may be misunderstood. For example, personal care may be seen as threatening or an invasion of personal space. Accepting help with intimate tasks such as washing, dressing or going to the toilet is understandably distressing and stressful (Alzheimers Society, 2015). X has the habit of not even cooperating with the doctors, carers and healthcare professionals. When doctors or other care givers ask about the problems facing by her, she often remains silent. At the same time, she has the habit of murmuring when she is alone. She does not like the intrusion of others in her personal space and often watches the actions of the caregivers suspiciously. She often complains about her poor appearance and even while dressing, she complains about the poor quality of her dresses. In short, negative thoughts are dominated in the life of X. Whenever, strangers visit home, X has the habit of hiding in her room. Earlier, she had the habit of reading newspapers. Reports about stealing and killing are common in newspapers. X believes that the strangers are coming to her home not for good purposes but for bad purposes. In short, H has difficulties in segregating the rights and wrongs. Things happening around her are perceived wrongly by her. Dementia is overwhelming for the families of affected people and for their caregivers. Physical, emotional and economic pressures can cause great stress to families and caregivers, and support is required from the health, social, financial and legal systems. People with dementia are frequently denied the basic rights and freedoms available to others. In many countries, physical and chemical restraints are used extensively in care facilities for elderly people and in acute-care settings, even when regulations are in place to uphold the rights of people to freedom and choice (Alzheimers Society, 2015) The family of X is facing several problems while giving care to X. Since all the family members of X have some kind of personal and professional commitments, the duty of looking after X is given to a caregiver. However, X has the habit of complaining about the inadequate care given by the caregiver even if the caregiver provides adequate care. As a result of that, the family of X forced to change the caregivers quite frequently. X has the habit of complaining about simple and silly things whenever, she gets an opportunity to speak to her family members. X never likes to see her family members going for work of studies. She wants everybody around her all the time. The role of the mental health nurse “In social psychology human being is taken as a person rather than an object”(Kitwood, 1997, p.12). Unlike objects, humans have many emotions and feelings and they will express it in many ways. Therefore, it is necessary for the caregiver to consider mentally disordered people as an active entity rather than a passive or inactive entity. Moreover, it is necessary to provide person centred nursing care while dealing with mentally disordered people since the needs of different patients could be different. In other words, there are no standardized procedures while dealing with dementia patients like X. “Person-centred care is a way to establish a balanced and respectful relationship between service users and nurses, incorporating all aspects of a service user’s personality and treatment wishes. The amount of time a nurse has to do this recurred as reason why this may not be possible” (Lees, 2014, p.22). The correct assessment of the needs of X would help a nurse to provide effective care to X. The nurse should assess whether X has any of the symptoms such as impaired verbal communication, impaired social interaction, violent behavior, bathing problems or hygienic problems etc. Based on this assessment, the nurse should formulate suitable intervention plan for X. X is facing all the above mentioned problems and hence it is necessary for the nurse to devise a suitable intervention plan and recovery model suitable for X. In order to overcome the impaired communication problems, the nurse should speak slowly using simple words so that X will understand the ideas properly. The nurse should address X with her name during her meetings with X. Instead of asking X to do many things at a time, the nurse should encourage her to do one thing at a time. If X has vision and hearing problems, the nurse should make arrangements for purchasing hearing aids and eye glasses. The environment surrounding X should be kept well all the time. If X shows violent behavior, the nurse should identify what caused the provocation and the reasons for the provocation should be avoided in future. The nurse should try to deviate the attention of the X from the things that caused violent behavior in the mind of X. A mental health nurse looking after a patient like X may face so many problems. It is necessary for the nurse to customize strategies suitable to deal with the problems generated by X. “It is important to adapt to the perspective and needs of the person with dementia. It can be frustrating but it is important to understand that reasoning or logical argument are unlikely to result in insight and change on the part of the person with dementia” (Alzheimers Society, 2015). X has many behavioural problems. It is difficult to change all such behavioural problems at once. The behavioural problems of X can be solved gradually. It is necessary for the nurse to attain the confidence of X first before she attempts to make changes in X’s life. Once the nurse was able to gain the confidence of X, it will be easy for her to convince X. “Beyond taking medications and meeting the psychiatrist, there are good and bad ways to manage your disorder” (Miklowitz, 2010, p.7). For example, deep breathing exercises and Yoga are found to be effective for patients like X. However, it will be difficult for X like patients to develop an interest in such activities. For them, the end is near and there is no point in trying to stop the death. The nurse should try to eliminate such negative thoughts from the mind of X. She should convince X that she is as strong as others both physically and mentally and the death may not occur in near future. In other words, it is extremely important in developing a desire to live longer in the mind of X. For that it is necessary to communicate effectively with X. Both verbal and nonverbal communication means can be used effectively by the nurse to convince X. Nonverbal communication means such as facial expressions, eye contacts, gestures etc can be used effectively while communicating with X. While dealing with X, the nurse should “try to stay calm and avoid any potential for confrontation. A heated response may make the situation worse” (Alzheimers Society, 2015). According to Barker (2003), time and space should be given to the mentally disordered people to overcome their problems. The nurse should recognize X as a child rather than an adult. If the nurse considers X as an adult, she may face problems in dealing with X because of her childish behaviour. On the other hand, if the nurse is able to treat X as a child, she can adjust with the wrong behaviours of X. When X realizes that the nurse is keen on looking after her, she will develop an attachment with the nurse and may reveal her mental problems and agonies. The nurse on the other hand should not show any fear, alarm or anxiety in front of X. She should always behave like a brave and confident person in front of X. She should be able to control her emotions and be able to tolerate the wrong behaviors of X. The nurse should always speak politely with X. Even if she feels angry, she should not reveal it to X. She should never shout in front of X even if X engaged in minor violent behaviors. X should get enough time and opportunities to relieve her mental frustrations. It should be noted that mental agonies and frustrations of X often comes in different forms such as violence and other unacceptable behaviors. “Try not to take the behavior personally – the person is most likely trying to communicate a need, not attacking you on a personal level. If you find the cause of the behavior, you may be able to prevent future incidents” (Alzheimers Society, 2015). Identifying the causes of violent or wrong behaviors is extremely important while dealing with dementia patients like X. If the nurse is able to identify the causes of violent or wrong behaviors, she can take precautionary measures to avoid the reasons that stimulate the wrong behavior. It is essential for the nurse not to argue with X. The nurse should realize that the patient does not have the maturity to understand rights and wrongs even though she is over the age of 60. It is often a good idea to accept all the claims and arguments put forward by X even if these arguments are wrong or baseless. X should develop a feeling that there is somebody who is ready to accept her thoughts and views. Conclusions Dementia is a mental problem, mostly developed after 50 years of age. At times, dementia can be developed even before the age of 50. Loss of memory is the major symptom associated with dementia. There are different types of dementia such as Alzheimer’s disease, vascular dementia, diffuse Lewy body disease (dLbd), and alcohol-induced dementia. Head injury, stroke, brain tumour, Prion diseases, HIV infection, reversible factors such as medication interactions, depression, vitamin deficiencies and thyroid abnormalities are some of the reasons for dementia. Dementia cannot be treated effectively with medicines at present. At the same time, the problems associated with dementia can be managed or reduced with the help of an experienced caregiver or nurse. References ALZ.org, 2015. What Is Alzheimers?. [Online] Available at: http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp [Accessed 19 January 2015] Alzheimers Society, 2015. Dementia and aggressive behaviour. [Online] Available at: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=96 [Accessed 19 January 2015] Alzheimer Society of Canada.2015. Normal aging vs dementia [Online] Available at: http://www.alzheimer.ca/en/About-dementia/What-is-dementia/Normal-aging-vs-dementia [Accessed 19 January 2015] Barker, P. 2003. The Craft of Caring. Publisher: CRC Press (29 Aug. 2003) DSM Criteria for PTSD. 2011. [Online] Available at: http://www.ptsd.va.gov/professional/pages/dsm-iv-tr-ptsd.asp [Accessed 19 January 2015] Harrison P., Cowen, P, and Burns T. 2013. Shorter Oxford Textbook of Psychiatry Publisher: Oxford; 6 edition (3 May 2013) Kitwood, T. 1997. Dementia Reconsidered: The Person comes first Publisher: Open University Press; 1 edition (January 15, 1997) Klein, D. F., M.D &Wender, P., M.D. 2005.Understanding Depression: A Complete Guide to its Diagnosis and Treatment.Publisher: Oxford University Press, USA; Revised edition (May 12, 2005). Lees, D. 2014. Recovery-focused practice in mental health. Nursing Times 19.03.14 / Vol 110 No 12 MNT. 2015. What is Dementia? What Causes Dementia? Symptoms of Dementia, [Online] Available at: http://www.medicalnewstoday.com/articles/142214.php[Accessed 19 January 2015] Miklowitz, D. 2010 The Bipolar Disorder Survival Guide- what you and your family need to know. Publisher: The Guilford Press; 2nd edition (December 15, 2010) Ruff, R. L., Riechers, R. G. & Ruff, S. S.2010.Relationships between mild traumatic brain injury sustained in combat and post-traumatic stress disorder.[Online] Available at http://f1000.com/reports/m/2/64 [Accessed Accessed 19 January 2015] Sayer, N. A., Rettmann, N. A., Carlson, K. F., Bernardy, N., Sigford, B. J., Hamblen, J. L. & Friedman, M. J. 2009. Veterans with history of mild traumatic brain injury and posttraumatic stress disorder: Challenges from provider perspective. Journal of Rehabilitation Research & Development, 46 (6), 703–716, DOI:10.1682/JRRD.2009.01.0008. Theories Of Neurological Aging And Dementia, (n. d), [Online] Available at: http://www.alzbrain.org/pdf/handouts/K2b.THEORIES%20OF%20NEUROLOGICAL%20AGING%20AND%20DEMENTIA.pdf[Accessed 19 January 2015] Understanding Depression. 2011. [Online] Available at http://helpguide.org/mental/depression_signs_types_diagnosis_treatment.htm[Accessed 19 January 2015] Whalley L.J. 2002. Brain ageing and dementia: what makes the difference? The British Journal of Psychiatry (2002) 181: 369-371, WHO, 2015. Dementia. [Online] Available at http://www.who.int/mediacentre/factsheets/fs362/en/ [Accessed 19 January 2015] Read More