Dementia and alzheimer's

Overview

Dementia is a broad term that refers to significant declines in memory, language, problem-solving, and other cognitive functions that disrupt everyday life¹. Alzheimer's disease is a progressive brain disorder marked by changes that result in the accumulation of specific proteins. This condition leads to the shrinking of the brain and the eventual death of brain cells². Alzheimer's is the most prevalent cause of dementia.

What's the Difference Between Alzheimer's Disease and Dementia?

Dementia refers to a range of symptoms including cognitive, and psychological issues—resulting from various diseases. While Alzheimer's disease is the most prevalent cause of dementia, other conditions such as Frontotemporal degeneration, Lewy Body disease, and Vascular disease can also lead to dementia symptoms. It's important to note that not every instance of cognitive decline qualifies as dementia; it specifically requires a progressive neurodegenerative disease as its underlying cause³. 

Symptoms of Dementia

Cognitive Changes

• Memory Loss: One of the biggest signs of dementia is memory loss, which is often first identified by friends or family members. Individuals may struggle to remember recent events or important information, leading to confusion and frustration in everyday situations.
• Communication Difficulties: Many people with dementia experience problems with verbal communication, making it hard for them to find the right words or follow conversations. This can result in misunderstandings and feelings of isolation.
• Visual and Spatial Challenges: Individuals may have difficulty with visual-spatial tasks, such as navigating familiar routes or accurately judging distances. For instance, they might get lost while driving or struggle to locate objects within their environment.
• Reasoning and Problem-Solving Issues: Dementia can impair reasoning skills, making it challenging to solve problems or make decisions. This might manifest in difficulty managing finances or planning simple tasks, which can lead to frustration.
• Complex Task Difficulties: Individuals may find it increasingly difficult to perform complex tasks that require multiple steps, such as cooking a meal or following a recipe. This decline can disrupt daily routines and reduce independence.
• Planning and Organizing Problems: Organizing activities or managing schedules can become overwhelming for those with dementia. This may lead to missed appointments or forgotten responsibilities, further complicating their daily lives.
• Coordination and Movement Issues: Poor coordination and control over physical movements can arise, impacting balance and increasing the risk of falls. This symptom can also make simple activities like dressing or walking more challenging.
• Confusion and Disorientation: Individuals may frequently experience confusion about time, place, or even their own identity. This disorientation can cause anxiety and lead to further emotional distress.

Psychological Changes

• Personality Changes: Dementia can lead to noticeable shifts in personality, causing individuals to become withdrawn or exhibit behaviours that are out of character. Family members may find these changes difficult to understand and cope with.

• Depression: Feelings of sadness or hopelessness can arise as individuals confront the realities of their cognitive decline. Depression in dementia patients can exacerbate other symptoms and affect their overall quality of life.

• Anxiety: Anxiety is another common psychological symptom, often stemming from confusion and uncertainty about one’s surroundings or abilities. Individuals may feel overwhelmed by their situation, leading to heightened distress.

• Agitation: Increased agitation may occur as individuals struggle to process their thoughts and emotions. This can result in restlessness, irritability, or even aggressive behaviour, which can be challenging for caregivers to manage.

• Inappropriate Behavior: Dementia can lead to social conduct that is deemed inappropriate or out of character, such as making inappropriate comments or acting impulsively. These behaviours can strain relationships and create uncomfortable situations.

• Paranoia: Some individuals may develop suspicious or paranoid thoughts, causing them to mistrust caregivers, family members, or friends. This can create a significant barrier to effective communication and care.

• Hallucinations: In some cases, individuals may experience hallucinations, perceiving sights or sounds that aren’t present. This symptom can be particularly distressing and may require careful management to ensure the individual feels safe and supported 5. 

Symptoms of Alzheimer's

Alzheimer's disease is divided into 3 stages⁴:

Early Stage Symptoms

• Forgetting Recent Conversations or Events: As Alzheimer's disease advances, individuals may find it increasingly challenging to recall recent conversations or events. This memory loss can lead to misunderstandings and frustration, both for the individual and their loved ones. 
• Misplacing Items Frequently: Frequent misplacement of items becomes a common occurrence during the early stages of Alzheimer's. This can lead to heightened frustration and confusion, as individuals may spend significant time searching for misplaced objects, such as keys, glasses, or even important documents. The inability to locate familiar items can evoke anxiety, and in some cases, may result in accusations directed toward others or even the belief that items have been stolen. 
• Struggling to Remember Names and Places: A common symptom of Alzheimer's is the difficulty in recalling the names of familiar places and objects, which can have a profound impact on social interactions. This struggle may cause individuals to feel embarrassed or self-conscious, leading them to withdraw from social situations. For instance, forgetting the name of a close friend or a favourite restaurant can create barriers to maintaining relationships.
• Difficulty Finding the Right Words: Communication becomes increasingly difficult for those in the early stages of Alzheimer's, as they may struggle to find the right words during conversations. This can result in pauses, incomplete sentences, or frustration when trying to express thoughts and feelings.
• Repeatedly Asking the Same Questions: Short-term memory loss often manifests in the repeated asking of the same questions. This behaviour is not only indicative of cognitive decline but can also create a cycle of frustration for both the individual and their caregivers. For example, a person with Alzheimer's might ask the same question multiple times within a short period, often forgetting that they have already received an answer. This can be emotionally taxing for loved ones, who may feel overwhelmed or exhausted by the need to provide constant reassurance. Understanding that this repetition is a symptom of the disease can help reduce feelings of frustration and foster more compassionate interactions.
• Poor Judgment and Decision-Making Challenges: Individuals with Alzheimer's may display poor judgment or face significant challenges in decision-making, which can affect their daily choices. This may manifest in various ways, such as dressing inappropriately for the weather, neglecting personal hygiene, or making uncharacteristic financial decisions. These lapses can create serious consequences, such as health risks or financial exploitation. 
• Becoming Less Adaptable to Change: A noticeable reluctance to embrace change can be observed in those experiencing middle-stage Alzheimer's. Individuals may become less adaptable and hesitant to try new activities or routines, preferring the comfort of familiar patterns. This can manifest in resistance to changes in living situations, daily schedules, or even modifications in caregiving approaches. 

Additionally, early signs may also include mood alterations, such as heightened anxiety, agitation, or moments of confusion.

Middle Stage Symptoms

As Alzheimer's disease progresses into its middle stage, individuals often experience a significant decline in their memory capabilities. At this point, recalling the names of familiar people can become increasingly challenging, and many may find themselves unable to recognize family members and friends they once knew well.

In addition to worsening memory issues, a range of other symptoms may emerge:

• Confusion and Disorientation: Individuals may experience heightened confusion, leading to situations where they become lost, even in familiar environments. They might wander without understanding where they are or have difficulty grasping the time of day.

• Repetitive and Impulsive Behaviors: There can be an increase in behaviours that seem obsessive or repetitive, as well as impulsive actions that are out of character.

• Delusions and Paranoia: Some may develop false beliefs, such as delusions, or feel paranoid, leading them to mistrust caregivers or family members, which can strain relationships.

• Language Difficulties: Problems with communication may arise, making it hard for individuals to find the right words or follow conversations.

• Sleep Disturbances: Sleep patterns can be significantly disrupted, leading to insomnia or other sleep-related issues, which further impact daily functioning.

• Mood Changes: Emotional fluctuations can become more pronounced, with individuals experiencing rapid mood swings. They may also feel increased levels of anxiety, frustration, or depression as they navigate their changing reality.

• Hallucinations: Some may experience hallucinations, perceiving sights or sounds that aren’t present, which can be distressing and confusing.

Late Stage Symptoms

People in the later stages may also exhibit changes in behaviour that can be alarming. They may become aggressive, demanding, or suspicious of those around them, including loved ones and caregivers. This shift can create a challenging environment for caregivers, who may find themselves navigating volatile situations that were once uncommon.

In addition to these behavioural changes, a range of physical symptoms may emerge as Alzheimer's progresses:

• Difficulty Eating and Swallowing: Known as dysphagia, this symptom can complicate mealtimes and may lead to choking hazards. Caregivers often need to modify food textures or provide assistance to ensure that the individual receives adequate nutrition.

• Challenges with Mobility: Individuals may experience significant difficulty in changing positions or moving independently. This can increase the risk of falls and may necessitate the use of mobility aids or assistance from caregivers.

• Weight Loss: Severe weight loss can occur as a result of difficulties with eating or a general decline in appetite. This can exacerbate health issues and lead to further complications, making proper nutrition a crucial focus for caregivers.

• Incontinence Issues: Many individuals may experience urinary incontinence or bowel incontinence as the disease progresses. These challenges can lead to embarrassment and discomfort, requiring caregivers to provide compassionate support and frequent assistance.

• Gradual Loss of Speech: As Alzheimer's disease advances, individuals may experience a gradual decline in their ability to communicate verbally. This can be frustrating for both the individual and their loved ones, as it may hinder meaningful interactions and expression of needs or emotions.

Dementia and Alzheimer's and TCIH Approaches

• Animal Assisted Therapy: Several studies have explored the benefits of animal-assisted therapy for the well-being of older adults. A review of the research indicates that interacting with animals may positively impact the behavioural and psychological symptoms of dementia. However, the duration of these effects remains unclear⁶. 
• Art Therapy: Art therapy offers a valuable outlet for individuals with dementia and Alzheimer’s, providing a new way to express themselves when verbal communication becomes challenging. This form of expression helps reduce frustration, promote emotional well-being, and foster a sense of accomplishment⁷. 
• Dance Movement Therapy: Dance/movement therapy (DMT) effectively supports individuals with Alzheimer’s and dementia by using movement and nonverbal communication to connect. This approach reduces the focus on verbal language and cognitive limitations, allowing participants to engage from a place of ability, rather than disability. It provides a way for people with dementia to actively participate and express themselves⁸. 
• Sound Therapy: Light and sound therapy for Alzheimer’s seems to be effective by utilizing a 40Hz frequency to help realign disrupted brain waves. This process appears to reduce many of the symptoms associated with the condition. The treatment is thought to work by enhancing specific brain functions⁹.