The implications of Dementia

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Dementia

The problem-

The term Dementia is used broadly to describe a range of signs and symptoms which involves the progressive decline in a personals mental abilities; it is an issue faced by around eight hundred thousand people in the United Kingdom alone. The ‘umbrella term’ Dementia is a result of damage caused to the brain by specific diseases such as Alzheimer’s, or a trauma within the brain; this then results in an extraordinary death of brain cells. Once these brain cells begin to die they cannot be replaced and therefore the brain begins to shrink. This is called Brain Atrophy; this is a progressive and ongoing effect to the brain that cannot, at this present time, be cured. There are many different signs and symptoms of the onset of Dementia these include; memory loss, disorientation, difficulty with perception, difficulty with cognitive thinking, changes in behaviour and many more. Although these are the typical signs and symptoms of Dementia, no two patients’ suffering from Dementia will display this in the same ways.

Dementia is most commonly found in people over the age of sixty five years old; as Dementia is hard to diagnosis a GP may refer patients to a Dementia specialist; such as a neurologist who would run a series of tests to determine if Dementia is a likely diagnosis. One test used is the Mini-Mental State Examination (MMSE) which assesses a range of mental capacities such as long and short term memory, language skills and concentration levels. Blood tests may also be run to exclude any different conditions that might show Dementia symptoms but not necessary result in Dementia.

Once other conditions are ruled out brain scans are taken, to make the official diagnosis of Dementia. There as several brain scans that can be used, such as; a Computerised Tomography (CT) scan which can help give detailed images of the brain and show more information of strokes, brain damage and other diseases. A Magnetic Resonance Imaging (MRI) scan can also be used to confirm Dementia and the specific type of Dementia the patient may have; as an MRI scan clearly shows damage to any blood vessels plus any Brain Atrophy.

Different types of Dementia can be diagnosed and can result in different methods of treatments and medication. Alzheimer’s disease is the most common cause of Dementia, causing 55% of all Dementias. Alzheimer’s leads to nerve cell death and tissue loss and shrinks the brain dramatically. The cortex shrivels up damaging areas of the brain that affect thinking, organisation and memory. Also ventricles within the brain begin to grow larger and plaques- abnormal clusters of proteins- form between the nerve cells; while dying nerve cells contain tangles which are caused by twisted strands of other proteins. All of these results in loss of brain function and activity. Fig 1. –A healthy brain activity vs Alzheimer’s sufferer brain activity.

http://www.intmath.com/blog/learning/use-it-or-lose-it-5411

Vascular Disease is the second highest cause of Dementia; caused by an interruption of blood supply to the brain. Any form of interruption of blood flow to the brain, either a leak or a blockage can cause a stroke, which then in turn causes damage to the specific part of the brain that was starved of blood. Although one large stroke can causes symptoms of Dementia, several smaller strokes can also gradually develop signs of Dementia in a patient. However, Vascular Disease can also be cause by a disease called Small Vessel Disease.; this is when damaged is caused to the small vessels in the brain.

Dementia with Lewy Bodies, is the cause of four percent of Dementia’s and is closely linked to Alzheimer’s and Parkinson’s Diseases. Lewy Bodies are small parts of proteins that develop from inside nerve cells. They disrupt communication, as they disturb the chemical messages that are sent between nerve cells. Lewy Bodies can affect any part of the brain and are known to cause hallucinations, lack of concentration and a decline in physical abilities, similarly to those who suffer with Parkinson’s disease.

Implications-

Implications of Dementia mainly include, financial, emotional and social. Dementia costs £26.3 million a year; that means that over £30,000 a year goes towards caring for an individual patient (as shown in figure two). Even though this large amount of money goes to each patient only £90 of it goes towards research, to enable further understanding of Dementia and its related diseases. This is needed in order to treat and improve quality of life for patients with Dementia, meaning that although research is being done it is not being funded significantly. Therefore these costs will continue to be a strong implication of Dementia.

In most cases two thirds of the costs fall on the patient or onto their loved ones. Families tend to have to offer not only social and emotional support but also finical support. Close relatives such as spouses or children often become carers for their suffering family member; burdening them with becoming full time carers often around a full time job and family. These people are unpaid, unaided and definitely overworked. Research in 2013, by the Alzheimer’s Society (Shown in figure three) showing it was worked out that 1,3,40,000,000 hours were spent looking after people with dementia, this clearly shows the massive affect Dementia has on people’s lives.

http://www.slideshare.net/Emergency-Live/as-downloadable-infographics

Although, the financial burdens must be noted, the greater implication of a diagnosis of Dementia is the social and emotional effects on the patient and their loved ones. However, the strain on care homes and NHS wards coping with patients with Dementia is great; usually due to lack of staffing when these patients often need one on one care.

Many NHS trusts have attempted to highlight the huge effects of Dementia on lifestyles. Guy’s and Thomas’ NHS Trust foundation did this successfully through a series of six short films called ‘Barbara, the whole story’ this follows an elderly woman getting diagnosed with Dementia, and show’s her suffering from the symptoms. As the film is done through her eyes, it is very emotive and questions the viewer on their personal behaviours towards those with Dementia and also highlights the extreme hardships the patient and their families endure. This video was shown to all staff at Guy’s and Thomas’ NHS Trust and have had a lot of positive responses to this from staff members: “Barbara’s Story is a powerful reminder of just how important everyone’s contribution is when it comes to creating a safe and positive environment.” said one staff member. This video has successfully highlighted the social and emotional implications of Dementia for the patient, family and care/ medical staff.

Fig. 4- Barbara’s Story explained on the Trust website.

http://www.guysandstthomas.nhs.uk/education-and-training/staff-training/Barbaras-story.aspx

Possible Solutions-

There is no real solution for Dementia, however there are exceptions to the rule; Dementia caused by vitamin and thyroid hormone deficiencies. This can be corrected by supplements. Also some Dementia’s caused by tumours or head injury can be treated and corrected surgically, successfully stopping signs of Dementia.

Research has shown that although there is no cure, prevention of further damage to the brain is advised. This means that the risks factors should be controlled, these include; high blood pressure, high cholesterol, smoking, diet and exercise and also insuring Diabetes, type one, is controlled.

In order to prevent further damage there are several medications used that have shown to affect different stages of Dementia. Not all patients suffering with Dementia will receive medication as it depends on the severity and type of Dementia they are suffering with.

Acetylcholinesterase inhibitors, is a medication used to treat mild/ moderate Alzheimer’s, as well Lewy Bodies Dementia. It is a chemical that prevents the acetylcholinesterase enzyme from breaking down acetylcholine, which increases both the level and duration of action of the neurotransmitter acetylcholine. The role of acetylcholine in cognition in the central nervous system is to control memory and learning. This means that the symptoms of memory loss and lack of understanding is reduced. This medication is proven to also be good at controlling hallucinations, and is used for patients with Parkinson’s as well as Dementia. Side effects include nausea and vomiting but this is usually temporary for the first few weeks. Acetylcholinesterase inhibitors can also slow a patient’s heart rate, so this would need to be monitored.

Another drug used in treatment of Alzheimer is Memantine hydrochloride. It was first produced in 1968 and is still seen as the most effect treatment of moderate to serve Alzheimer’s. This medication blocks the effects of chemicals in the brain.

One common symptom of Dementia is depression, as patients often feel alone and scared. Therefore antidepressants are often prescribed as a method of treatment for this symptom. Another common symptom is a change in behaviour. Therefore, antipsychotics are sometimes used to help control a patient with Dementia’s; aggressive or challenging behaviour. However antipsychotics should only be used short term and with careful consideration; due to adverse side effects; such as worsening of other Dementia symptoms and cardiovascular diseases.

Psychological methods of treatment are effective with helping patients and carers manage the symptoms of Dementia; unfortunately it does not slow down the progression of Dementia. These methods focus on cognitive stimulations promoting brain activity, memory, problem solving and communication. These vary from group activities and games, the Alzheimer’s Society offers ‘Singing for the brain’ within communities(as shown in figure five); where people with Dementia and their carers go to develop social skills, memory and to give them something to keep them active and positive.

http://www.alzheimerswiltshire.org.uk/support-images/SfB-rowde.JPGAlthough there is no ‘solution’ for Dementia; one important prevention and aid to helping those with Dementia is care and support. As previously mentioned families and carers are put on greatly to socially, emotionally, physically and finically support their loved one. However, this love, support and care can make the ultimate difference to how a person copes with Dementia, especially in the late stages when it is often loneliest and most confusing and frightening.

Fig. 5- A group at ‘Singing for the Brain’

http://www.alzheimerswiltshire.org.uk/services/singing/singing-for-the-brain.html

Evaluation-

Several medications have found to reduce the symptoms of Dementia in its various stages of severity. However, no cure or solution has yet been found and although the drugs are effective they still have some major side effects. Such as Acetylcholinesterase inhibitors, that in extreme circumstances can cause bradycardia in patients. Whereas, other treatments such as antipsychotics used to control a patients behaviour can have adverse side effects such as worsening other symptoms of Dementia and can cause cardiovascular diseases. This shows that even though this drugs are effective in controlling some symptoms of Dementia, the side effects can be extremely detrimental to the patients overall well-being.

Dementia inflicts financial struggles on the NHS and for individuals and families suffering with Dementia; however not enough money is going towards research into Dementia, this is an area that needs to be addressed.

From research , I have found The Alzheimer’s Society offers a vast amount of information and support to those with Dementia and their families and carers; as well as offering advice for health care professionals. It is clear to see that the main treatment that can be given to those with Dementia is love, care and support.

Brodie Smart

Word Count: 1,858

Bibliography of Internet Resources:

Brodie Smart

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