What is Dementia?
If I asked you what dementia was, what would you say? When I have asked people in the past, I have received an array of answers;
“Dementia is like Alzheimers”
“It happens when you get old”
“It affects your memory”
Usually all the answers involved three things: Alzheimer's, old-age, and memory loss. What many people do not know is that, yes, Alzheimer's is a form of dementia, but not all dementia is a form of Alzheimers. There are more than 150 types of dementia. Each can affect different parts of the brain, have different behaviors, and longevity. You may have heard of some other forms of dementia besides Alzheimers. Some of those include Lewy-Body Dementia and Vascular Dementia.
Webster dictionary defines dementia as, “A usually progressive condition (such as Alzheimer's disease) marked by the development of multiple cognitive deficits (such as memory impairment, aphasia, and the inability to plan and initiate complex behavior).”
Old-age may be a precursor to memory loss, but not all older adults have dementia. Columbia University found that 10% of adults 65 and older have dementia. That leaves 90% without it! With age, change in memory can happen. You may have heard doctors say you have “Age brain” or something along those lines. Mild memory or cognitive changes does not necessarily mean you have dementia. That can be part of the normal aging process.
Is Dementia Part of the Normal Aging Process?
No it is not! It is a disease. It causes abnormal body reactions that lead the human body down an abnormal path. Alzheimer's specifically causes shrinkages and plaques on the brain. Lewy-Body Dementia is caused by protein deposits on the brain that build up leading to memory and muscle issues. Vascular Dementia is caused by lack of blood flow to the brain. All of these types of dementia are not the normal way the body ages. Hence, dementia being called a disease.
Dementia Only Affects Memory
This Webster Dictionary definition above does a great job at touching on how dementia is a “multiple cognitive deficit.” This means it affects much more than just memory. It can affect the ability to understand speech and the ability to speak. This is why when communicating to someone with dementia they may not understand you, or their response back is “word salad.” Dementia can affect fine motor skills. This can be movements like tying one's shoes or bringing a spoon up to their mouth. Other effects include:
Personality changes
Behavioral Changes: restlessness, hallucinations, paranoia, agitation, sleep disturbances, etc.
Vision: Difficulty processing visual information and difficulty recognizing faces, shapes, and reading.
Memory does not Disappear all at Once
If you or someone you know has dementia, you will notice that memory does not go away at once. It is not like one day they wake up a blank slate. It is more like an eraser. Slowly, over many years, things disappear. First it might be forgetting names or repetitive questioning. This can then change into refusing to leave the home, not being able to recognize people, missing appointments, and slight change to personality. The perception many people have of dementia is what is shown in the later stages: immobile, not able to speak coherently, and complete or major loss of memory. In reality, every stage shows different aspects. Many of my clients are in the beginning to middle stages of dementia. They are able to hold a conversation, but will repeat questions. Some are able to walk independently, others are still able to do most of the daily living tasks like showering and making food.
NOTS of Dementia
Having a family member diagnosed with dementia is hard as is. Seeing your family member slowly change over time is harder. As the family member goes through the process of dementia, there are many important aspects to note, especially change in communication
Never Argue
They will get things wrong. They might retell a story wrong, or repeat questions. It is important to not get angry or tell them they are wrong. Telling them they are incorrect will do nothing, but make them anxious and self-conscious of their new forming deficit. If someone told you that you were wrong, or normal human reaction is to get upset. That is still the same for those with dementia. It is important to understand, what they are saying is true in their reality. Yes, they might ask when dinner is 10xs or mistake memories on the linear timeline. But, for them, their memories are not linear anymore.
Most of the Time, Do Not Reorient
Just like above, most of the time it is important to not reorient. My definition of re-orientation is when the individual with dementia is experiencing a delusion or false reality, and another individual orients them to reality. It is similar to telling them that they are wrong. It can cause a similar reaction of anxiousness or anger. There has been a little bit of proof that it works in early stages of dementia, but after that, it is useless.
That is their reality, and telling them that it is not true makes it very “Matrix” for them. If their disillusion is not hurting themselves or anyone else, what does it hurt? Okay, they think their spouse is still alive? That's beautiful! No one else can feel like the people they lost are still alive. In my years as a Memory Care RN, I have only seen re-orientation work once. All the other times, it turned sour. The one time that worked was when the resident specifically said to re-orient her when she became confused. She even went into detail on how to reorient her.
Re-orientation also has a time or place. If the individual is in the mindset to take in reality information, such as the date, location, and what is going on, that is okay! You can tell them the date, you can tell them where they are. It can only be difficult if they are not in the mindset to take that in. For example, if the person is argumentative and saying they must find their “husband” who has passed. That probably is not a good time to tell them it is September 29th, 2023 and they are in a retirement home. But, if they were calm and getting dressed in the morning, it would be okay to go over the plans for the day. They will not remember, but that is okay. This leads into the next point.
Treat Them Like a Human Being
Yes, they will forget the day's plan and ask questions multiple times. Still, keeping them included in the day to day plans keeps their dignity. Allow them to make choices. When choosing food or an outfit, ask their opinion. Not only does this help maintain their independence, but it also keeps their decision making brain working!
Dementia does not make them any less human. They are still a person with a personality and a life before the disease took place. It is important to note what they like and what they dislike. If they do not want to do something, then don’t do it. Forcing anyone to do anything is inhumane. In my experience, a lot of family members have a misconception on “making” the residents/clients do things. Facilities can not “make” residents do anything. If they verbalize refusal, they do not force it on them. This can be medication, food, activities, etc. They still have the right to refuse.
Conclusion
This short article will not be the only information you need about dementia. As the Webster dictionary says, dementia affects so many aspects. It is important to do your research, contact a Geriatric Physician, and be there for your loved one. It is a hard journey, but you being an advocate will help the process. If you want more information, please feel free to contact our team anytime!
Barton, Lynn M., et al. Webster.
Manly, Jennifer. “One in 10 Older Americans Has Dementia.” Columbia University Irving Medical Center, 26 Oct. 2022, www.cuimc.columbia.edu/news/one-10-older-americans-has-dementia#:~:text=In%20the%20first%20nationally%20representative,22%25%20have%20mild%20cognitive%20impairment.
