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Diagnosis and Management of Dementia
The worlds population is aging, and advances in modern health care have meant that people are living longer. However, at the same time, the number of people suffering from non-communicable diseases is increasing. One of the essential tasks of todays health care system is to preserve the older generations health and increase the duration of active life. The medical and social significance of age-related diseases, particularly cognitive disorders and dementia, is steadily growing in the aging society.
Dementia
Dementia is a syndrome caused by various progressive disorders that result in impairment of memory, attention, thinking, behavior, and ability to perform daily activities. The greatest manifestation of cognitive impairment is seen in old age against a background of brain impairment caused by diseases of the nervous system. However, it is worth remembering that dementia is not a normal aging condition. Starting with benign forgetfulness, dementia in 5-10 years leads to household and professional skills loss. It ends with the complete loss of basic self-care skills (Hickey and Bourgeois, 143). Dementia is a chronic, general, usually irreversible decline in cognitive function, affecting all aspects of cognitive activity.
This disease affects all parts of the body, including the cells. The immune system cells of the brain, which begin to absorb nutrients, play a role in initiating the process of nerve tissue degeneration. Microglia cells, a specialized class of glial cells of the central nervous system, act as phagocytes destroying infectious agents and destroying nerve cells (Hickey and Bourgeois, 135). Thus, they are active participants in the development of dementia.
This disease also has a devastating effect on brain tissue. Frontotemporal dementia is caused by the depletion of frontal or temporal lobe tissue (Innes 146). It can also give complications in the form of misfolded proteins in the brain, which in turn cause dangerous adverse reactions and misfolded proteins in other cells. Because the disease is chronic and irreversible, it has a devastating effect on all organ systems, destabilizing them.
Psychological Effects
Changes in emotions for people with dementia are often sporadic, with the patients having little control in their emotive reactions. Dementia patients suffer from mood changes, poor emotional expression, and overreacting to situations. These patients appear uninterested in most activities due to their inability to express their feelings effectively (Reul et al.). These patients are also excessively anxious and easily agitated while displaying symptoms of depression. Insomnia is a common occurrence in dementia, with patients having difficulties getting enough sleep at night. The patients suffer from repetitive questioning of issues already raised, and this may irritate caregivers. Caregivers must understand the mental decline stems from an illness rather than a deliberate attempt to frustrate them.
The confidence and self-esteem of dementia patients experience a rapid decline with decreased belief in their judgment. These patients are constantly worried they may be making wrong decisions. They experience stigma and social demotion, as they cannot easily interact with other people (Reul et al.). The relationships these people held dear in the past are also battered by this condition, as they cannot maintain them effectively by showing the necessary feelings. The rarest psychological manifestations for people with dementia are euphoria, hallucinations, and disinhibition. The most significant clinical presentations of this condition are depression, apathy, and anxiety.
Diagnosis
The diagnosis of dementia is made clinically; laboratory and neuroimaging tests are usually used for differential diagnosis and identification of curative diseases. Treatment of such a disease is primarily supportive. In dementia, all cognitive functions are affected. The disease develops gradually, but family members may note the sudden onset of symptoms when impairment is already pronounced. Often, loss of short-term memory may be the first symptom. Although the symptoms of dementia have a continuous course, they can be divided into stages such as early, intermediate, and late. In the early stages of the disease symptomatology, there is a loss of memory of recent events. It becomes challenging to learn and retain new information. Language problems, mood swings, and the development of personality changes are also noted.
Patients may experience progressive difficulties in self-care in everyday life. Abstract thinking, the ability to get to the heart of problems, and critical thinking may also be reduced (Hickey and Bourgeois, 141). In the intermediate stage, symptoms worsen, and patients become incapable of learning and reproducing new information. Memory for distant events decreases but is not entirely lost. A person in the intermediate stage of the disease may need assistance maintaining the essential elements of daily activities. In the later stages of the disease, patients cannot walk, eat independently, or perform any other activities of daily living (Innes 45). Short- and long-term memory is completely lost, therefore, patients become dependent on outside help, making it necessary to admit them to long-term care facilities.
Treatment
Controlling of dementia is done to reduce the suffering that results from cognitive symptoms while also minimizing the rate of cognitive decline. Management of dementia can be carried out using non-pharmacological and pharmacological treatments to enhance a patients quality of life. Some of the non-pharmacological approaches applied in the management of dementia include stimulating activities, physical exercise, having a healthy diet, and adequate sleep (Arvanitakis et al., 1). Some of the pharmacological treatments applied in the management of dementia are cholinesterase inhibitors, memantine, antidepressants, and antipsychotic medicines (Salamon 1). The methods applied in controlling dementia help to reduce symptoms while also preventing cognitive decline.
Non-pharmacological treatments applied in the control of dementia focus on initiating lifestyle changes to ensure that a person feels good. A dementia patient must stay active through physical exercise since it helps to reduce symptoms such as challenges in thinking, anxiety, and depression (Innes 45). Another non-pharmacological treatment used to manage dementia is having a good sleep since it helps to create a calm feeling to prevent symptoms from worsening. Having a healthy diet can also play a significant role in slowing down dementia.
Pharmacological treatments cannot help treat dementia since they only help ease symptoms caused by the medical condition. One of the pharmacological treatments applied in the control of dementia is cholinesterase inhibitors such as donepezil and galantamine. Cholinesterase inhibitors significantly reduce the breakdown of brain chemicals utilized in memory and judgment (Salamon 1). Another treatment used to manage dementia is memantine, which helps to control a chemical in the brain used for learning and memory. Antidepressants can also be used to enhance a patients mood and reduce the likelihood of irritability. Antipsychotic medicines also help manage dementia by helping to control hostility, agitation, and illusions.
In conclusion, the treatments applied to control dementia help to reduce symptoms while also preventing cognitive decline. Non-pharmacological treatment applied in the management of dementia help to reduce symptoms of the condition by initiating lifestyle changes such as diet, exercising, and having a good sleep. Pharmacological treatments applied in the management of dementia include cholinesterase inhibitors, memantine, antidepressants, and antipsychotic medicines.
Conclusion
To summarize, dementia is a complex, incurable, and progressive disease affecting all human organ systems. The central part of its treatment is maintenance therapy. This disease also has a significant effect on the emotional state of the patient. He may experience irritability, anger, and disorientation. In the late stage of the symptomatology, the patient must be placed in a specialized care facility, as he loses his independence completely.
Works Cited
Arvanitakis, Zoe, Raj C. Shah, and David A. Bennett. Diagnosis and management of dementia. Jama 322.16 (2019): 1589-1599. Web.
Hickey, Ellen, and Michelle Bourgeois, editors. Dementia: Person-centered assessment and intervention. 2nd ed., Routledge, 2017. Web.
Innes, Anthea et al. Dementia: The basics. Routledge, 2020. Web.
Reul, Sophia, et al. Can cognitive assessment really discriminate early stages of Alzheimers and behavioral variant frontotemporal dementia at initial clinical presentation? Alzheimers Research & Therapy, vol. 9, no. 1. 2017. Web.
Salamon, Maureen. What Are the Treatments for Dementia? WebMD, 2018. Web.
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