Dealing with dementia: Empathy, sharing responsibility the key

Lokmat News Network

Dr Mangala Borkar

Dementia is a serious mental problem, often progressive, that affects behaviour, memory and ability to understand. Alzheimer’s disease is one of the common, incurable types of dementia that develops gradually. Loss of memory for recent events may be an early sign, if the memory loss is sustained. Otherwise, the elderly often tend to forget, but remember the event or incident soon after - this is quite normal. The cells of the brain responsible for reasoning, memory slowly die, the brain shrinks. Initially, the patient may be disturbed by his memory loss, but later, he is blissfully unaware of his condition. Now, the caregivers may suffer due to the agitated, uncooperative, violent behaviour of the patient. The situation has to be handled with care and responsibilities shared by the family where possible to prevent harm both to the patient and the person(s) caring for him/her.

(The writer is Professor, Department of Geriatrics, GMC, Aurangabad).

Dementia challenges in elder care/nursing homes.

Dementia and Alzheimer’s are very challenging diseases to manage. Patients have loss of memory, mood swings, irritability and neglect self-care. They require assistance for their activities of daily living but providing this assistance is also very difficult. They often forget food and medicines, may demand these repeatedly. Many a time, they are in bad mood and one has to calm them down actively. They totally neglect self-care so we may have to provide even oral and back care to them apart from mental and nutritional support. We have to deal with them with a lot of patience, sympathy and empathy…

Dr Balaji Asegaonkar

Snehsawali Care Centre, Aurangabad

Every Memory lapse is not Alzheimer’s Disease

Dementia is a complex disorder manifested by loss of cognitive functions including thinking, remembering, reasoning to such an extent that it interferes with the person’s daily life and activities.

Although Alzheimer’s disease is the most common cause for dementia, many conditions may cause dementia.

The reversible causes include:

*Vit B1, B3, B12 deficiency

*Thyroid and parathyroid disorders

*Depression in elderly mimics dementia and treatment may be gratifying.

The progressive causes include:

*Multi infarct dementia caused by blockage of blood vessels in the brain.

*Frontotemporal dementia (FTD) – Most common type of dementia in persons below 60 years of age, early language disorder is more common.

*Lewy body dementia - Abnormal visual perceptions and sleep disorders are common in the early stage.

Dr Shailaja Rao

Senior geriatrician

Government Medical College (GMC), Aurangabad

Behavioural and psychological symptoms of dementia (BPSD)

No matter what sub-type of dementia, up-to 90% of all patients develop BPSD over the course of illness. These strongly co-relate with the degree of cognitive and functional impairment. These are also known as neuropsychiatric symptoms. They include agitation, aberrant motor activity, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, sleep, and appetite changes. Patients report about people coming in home and hiding/ stealing objects, the place they reside is not their home, accuse of conspiracy to abandon or institutionalise them and complain spouse is unfaithful. It is essential to be empathic, non–judgmental and supportive towards sufferers. Preferably non–pharmacological approaches viz. light therapy, massage/ soothing touch and music therapy needs to be practiced. Where behaviour disturbances are very severe, psychotropic medicines in minimum effective yet safe doses for very short periods can be considered under the supervision of psychiatrists.

Dr Prasad Deshpande,

Professor of Psychiatry, GMC Aurangabad.