At first, even with a Master’s degree in geriatric nursing, I wasn’t prepared for the challenges of working with patients who sometimes exhibited the various behaviors frequently seen in people who have dementia. It is not unusual to find someone with dementia suffering from such problems as hallucinations, delusions, defensiveness or even combative behaviors because they do not understand what is happening around them. It helps to have a basic understanding of what “dementia” is and what it does to the brain.
Like everyone else, I started out struggling to understand the various forms of dementia and why those who suffered from it frequently behaved in odd ways. What I’d been formally taught about the nursing care of the elderly fell short of meeting the needs of my dementia patients, primarily, because they were different. My patients suffered from symptoms such as: profound memory loss, major communication problems, the inability to inhibit knee jerk responses to challenging situations and occasional aggressive behaviors toward their families, the long term care staff, and other patients.
At one time the term “dementia” was an acceptable diagnosis. However, the word “dementia” is simply a catch-all term used to describe a set of symptoms, any one of which could have been brought on by a number of diseases. Years ago, little was done to find the actual cause. Today, we use the word “dementia” as a description for a group of illnesses all resulting in the injury to or death of brain cells. The result of these diseases includes memory loss, decreased cognition (the ability to figure things out) and declining physical and mental status to name a few.
“Dementia” covers many types of illnesses. Alzheimer’s disease, Picks disease, and multi infarct dementia are all examples. Dementia can also be caused by physical brain injury, medication errors or misuse, illness, and even vitamin deficiencies. Some dementias are treatable and can be halted or even reversed but the vast majority cannot. An individual can also have more than one cause of dementia such as Alzheimer’s disease and multi-infarct dementia.
In some cases the existence of the early stage of an illness such as Alzheimer’s disease, can prevent an individual from managing their medications properly. Incorrect doses, missed doses, taking prescription medications with over the counter products which enhance or interfere with the prescription drugs, can all cause serious problems. Because of this medication mismanagement, new or more severe symptoms can occur leading to the perception that the person is less functional than they actually are. For these reasons it is extremely important for the family to arrange for a complete dementia workup. Once this is done, a more definitive diagnosis is obtained.
Too often when a physician diagnoses a loved one with “dementia," families do not realize that more must be done to find the exact cause of these symptoms so treatment can begin. It’s important to remember that there may even be more than one cause and all of them must be treated, if appropriate, in order to assure a good quality of life for the dementia patient. Geriatric psychiatrists and neurologists familiar with dementia are the best as diagnosing these diseases and laying out a plan of care. Alzheimer’s can be helped but not cured by such drugs as Aricept and Exelon, vascular dementia may be slowed by blood thinners and thyroid disease, which can cause dementia can be treated with medications. There are many more causes of dementia and other treatments available, some of which can cure the disease, others to either slow it or help the brain to function more efficiently. So when a diagnosis of “dementia” is given, make sure a total dementia assessment finds the cause and appropriate treatment given.
Stephanie Zeman RN MSN kissesforelizabeth.com