A Norton Rose Group magazine Issue 3 Re: WoRk dementia the ...

e: Feature
Does it matter what type of dementia one has, when
the paths of each cross over, meet and come to one
indistinguishable end? Perhaps not; but if you are the
child of a parent who develops dementia, you may start
to think, will this happen to me? What can I do to ward
it off?
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Alzheimer’s disease involves the atrophy
of brain tissue, a build-up of amyloid
plaques and atrophy of fibres along which
nerve impulses are transmitted. The risk of
it being passed down through the family
appears low (only 15% of cases are thought
to be familial) but more research is needed
on genetic predisposition. it is more
common in females (a ratio of 2:1).
Vascular dementia is the result of tissue
death (through oxygen starvation) caused
by a thrombosis or embolism. Nerve
impulses can no longer travel along the
cell fibres in the brain. A mix of blood
pressure control (diet and exercise) and
treatment with anti-coagulants can reduce
risk factors.
People who suffer from Parkinson’s may
develop dementia with Lewy bodies. This
form is also linked with depression and
sleep disturbance.
Korsakoff’s syndrome is caused by a
deficiency of vitamin B1 through poor
nutrition related to alcoholism.
“All the world’s a stage”, says the melancholy Jaques in
As You Like It. He goes on to talk about the seven ages of
man: the infant, the schoolchild, the lover, the soldier,
the justice, and then the sixth age, which “shifts / Into
the lean and slippered pantaloon / With spectacles on
nose and pouch on side / His youthful hose, well saved,
a world too wide / For his shrunk shank, and his big
manly voice / Turning again towards childish treble,
pipes / And whistles in his sound”, and finally, “Last
scene of all / That ends this strange eventful history /
Is second childishness and mere oblivion / Sans teeth,
sans eyes, sans taste, sans everything.”
Shakespeare got it right, of course, when he talked
about the child in us. There are three (very approximate)
stages to dementia, and for part of that time it can seem
that the adult has become a young child, in need of care,
without self knowledge or inhibition, living in the Now.
The passing from one stage to another is
blurred, and for the observer often only
becomes clear when there is time later to
reflect on what happened.
The early stage
early signs include increasingly poor
judgement and decision-making; the
inability to manage a budget; losing track
of the date or the season; difficulty holding
a conversation; misplacing things without
knowing how to retrace your steps or what
to do once you find it. There may also be
signs of depression and trouble sleeping.
The middle stage
Memory loss steps in. they may lose
track of why they are where they are; and
where they should be. They may revert to
a time in their past. Conversations lose
their structure; they may repeat questions
many times over, or listen to the same
topic with no sign of having heard it before.
Recognition of names or faces starts to
go. Inhibitions disappear and behaviour
changes; they may try to undress in public;
they may get aggressive and behave in a
way that is “out of character”. Habits die
as memories and associations fade; so
smokers no longer smoke, drinkers no
longer drink and readers no longer read.
Photographs that once might hold their
attention may be torn up or discarded. they
may not remember which item of clothing
belongs to them, or care. incontinence
sets in. standing up, getting out of a car
or a wheelchair, walking any distance will
take time and patience. At some point you
will have to decide whether they can stay
in their own home, move in with a family
member or be cared for in a residence,
which will have locked doors.
The late stage
Mobility goes. they stay in the chair and
then the bed as they forget how (or why)
to use their muscles to create movement.
incontinence gets a grip. they eat when
fed and toward the end they no longer
eat, and no longer swallow. speech is
first incomprehensible and then it stops.
Regression to infancy follows a recognised
path. the smile stays almost to the end. the
moment of death slips in quietly.