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Dementia: A Carers Viewpoint


My name is Maria. I have worked in a care home with 100 residents, for almost two years. In the length of my time as a nurse in the aged care home, I have a fair share of insights on what it's like to care for a patient with Dementia.

My deep understanding of the condition came when I met Mrs. Arnold*. She was 89 years old at that time and was confined to a wheelchair as she was no longer able to support or steady herself walking; one of the many debilitating effects of Dementia. She was at the late-stage, severe Alzheimers disease. Patients on this phase require full-time, around-the-clock help with daily personal care, as they lose coordination with their movement. Her arms and hands were still able to move, and whenever she wants, she would meander across the hallway, back and forth, and over again. During this phase, some patients would lose their awareness on their recent experiences as well as with their environment, for Mrs. Arnold she would go through every room, in search for chocolates. She must have loved chocolates very much, so much that it still manifested in her action. That tiny detail in her personality didn't leave her, just yet.

In late-stage, severe Alzheimer's, patients often develop increasing difficulty in communication and comprehension. We could not formulate a proper conversation with her, as she only had three things she could eloquently say: Papi (Her Husband), WC (German for toilet), and schoggi (Swiss-German for chocolates). Some of the elders were resilient and completely understanding of her case, some just did not give a hoot.

Another common occurrence for people with late stage alzheimers is wondering. There were times when we would look for her across the ward, only to find her already sitting on the toilet seat. Whenever she was lucid, this process would go by without a complication. As time went on, she would increasingly lose control and have an accident without realising, often claiming another resident had poured water on her. We would try to remind her every time, to call for help or to push the green call button beside the handrail, left of the toilet seat.

Patients that are on this phase often go through changes in physical abilities, like having difficulty in walking, sitting, or even swallowing. Mrs. Arnold could eat properly on her good days, with minimal supervision. Sometimes, we would feed her, either because she would not eat and would call Papi, which would irritate some of the elders eating in the dining hall; or her utensils would slip out of her grasp. There were instances when we would sit with her, then she would hold our hand and just start to cry.

Looking back at that time makes me think about the things that I could have done more of as a carer for a person with dementia. But then it got me thinking further, how many people who have relatives that suffer from this condition, truly understands what dementia is all about? Do we have a profound way of knowing when it triggers and how this disease, which takes away an individual's core self, will be diagnosed?

Here are some of the basic facts I'd like to share with you:

People often interchange Dementia and Alzheimers. Dementia is a general term for the decline in mental ability. With that being said, a person with dementia will have difficulty with his cognitive functions, such as memory, language, reasoning, planning, recognizing, identifying people, events or objects. The most common form of Dementia is Alzheimers disease, which accounts for about 60-80% of all Dementia cases. It is a progressive (continuous), degenerative (deteriorating) brain disease that slowly impairs a person's memory and ability to learn, reason, make judgement, communicate, and carry out daily activities.

Vascular dementia or previously called, multi-infarct or post-stroke dementia, is a less common form of the disease. It accounts to almost 20-30% of total dementia cases. This condition occurs when there is diminished blood flow to the brain, due to either fat deposits or blood clots along the inner linings of the blood vessel going to the brain.

Another lesser known form of dementia is dementia with Lewy bodies. It is an abnormal clump of alpha-synuclein protein that develop in a specific brain part called the cortex. It can co-exist with Alzheimer's and they have similar symptoms.

Now that we know what dementia is and its common forms, let's talk more on how dementia is being examined.

There is no known specific test that can show if a person has dementia. If a patient consults a primary care physician, whether for just a check-up or the annual examination, it is common practice that a patient will be asked about their medical history. The physician would like to know about the past and current illnesses, as well as the medications that are being taken. This is to rule out other medical condition that causes dementia-like symptoms, like a heart disease that causes lesser blood flow to the brain, resulting in confusion or lack of orientation. During this time, if the patient mentions having difficulty in comprehension or often bouts of forgetfulness, the physician will then perform a mini-mental status exam (MMSE).

During MMSE, the physician will ask the patient a series of questions devised to test a range of everyday mental skills. The patient might be asked, "Who is the current president?" or "What's the name of your grandson?". After MMSE, a cognitive examination that aids in detecting Alzheimer's will be done by the doctor. To do this, the patient will be asked first to repeat 3 simple object, such as chair, plate, cup. If the patient cannot repeat the words, the patient will be asked to consult a specialist immediately. Then, the patient will be asked to draw a clock, complete with numbers and shape, and to draw out a specific time that the physician will instruct the patient. For instance, the doctor will tell the patient to draw out 11:10 on the clock. If the patient cannot draw the clock or if it looks abnormal, he/she is might be dealing with mild cognitive impairment. And lastly, ask the patient to repeat all three words.

Aside from gauging the mental status, the doctor will then evaluate the patient's well-being to detect a mood disorder or depression. As this may also cause memory problems and disinterest in life. Then the doctor would order a series of laboratory tests that includes blood works and brain imaging, which is a vital component in diagnosing dementia and the kind of dementia the patient has.

Unfortunately, Dementia is still incurable to this day. Many Alzheimer's associations such as Alzheimer's Australia are working hard with research teams to develop a cure, but there is a fair way to go still. As a health professional, I encourage each and everyone to seek help from your primary care physician, if you start to experience memory loss, cognition failure, and comprehension problems at any stage.

Living with dementia might be challenging, but there are many quality professional help, and support networks to ensure no one has to deal with it alone.

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