Dementia is a chronic and usually progressive deterioration of mental abilities and intellectual capacity due to changes in the brain such as widespread loss of nerve cells and the shrinkage of brain tissue. Since dementia is most commonly seen in the elderly, it is often erroneously considered to be part of the normal aging process. However, it is important to remember that dementia is a condition that is a result of a disease (or trauma) and does not occur in a healthy person simply because of old age. In this essay I shall discuss why dementia is not an inevitable part of the aging process; describe the types of dementia and the ways in which they affect the cognitive functions of the afflicted person; the importance of diagnosing dementia and the role of the cognitive psychologist in diagnosis; and how people with dementia can be helped to cope with their condition.
Differentiating Dementia and Normal Aging Process
Dementia affects our memory, decision-making, judgment, spatial orientation, thinking, reasoning, and verbal communication. Its symptoms may include asking the same questions repeatedly; becoming lost in familiar places; being unable to follow directions; getting disoriented about time, people, and places; and neglecting personal safety, hygiene, and nutrition. Similar symptoms are sometimes displayed by older people due to emotional problems, which can be mistaken for dementia. These emotional problems may be triggered in the older people due to the trauma of major changes in their lives such as at the time of retirement or having to cope with the death of a spouse, relative, or friend. Such emotional upheavals leave an old person feeling sad, lonely, worried, or bored. Adapting to these life-changing events can confusion and forgetfulness in some people -- the classic symptoms of dementia. Fortunately, emotional problems can be eased by supportive friends and family, or by treatment from professional doctors, psychologists or counsellors and are not a permanent feature. Furthermore, certain physical conditions such as high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicines, problems with the thyroid gland, or a minor head injury may also result in dementia-like symptoms but the resulting condition is not dementia and needs to be treated differently. ("Forgetfulness: It's Not Always What You Think," 2004.) On the other hand, when similar cognitive functions are adversely affected due to changes in the brain, the resulting condition is dementia.
Another reason why dementia is often confused with the normal aging process is its widespread prevalence. According to recent statistics, an estimated 2 million people in the U.S.
suffer from severe dementia and another 1 to 5 million people experience mild to moderate dementia. If we look at the population over the age of 65, the prevalence of dementia is even more common, i.e., 5~8% of people over the age of 65 have some form of dementia and the number doubles every 5 years over age 65. ("Dementia," 2004) With so many older people suffering from dementia, many people mistakenly assume that the condition is a normal part of the aging process.
Types of Dementia
The two most common forms of dementia are Alzheimer's disease and multi-infarct dementia
. Both these types of dementia are irreversible, and cannot be cured, although there progress can be slowed with proper treatment. Other types of dementia can be caused by Huntington disease, syphilis, multiple sclerosis, AIDS, and some types of encephalitis
Alzheimer's disease is the most common form of dementia and occurs due to nerve cell changes in certain parts of the brain, which result in the death of a large number of cells. This degenerative brain disorder, was first discovered in 1906 by Alois Alzheimer, and usually develops in mid to late adulthood. It results in a progressive and irreversible decline in memory and a deterioration of various other cognitive abilities. Specifically, the disease occurs due to the destruction of nerve cells and neural connections in the cerebral cortex of the brain and by a significant loss of brain mass.
Typically, the first symptom in Alzheimer's disease is memory loss. As the disease progresses memory loss becomes more pronounced, and other cognitive functions such as language, perceptual, and motor skills deteriorate. Other manifestations of Alzheimer's disease include personality change as the sufferer displays unstable moods, irritation and/or alternate bouts of aggressiveness and docility. Anger, anxiety and depression are other symptoms of the disease. In advanced stages, Alzheimer patients becomes unresponsive, lose mobility and control of body functions.
Multi-infarct dementia is the result of a series of small strokes or changes in the brain's blood supply that results in the death of brain tissue. The seriousness and symptoms of multi-infarct dementia depend on the severity and of the strokes and their location in the brain. High blood pressure is often the cause of the strokes and, therefore, the control of high blood pressure is the key in controlling this type of dementia. Multi-infarct dementia, like Alzheimer's disease is irreversible although controlling blood pressure can slow its progress.
The third type of dementia, which occurs due to other specific diseases, can be controlled by the treatment of the underlying affliction, although in serious diseases such as the advanced stage of syphilis and AIDS, the condition is also irreversible.
Diagnosing Dementia and the Role of the Cognitive Psychologist in Diagnosis
Correct diagnosis is important in every disease because on it depends the appropriate treatment. In case of dementia, this is even more important as differentiating between different types of dementia and between conditions that resemble the symptoms of dementia and actual dementia determines the type of treatment to be given.
Diagnosis of dementia includes physical and neuropsychological examination as well as appropriate laboratory tests. In the diagnosis, the cognitive psychologist plays an important part because they are uniquely equipped by training, expertise, and the use of specialized neuropsychological tests to assess changes in memory and cognitive functioning and to distinguish between normal changes in the cognitive abilities of older people and the onset of various types of dementia. Their role in diagnosis is doubly important because no conclusive biological markers have so far been developed for the diagnosis of the most common forms of dementia.
Cognitive psychologists are aware that biases relating to age, gender, race, ethnicity, national origin, religion, sexual orientation, language, culture, and socioeconomic status may interfere with the evaluation and diagnosis of decreased cognitive functions. They are also aware that many aged people may perform poorly on ability assessment tests when due to reasons such as fatigue, medication side effects, physical illness and frailness, disability, poor motivation, anxiety and in particular, severe depression. These conditions, especially depression gives rise to pseudo-dementia -- a condition in which severely depressed patients exhibit cognitive changes that resemble dementia including slow motor movements and thinking and short-term memory loss. During tests, such patients may be apathetic and answer questions without even attempting to provide the correct response. The psychologists have the training and the skill to distinguish between the display of similar symptoms by different types of patients. ("Guidelines ... " 1998)
Helping Patients to Cope with Dementia
It is important to recognize that although most forms of dementia are irreversible, patients can be helped through appropriate treatment. For example, there are several drugs that slow the progress of Alzheimer's disease and people with multi-infarct dementia can be helped by controlling their blood pressure, treating their blood cholesterol and diabetes to prevent further strokes. Medication for reducing agitation, anxiety, depression, or sleeping problems, a balanced diet, avoidance of alcohol and smoking and continuance of physical and mental activities greatly help in dementia patients (and even older people exhibiting dementia-like symptoms) greatly help people cope with this dilapidating illness.
As we saw in this essay, most people exhibit some decline in…