Dementia Awareness

What is Dementia?

Dementia is the term used for a collection of symptoms that are caused by disorders affecting the brain–it is not one specific disease.

Dementia should not be considered a ‘normal’ part of ageing. Dementia can happen to anybody, though it is more common after 65 years of age (Dementia Australia n.d.b.; Alzheimer’s Association 2019).

There are six main cognitive domains that may be affected by dementia. They include complex attention; executive function; learning and memory; language; social cognition and perceptual-motor function (Woodward 2015).

It is essential that you have an awareness of dementia, as it is a growing epidemic in Australia. There are an estimated 1,800 new cases of dementia detected each week and this is expected to grow (Dementia Australia 2018).

Dementia awareness specifically relates to Standard 3 of the Aged Care Quality Standards: Personal and Clinical Care..

This article will outline types of dementia; signs and symptoms; presentation; treatment and prevention and provide you with material for further research.

Dementia in Numbers

Statistics of dementia in Australia in 2019 reveal

Dementia is the second leading cause of death of Australians.

It is the leading cause of death of Australian women as of 2016, surpassing heart disease.

There is an estimated 447,115 Australians currently living with dementia.

Indigenous Australians are three to five times more likely to develop dementia compared to non-indigenous people.

Almost 1.5 million people in Australia are involved in the care of someone living with dementia.

People with dementia account for 52% of all residents in residential aged care facilities.

(ABS 2018; Dementia Australia n.d.b; Mavromaras et al 2017; Queensland Brain Institute 2019a)

Types of Dementia

• Alzheimer’s disease:
• The most common type of dementia; Alzheimer's is a degenerative illness that attacks the brain.
• Vascular dementia:
• A disease in the blood vessels of the brain.
• Dementia with Lewy bodies:
• An umbrella term for the formation of clumps in the brain called Lewy bodies; it includes Parkinson’s disease.
• Frontotemporal Lobar Degeneration (FTLD):
• Degeneration to one or both of the frontal or temporal lobes of the brain.
• Huntington’s disease:
• An inherited degenerative brain disease.
• Alcohol related dementia (Korsakoff's syndrome):
• Damage occurs primarily to the area of the brain responsible for short-term memory.
• Creutzfeld-Jakob disease:
• A rare and fatal brain disorder caused by a protein particle called a prion.

(Dementia Australia n.d.b; Better Health Channel 2014a; Legg 2017; Alzheimer’s Association 2019)

Stages of Dementia

There is a generally recognised trajectory to the progression of dementia. It is characterised by the following three stages:

1. Mild/early-stage dementia

A person is able to carry out daily tasks without assistance, but a number of areas within personal care and memory are observed as showing deficits (Dementia Australia n.d.a).

2. Moderate/middle-stage dementia

These deficits have become more obvious and severe, and the level of assistance needed to function in and out of the home is steadily increasing (Dementia Australia n.d.a).

3. Severe/late-stage dementia

By this stage, the person is almost completely dependent on the care and supervision of other people (Dementia Australia n.d.a).

Early Signs and Symptoms of Dementia

• Progressive and frequent memory loss;
• Confusion;
• Reduced concentration;
• Problems with spatial skills;
• Problems with language;
• Misplacing things;
• Difficulty with abstract thinking;
• Altered mood and/or personality;
• Apathy and withdrawal;
• Loss of ability to perform everyday tasks.

(Dementia Australia n.d.b; Woodward 2015; Clark 2015; Better Health Channel 2014b; Alzheimer’s Association 2019)

Beyond these signs, look for more subtle red flags such as frequent falls or trouble maintaining balance; or unexpected deterioration (Clark 2015).

Dementia Presentation

The difficulty of detecting dementia is that many of its effects overlap with the common effects of ageing. This is why early and confident diagnosis is needed.

Someone who has dementia will present with having lost or being in the process of losing one or a combination of the following:

• Memory;
• Intellect;
• Rationality;
• Social skills; and
• Reasoning.

(Dementia Australia n.d.b)

Dementia Treatment

Ongoing support is critical for people living with dementia. As a care worker or healthcare professional, you are in a unique position to empower patients and their loved ones with relevant information that will help them to understand and manage the condition, for both the immediate and distant future. Your intervention could considerably improve their quality of life (Woodward 2015; Health Direct 2018b).

Pharmacological therapies may be available to them. Additionally, referral to non-pharmacological therapies may be appropriate such as:

• Psychological support;
• Behavioural management; and
• Environmental therapies.

(Woodward 2015; Dementia Australia n.d.b.; Health Direct 2018b).

Therapies may include cognitive behavioural therapy, psychotherapy, and music, art and pet therapy (Woodward 2015; Better Health Channel 2018).

While there is not yet a cure for dementia, there are medicinal options that are able to slow the progression of the illness and, in some cases, ameliorate the symptoms (Woodward 2015).

Timely diagnosis is crucial to the treatment of dementia as medicinal intervention has been shown to be most effective in the early stages of illness (Woodward 2015).

Dementia Prevention

Some people are more prone to the risk of developing dementia for reasons that are out of their control, such as genetics or incurring brain injury. There are, however, a list of modifiable risk factors that put people at risk.

Dementia Risk Factors

Major Risk Factors

• Age;
• Genetics; and
• Brain Injury.

(Woodward 2015; Dementia Australia n.d.b)

Modifiable Risk Factors

• Education;
• High cholesterol;
• Diabetes;
• Hypertension;
• Cardiovascular disease;
• Smoking;
• Vitamin deficiencies;
• Excessive consumption of alcohol;
• Depression; and
• Physical inactivity / obesity.

(Woodward 2015; Dementia Australia n.d.b; Alzheimer’s Association 2019; Health Direct 2018a)

Researchers continue to investigate measures to reduce the risk of developing dementia. The most active areas of research and risk reduction and prevention include:

• Cardiovascular factors;
• Physical fitness; and
• Diet.

(Alzheimer’s Association 2019)

The Future of Dementia

It’s possible that like cancer, dementia will never be completely preventable, but we can improve on methods to delay its onset and lessen its damage. The Australian Government set up the National Institute of Dementia Research in 2013 to coordinate funding and research projects on dementia. State and federal governments are committed to continued funding dementia research (Queensland Brain Institute 2019a).

Additional Resources

• Aged Care Quality Standards: https://agedcare.health.gov.au/quality/aged-care-quality-standards
• Alzheimer’s Association: https://www.alz.org/
• Dementia Australia: https://health.dementia.org.au/

References

• Alzheimer’s Association 2019, What is Dementia, Alzheimer’s Association, viewed 9 September 2019, https://www.alz.org/alzheimers-dementia/what-is-dementia.
• Australian Bureau of Statistics 2018, Causes of Death, ABS, viewed 9 September 2019.
• Better Health Channel 2014a, Dementia - Different Types, Better Health Channel, viewed 9 September 2019 https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dementia-different-types
• Better Health Channel 2014b, Dementia - Early Signs, Better Health Channel, viewed 9 September 2019 https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/dementia-early-signs
• Clark, M 2015, Detecting Dementia in General Practice, Dementia Australia, online video, 23 December, viewed 9 September https://www.youtube.com/watch?v=uOljschA25o&list=PLAwhBH-4GO5hNuz5XHQVY3r63-BHnI2m8&index=2
• Dementia Australia n.d.a, The Disease Trajectory, Dementia Australia, viewed 9 September 2019, https://health.dementia.org.au/information/health-professionals/dementia-the-essentials/the-disease-trajectory
• Dementia Australia n.d.b, What is Dementia?, Dementia Australia, viewed 9 September 2019, https://www.dementia.org.au/about-dementia/what-is-dementia
• Dementia Australia 2018, Dementia Prevalence Data 2018-2058, commissioned research undertaken by NATSEM, University of Canberra.
• Health Direct 2018a, Dementia Prevention, Health Direct, viewed 9 September 2019, https://www.healthdirect.gov.au/dementia-prevention
• Health Direct 2018b, Dementia Treatment and Care, Health Direct, viewed 9 September 2019, https://www.healthdirect.gov.au/dementia-treatments-and-care
• Mavromaras, K, Knight, G, Insherwood, L, Crettenden, A, Flavel, J, Karmel, T, Moskos, M, Smith, L, Walton, H and Wei, Z 2017, National Aged Care Workforce Census and Survey – The Aged Care Workforce, 2016, Department of Health.
• Legg, TJ 2017, 10 Types of Dementia, Healthline, viewed 9 September 2019, https://www.healthline.com/health/types-dementia#alzheimers
• Queensland Brain Institute 2019a, Future of Dementia Research, The University of Queensland, viewed 9 September 2019, https://qbi.uq.edu.au/dementia/future-dementia-research
• Queensland Brain Institute 2019b, What is Dementia, The University of Queensland, viewed 9 September 2019, https://qbi.uq.edu.au/dementia/what-is-dementia
• Woodward, M 2015, Debunking Dementia Myths, Dementia Australia, online video, 22 December, viewed 9 September https://www.youtube.com/watch?list=PLAwhBH-4GO5hNuz5XHQVY3r63-BHnI2m8&v=Ts41ErswKVY

(Answers: b, a, c)