The Interface Between Delirium & Dementia
Delirium and dementia are two major causes for cognitive impairment in later years of life. Though these two conditions had been conceptualized as distinct, mutually exclusive entities, it can be difficult at times to differentiate between them. Delirium in late life is often superimposed on pre-existing dementia and can be the reason for help seeking. Dementia is the leading risk factor for delirium in an older person. Occurrence of delirium in turn is a risk factor for subsequent dementia in older people without pre-existing dementia. The clinician needs to differentiate between three possible scenarios namely Delirium with no features suggestive of pre-existing dementia dementia with no features suggestive of delirium dementia with superimposed delirium. See for broad guidelines for making this distinction, which by no means, will be easy in a given clinical setting. When faced with uncertainty, it is better to attribute the symptoms to delirium and manage it as delirium. This will allow careful monitoring and detailed evaluation to identify modifiable conditions/factors.
Caregiving In The Middle Stages
According to the Alzheimers Association, this can be the most prolonged period you will face as a caregiver. The symptoms associated with the middle stage can continue for most of your loved ones later years. During this time, you will need to learn to develop patience, flexibility, and understanding as their day-to-day functions become more difficult to achieve. Your loved one might need assistance with ADLs, act out in strange ways, or grow frustrated and angry with you, which can be stressful. Be sure to take care of yourself and reach out to family, friends, and other support services to make this transition smoother.
What Is The Life Expectancy For Dementia Can It Be Cured
There is no cure for dementia.
- Although Alzheimer’s disease is listed as the 6th most common cause of death in the U.S.. Patients with Alzheimer’s disease most commonly die due to infections caused by lack of mobility.
- Pneumonia, bladder infections, bedsores, and other causes can lead to more wide-spread infection and subsequent death.
- Patients with dementias have widely varying life expectancies, depending on the underlying cause of their dementia. Life expectancy can range from only 1 to 2 years to more than 15 years; the average duration of the disease is between 4 and 8 years after diagnosis.
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Assessment Of Dementia Syndrome
We need to rule out delirium and mild cognitive disorder before we make a clnical diagnosis of dementia. Then one should apply and see if the person meets the diagnostic criteria for Dementia. If that is met, then there is a need to make further evaluations. The next part of evaluation is aimed at establishing the cause for the dementia syndrome.
Phases Of The Condition
Some of the features of dementia are commonly classified into three stages or phases. It is important to remember that not all of these features will be present in every person, nor will every person go through every stage. However, it remains a useful description of the general progression of dementia.
- Early Dementia ;
- Advanced Dementia
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Why Is Dementia Progressive
Dementia is not a single condition. It is caused by different physical diseases of the brain, for example Alzheimers disease, vascular dementia, DLB and FTD.
In the early stage of all types of dementia only a small part of the brain is damaged. In this stage,;a person has fewer symptoms as only the abilities that depend on the damaged part of the brain are affected. These early symptoms are usually relatively minor. This is why mild dementia is used as an alternative term for the early stage.
Each type of dementia affects a different area of the brain in the early stages. This is why symptoms vary between the different types. For example, memory loss is common in early-stage Alzheimers but is very uncommon in early-stage FTD. As dementia progresses into the middle and later stages, the symptoms of the different dementia types tend to become more similar. This is because more of the brain is affected as dementia progresses.
Over time, the disease causing the dementia spreads to other parts of the brain. This leads to more symptoms because more of the brain is unable to work properly. At the same time, already-damaged areas of the brain become even more affected, causing symptoms the person already has to get worse. Eventually most parts of the brain are badly damaged by the disease. This causes major changes in all aspects of memory, thinking, language, emotions and behaviour, as well as physical problems.
Aging Depression And Dementia
Before we examine the management of dementia, let us look at the issues related to the clinical diagnosis of dementia. Mental health problems and disablement are frequent in late life. Dementia and depression are two major mental health problems in late life. It is well known that the prevalence of dementia increases steadily with age. Normal aging itself is associated with age related decline in cognitive functions. Depressive symptoms are more common in later years of life. The differentiation between depressive disorder and a cognitive disorder can be problematic in this age group. There are many symptoms which can be seen in both in depressive disorders as well as in cognitive disorders. Depression can co-exist with mild cognitive impairment a condition which is being increasingly recognized as an important entity.
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Stage : Mild Cognitive Decline
Stage 3 is where dementia or Alzheimers disease symptoms can become more noticeable to friends and family. This stage will not have a major impact on your loved ones everyday life, but signs can include:
- Trouble with complex tasks and problem-solving
- Memory loss and forgetfulness
- Asking the same question repeatedly
- Diminished work performance
The Early Stages Of Dementia: Noticeable Cognitive Decline
A person is not typically diagnosed with dementia until theyre at stage 4 or beyond. This is when medical professionals and caregivers notice personality changes, as well as cognitive impairment.
Dementia stage 4: moderate cognitive decline
At this point, a person has clear, visible signs of mental impairment. While its considered mild or early stage dementia, the medical terminology for the fourth of the seven stages of dementia is moderate cognitive decline.
Doctors and caregivers will likely notice a worsening of stage 3 dementia symptoms, such as difficulties with language, problem-solving, and travel.
Stage 4 dementia symptoms
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How Quickly Does Dementia Usually Progress
There are 7 signs of dementia and each stage where signs present themselves can last for different lengths of time.;
Symptoms could progress differently from patient to patient.
Once early dementia hits and loss of cognitive function becomes more noticeable, it becomes easier to identify how quickly dementia might progress.
Mild Cognitive Impairment And Dementia
Mild cognitive impairment is a controversial entity but remains a useful construct in terms of targeting interventions to prevent dementia. MCI detection relies largely on subjective memory complaint as a presenting symptom. However SMC is heterogeneous in its etiology and poorly predicts medium-term dementia risk. The differentiation of early dementia from MCI depends on the level of cognitive impairment and the resultant disability. Cognitive impairment in dementia causes significant impairment in instrumental activities of daily living and this is known to increase with time. Most diagnostic criteria use the resultant disability as an important differentiating feature. However reliance on informant reports can be problematic as that could be influenced by the social context, expectations of the informant and his or her ability to know and the current level of functioning of the older person.
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History Of Cognitive Changes
History taking is the main tool in eliciting and evaluating the nature and progression of cognitive decline. Choose an informant who knows about the person’s current and past personal, social and occupational functioning. A reliable informant should be interviewed separately in person. This will allow discussion of a certain information which may otherwise be difficult in the presence of the patient. While doing the assessments, one has to be mindful of the family’s culture, values, primary language, literacy level and also the decision making process. A thorough history should include details like the mode of onset of cognitive decline which affects multiple cognitive domains. The pattern progression, clinical manifestations of cognitive dysfunction, behavioral as well as personality changes will have to be enquired into.
How To Tell What Stage Of Dementia Someone Is In
It can be difficult to tell exactly what stage of dementia someone is in. At times, doctors may need to do in-depth evaluations to determine the stage of dementia their patient is in. However, in other cases, it can be quite obvious to what stage the patient is in. Are you or a home care provider going to bring your elderly loved one in to be assessed for dementia? If so, there are some things you can tell the doctor about your loved one that can help them diagnose the stage of dementia they are in.
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What Is Mild Dementia
Mild dementia is the least severe stage of dementia, a condition that affects a person’s mental state, making it difficult or even impossible to remember memories and skills. As such, it can hinder the ability to perform activities, and cause frustration to individuals by disrupting their daily routine. The mental stress of this condition commonly causes behavioral changes. With mild dementia, the condition is not so severe that it can’t be reversed, or at least adjusted to. People may still even be able to lead relatively normal lives. In some cases, what seems to be mild dementia may be the earliest stage of a dementia which will grow progressively worse, such as with Alzheimer’s disease.
Dementia isn’t a disease in and of itself, but rather a secondary condition caused either by an illness, an imbalanced mental state or physical injury. If the cause of the dementia can be resolved, then the dementia itself may be reversed. Individuals working through a traumatic event, through a bout of depression, experiencing trouble with medications or who have some other sort of treatable condition may be able to successfully cure symptoms of dementia.
Stage : Moderately Severe Cognitive Decline
Stage 5 is when your loved one is likely to need help with routine tasks, like dressing or bathing. They may require a home caregiver or to move to a;memory care;community. Other symptoms include:
- Memory loss of personal details and current events
- Reduced mental acuity and problem-solving ability
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Little Data On The Severity Of Disease Among People Living With Ad Currently Available
- Boston University School of Medicine
- What percent of patients with Alzheimer’s Disease currently have severe dementia? Do more people have mild disease? Or are the majority suffering with moderate dementia? A new study using data from the Framingham Heart Study sheds light on these trends.
What percent of patients with Alzheimer’s Disease currently have severe dementia? Do more people have mild disease? Or are the majority suffering with moderate dementia? A new study using data from the Framingham Heart Study sheds light on these trends. Boston University School of Medicine researchers have found that slightly more than half of cases are mild, just under one-third of cases are moderate and 19.3 percent are severe cases. Among all participants with mild cognitive impairment and AD, the pooled percentage was 45.2 percent for the combined group of mild AD dementia and MCI that later progressed to AD.
“Early intervention in MCI or the mild stage of AD dementia has been the primary focus for AD research and drug development in recent years. We found that approximately 45 percent of all those who are cognitively impaired or diagnosed with AD-dementia had early AD. Our results serve to inform the design of future research studies such as clinical and observational studies and provide optimal resource allocation for policy-making,” explained corresponding author Rhoda Au, PhD, professor of anatomy and neurobiology at Boston University School of Medicine.
Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
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Types And Causes Of Dementia
Dementia is a syndrome which can be caused by many diseases. After the clinical recognition of dementia syndrome, the evaluations shall focus on identifying the cause of dementia. Causes can be broadly classified as reversible causes and Irreversible causes. Though Reversible causes are less frequent, they carry good prognosis with prompt treatment of the underlying condition. Thus the evaluation for all potentially reversible conditions which cause dementia syndrome is the first most important step in the assessment of dementia syndrome and this is essential in all cases presenting with features of dmentia. The type of investigations can be decided based on the clinical features and context of care. This aspect is discussed in detail in the 2009 Dementia Supplement of Indian Journal of Psychiatry.
F00 Dementia In Alzheimer’s Disease
The general criteria for dementia must be met.
There is no evidence from the history, physical examination or special investigations for any other possible cause of dementia , a sysytemic disorder , or alcohol- or drug-abuse.
The following features support the diagnosis, but are not necessary elements: Involvement of cortical functions as evidenced by aphasia, agnosia or apraxia; decrease of motivation and drive, leading to apathy and lack of spontaneity; irritability and disinhibition of social behaviour; evidence from special investigations that there is cerebral atrophy, particularly if this can be shown to be increasing over time. In severe cases there may be Parkinson-like extrapyramidal changes, logoclonia, and epileptic fits.
Specification of features for possible subtypes. Because of the possibility that subtypes exist, it is recommended that the following characteristics be ascertained as a basis for a further classification: age at onset; rate of progression; the configuration of the clinical features, particularly the relative prominence of temporal, parietal or frontal lobe signs; any neuropathological or neurochemical abnormalities, and their pattern.
The division of AD into subtypes can at present be accomplished in two ways: first by taking only the age of onset and labeling AD as either early or late, with an approximate cut-off point at 65 years
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Alzheimer Disease Begins Long Before The First Symptoms
Alzheimers disease can begin a decade or more before the first symptoms. Despite a lack of outward evidence, toxic changes are happening in the brain.
Researchers have identified a condition called mild cognitive impairment that in some but by no means all individuals may be the earliest indication of Alzheimers or another type of dementia.
MCI involves lapses in memory, language, thinking, and judgment that are noticeable to the person and his family and close friends yet are not serious enough to interfere with everyday life.
A meta-analysis published in the journal Acta Psychiatrica Scandanavica examined 41 studies and found that among people with MCI who were tracked for five years or longer, an average of 38 percent developed dementia.
One of the highest priorities of Alzheimers research is understanding what happens inside the brain long before the first symptom. The hope is that these insights will lead to more effective treatments that slow or even prevent damage.
After the onset of symptoms, the disease progresses through three main stages: mild , moderate , and severe .
Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
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Middle Stage Or Moderate Dementia
As they progress through the seven stages of dementia, elderly people require more intense care and supervision. Someone with middle stage dementia often needs some caregiver assistance with regular day-to-day activities, such as dressing, eating, or bathing.
Dementia stage 5: moderately severe cognitive decline
This stage marks the onset of what many professionals refer to as mid-stage in the seven stages of dementia.
At this point, a person may no longer be able to carry out normal;activities of daily living;, such as dressing or bathing, without some caregiver assistance. They know major facts about themselves such as their name and their childrens names but they may not remember grandchildrens names, their longtime address, or where they went to high school.
Stage 5 dementia symptoms
- Further reduced mental acuity and problem-solving ability
Limitations And Further Research
First, we considered a relatively short period of time here, that is, change in the predictors across a 6-month period or the effect of certain variables on institutionalization during the next 6months. It would be interesting to examine the relationships between variables across a longer period of time, such as Eska and colleagues did for a 4-year period . Second, the focus in this study was on the earlier stages of dementia. Thus, severe dementia was not covered. Third, only CRs that have a CG were considered. Thus, CRs who do not have a CG could not be assessed. In addition, caregivers were only assessed with quantitative method. Qualitative data on reasons for institutionalization could generate new insights. Forth, the study is a secondary analysis of an intervention study. A part of the sample participated in MAKS therapy for 6months, which had an impact on neuropsychiatric symptoms and everyday practical and cognitive abilities. The CGs received three telephone interventions. To control this influence we included the moderator variable MAKS therapy and telephone intervention in the multivariate Cox regression. To test the predictors independently of any intervention, future research should focus on samples in care as usual. Furthermore, the variable frequency of attendance at DCF, which could have an influence on institutionalization, was only collected at baseline and could therefore not be included in the analysis.
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