- Senility was once a benign term but became commonly associated with infirmity and the cognitive decline linked to aging
- It is noteworthy to ascertain exactly what a health care professional means when they refer to senile or old age dementia
- Dementia is a progressive, degenerative brain syndrome; There are varying symptoms specific to the different types of dementia
- There are 3 stages of dementia in the elderly: Early stage, Middle stage and Late stage
- Although there’s no cure for dementia, treatments can assuage some of its symptoms and delay its progression
Senility, from the Latin senectus, means old age, or pertaining to old age. It was once a benign term, but over the past two hundred years, it became commonly associated with infirmity and the cognitive decline linked to aging.
Whereas people with a healthy brain do not necessarily experience memory loss or other signs of dementia, senile dementia is a progressive disease that stems from the degeneration in brain cells.
In the early 1900s, “hardening of the arteries” was the diagnostic handle for dementia. The name progressed to “organic brain syndrome” in the 1950s, while the 1970s term “pseudodementia” was used to describe dementias caused by physiological conditions. All of these terms have now become outdated and have been replaced by the overarching term, dementia.
The term senile dementia is still commonly used, although it is noteworthy to ascertain exactly what a health care professional means when they refer to senile or old age dementia.
Dementia is the diagnosis of a constellation of symptoms, formerly known as senility or senile dementia. Dementia is a progressive, degenerative condition that for the most part has no cure, although treatments can assuage some of its symptoms and delay its progression.
Influenced by a variety of factors, including genes and overall physical health, the speed with which dementia progresses differs from person to person. Dementia is also referred to as “early onset” when individuals develop symptoms before age 65.
People with dementia exhibit cognitive physical and behavioral changes that affect their ability to go about their activities of daily living without assistance. Important among those changes is the fact that their ability to create and store new memories or to retrieve old memories becomes more impaired as dementia progresses.
Dementia has varying symptoms, depending on which type of dementia a person has. Some symptoms are common to multiple forms of dementia, while others are quite specific. Over all, dementia patients often have difficulties with many of the following symptoms:
A 2006 study by researcher Eric B. Larson, MD discovered that the earliest sign of dementia are physical. In testing 319 patients over a six-year period for ambulating, balance while upright, hand grip, and time needed to stand from a seated position, those who scored less than 10 out of a possible 16 points were far more likely to develop dementia. Other physical signs of dementia are a gait with shorter or unsteady steps, often with one side weaker than the other, numbness in extremities, inability to combine muscle movements, and jumbled speech.
Short-term memory problems include:
- Problems recalling recent events
- Problems in creating new memories
- Difficulties concentrating and planning
- Organizing steps in which to complete a task such as cooking a meal
- Difficulties making decisions
- Solving problems or articulating the nature of a difficulty
This type of challenges include following conversations, difficulties recalling the proper word to identify something (known as aphasia), and early evening confusion (known as sundowning).
These skills may also be affected: patients may have difficulties estimating distances, for instance in descending a staircase, or perceiving objects in three dimensions, confusion as to the day of the week or date, and confusion about their location are also common.
Crankiness, temperament changes, agitation, lack of self-control, or roaming and becoming lost.
While there are over 100 types of dementia, the majority of them fall into four categories:
AD accounts for the majority of dementia patients. Between sixty and eighty percent of newly diagnosed dementias are Alzheimer’s, a disease that causes irreversible damage to brain cells.
In the United States, there were over five million patients in 2015, and new patients develop the disease every sixty-seven seconds. As brain chemistry changes, bewilderment and unusual temperament variations are noticed in patients with Alzheimer’s. Eventually, they have difficulty speaking and are unable to walk. People over 65 are most prone to Alzheimer’s disease. Early Onset Alzheimer’s is less common, occurring in less that ten percent of new diagnoses; these patients are generally in their 40s and 50s. Unfortunately, this form of the disease is particularly aggressive.
This is due to vascular problems such as stroke, uncontrolled high blood pressure, head traumas, and injuries that lead to brain bleeds. It is the next most common form of dementia, after Alzheimer’s, and the culprit is impaired blood circulation in the brain.
Vascular dementia occurs as people age, or following a stroke. In addition, patients who suffer with later-stage heart disease are more susceptible to vascular dementia.
Symptoms may appear gradually or rapidly, depending on the underlying cause. Misunderstandings and confusion about time and place are common early signs. As dementia progresses, people struggle to finish chores with now limited attention spans. Eyesight issues and hallucinations are also associated with vascular dementia.
The third and a rarer form of dementia is Lewy Body Dementia, which is characterized by sleep loss, memory problems, slowed gait, imbalance problems, and hallucinations.
Lewy Body dementia is less common, with currently 1.3 million patients in the United States. In Lewy Body dementia, deposits of protein on nerve cells are the offender; these result in breaks in the chemical signals to the brain.
Recall ability along with place and time orientation are impaired; hallucinations and sleep disturbances—napping during the day and wakefulness at night—are common. They might also experience syncope, or lose their way in the grocery store or other places that were once familiar. Dementia with Lewy Bodies can appear like other illnesses such as Parkinson’s and Alzheimer’s. Peripheral weakness, quivering hands, and ambulatory difficulties are common.
The fourth most common dementia is Frontotemporal Dementia, which is characterized by changes in personality and behavior, language problems such as aphasia, using gestures in place of words, and incomplete or vague sentences. Patients often in their 40s are shocked when diagnosed with Frontotemporal Dementia. Its causes are as yet unknown, although there is commonly a genetic connection. A mutation in genes GRN, MAPT, or C9ORF72 has been found in numerous patients with Frontotemporal Dementia, which seem to primarily affect the nerve cells at the frontal and side regions of the brain.
Currently, Frontotemporal Dementia affects 40,000 to 60,000 Americans yearly, although actual numbers may be higher due to misdiagnosis.
Patients can be diagnosed with Mixed Dementia, such as having both Alzheimer’s and Vascular Dementia.
In addition, other diseases of the brain can eventually lead to dementia. These include Creutzfeldt-Jakob Disease, Parkinson’s, Normal Pressure Hydrocephalus, Huntington’s Disease, Wernicke-Korsakoff Syndrome, Alcoholism, and Pick’s Disease.
Senile Dementia vs. Old Age Dementia
Health care professionals who use the word dementia are generally referring to Alzheimer’s or vascular dementia. For caregivers and family members, it is naturally important to confirm the precise diagnosis.
“After blood tests, a thorough physical, and memory testing, Mary Frances’s mother Regina was diagnosed with vascular dementia. Because her husband of sixty plus years had recently passed away, there was some question as to how much of her dementia issues were due to depression.”
This may appear as simple forgetfulness—misplacing the checkbook, forgetting someone’s name, or going into the kitchen to get something and not remembering what that was. Is the problem dementia, or just being overtired or distracted? Aren’t most folks over 65 a little more forgetful?
In this early stage, patients are still able to live and function independently, although increased contact with family and friends, and some assistance, like weekly housecleaning services, can help. In this way, a trusted caregiver can monitor the patient’s ability to cope with mild dementia.
In those stages, patients may still be able to live independently, although they will require more assistance with their activities of daily living. Managing finances, and assistance with dressing and bathing are commonly needed, as people with mid-stage dementia often experience more confusion, additional memory loss, sleep pattern disturbances such as sleeping during the day and restlessness at night.
This is marked by behaviors that are out of character. These include increased agitation, continual questioning, pacing, and unusual sleep patterns.
Challenges to the caregivers of people with late stage dementia include physical symptoms such as muscle weakness, weight loss, appetite suppression, and an inability to swallow. Dementia patients may no longer be able to walk, sit up, or hold their head up. Eventually, the ability to swallow, to control bladder and bowel functions, and an increased susceptibility to infections such as urinary tract infections and pneumonia take over. At this stage, around the clock care is required.
Donepezil, Rivastigmine and Galantamine are medications that boost levels of the chemical messengers that affect recall and reasoning. They are mostly used in the treatment of Alzheimer’s disease, but they have also been recommended for vascular dementia, Parkinson’s disease dementia, and Lewy body dementia.
This controls the amount of glutamate that is released into the brain. It is a chemical messenger that regulates brain tasks, including processing new information and recall. Memantine works well when taken with a cholinesterase inhibitor.
These include antidepressants, medications that assist with sleep disturbances, and anti-agitation medication to reduce nervousness and anxiety.
Occupational Therapy (O/T)
An occupational therapist can provide coping behaviors for family members, caregivers and patients. The purpose is to prevent falls and other accidents, improve behavior, and to keep a smoothly operating support system for the patient in place.
Breaking tasks down into manageable steps, and emphasizing accomplishment rather than disappointment, can be empowering for a person who is losing function and cognitive skills. Clear expectations and consistent routines also help people with dementia to live less chaotically.
Some supplements, natural remedies and herbals have proved to be beneficial for dementia patients. That said, it is best to consult with a healthcare professional about using over the counter therapies, especially in conjunction with other medications since stringent FDA testing and guidelines seldom apply to many of these supplements.
Vitamin E has been touted to slow Alzheimer’s, but the clinical evidence does not support this claim. Furthermore, too much vitamin E may put people with heart disease at a heightened risk.
On the other hand, Omega-3 fatty acids found in seafood seem to lower the risks of developing dementia. Eating fish a few times weekly provides this protection. However, studies show that once Alzheimer’s has been diagnosed, fish and Omega-3 fatty acids have little effect.
Ginkgo has been touted for improved memory and is safe to use, but various clinical studies report conflicting results for people with dementia. Evidence that Coconut oil can be helpful in slowing the pace of progression is currently under study.
Exercise can be very helpful to both patient and caregivers. Exercises should be part of a daily routine, whether it is going for a walk or gentle leg lifts in bed. If a patient can no longer walk, pushing her or him in a wheelchair for thirty minutes in the sunshine helps everyone. It also contributes to sleeping better.
Therapies that may also help include music or pet therapy. Visits from therapy dogs that are empathic and affectionate toward the patient, or even adopting a cat or a dog have been shown to be helpful.
Aromatherapy, the use botanical oils such as rosemary and lavender oil can be calming and soothing. Massage therapy often incorporates aromatherapy in its soothing effects, and can also ease anxiety. The power of human touch is as important for newborns as it is for the elderly.
Art therapy such as painting, collage, photography, and clay with emphasis on the method and not the end product can be relaxing. Art can provide fun and joy, pieces of life that are often missing for people with dementia.
The best therapy, of course, is unconditional love and care, which can be a challenge to both family members and caregivers.
It is important to understand however that those who give must also be given to. When families and caregivers are immersed in providing around-the-clock help for an aging family member with dementia, they too, need care and pampering. Retreats, time off, holidays away from the demands and stress of dealing with serious illness cannot be underestimated.
Early Stage Dementia Evolving
Rosie P., a forty-nine-year-old daughter, now works part-time so that she can take care of her seventy-year-old mother, Helene, whose Alzheimer’s is worsening. “I am thankful I can do this, that I can keep my mother out of a nursing home for now. I have some help from a local staffing company, and my brother also helps out. Caretaking, especially a parent, is both rewarding and draining. I tell myself that when all of this is over, I will be at peace, knowing that I did all that I could for my mother; that I gave back to her in the way that she has always given to me.”
Helene was diagnosed four years ago. At first, Rosie didn’t realize what was happening. Her mom would call her at work, telling her that someone was trying to break into the house, or that there were strangers in the neighborhood who looked suspicious. Rosie had no reason not to believe her mother’s worries. She had called the police three or four times over a six-week period, sending them each time to her mother’s home on a wild goose chase.
“Ma’am,” one of the officers asked, “Has your mother been to see her doctor recently? Because we’re wondering if she’s imagining these incidents.”
That was the beginning. Her mother’s delusions have only increased, and for Rosie that is the most heartbreaking issue that she deals with. “My mother used to be such a serene person. My brother and I could always count on her to be a calming force in our lives, but now we are the ones dolling out the soothing back rubs. We have lost our mother, and she slips away a little more each day like a drumbeat, though I guess we have to be thankful that Mom’s decline has gone more slowly than many.”
Rosie P. will finish up at her mother’s around eight in the evening, after putting her mom to bed. She’ll head home for a late supper with her husband, while a local staffing company provides care three night shifts a week. Rosie was wary at first, leaving her mom at night, but with a baby monitor and their luck in finding responsible and compassionate caregivers, Rosie has slept better.
“That was one of the biggest problems for me—the sleep deprivation. At first, I wouldn’t let anyone else help me. I worried all the time, and just couldn’t seem to relax. It felt like my whole world was upended, which I guess, it was.”
Through a local support group recommended by her mom’s doctor, Rosie met other sons and daughters, and even granddaughters who were the primary caregivers of Alzheimer’s patients. They all had varied stories about coping with their caregiving responsibilities, their own families, and now an ill and aging family member. Rest and sleep and simply getting out from under the cloud of worry and anxiety were common problems.
Group members suggested creating a comfortable and inviting sleeping space. From there, other strategies were suggested: establish bedtime routines, take a daily walk in the sunshine, reduce electronic use a couple hours before bed—turn off the television and the computer, and when the worries creep in, decide to let them wait until the following day.
With these steps and others, Rosie has learned to manage her responsibilities to everyone around her, while at the same time, taking good care of herself, and on most nights, getting at least seven hours of restful sleep. “My days are much better, despite the sometimes overwhelming care my mother requires. I’m happier and far more at peace with this road we’re on . . .”