by C McNamara

Created on: April 25, 2008   Last Updated: December 01, 2010

Dementia is a process of deterioration in brain functions, rapidly over months  or gradually over several years. This decline is due to brain disease or damage, above what might normally be expected from the general aging process.

There are many types of dementia, including vascular dementia and frontotemporal lobar degeneration. Dementia arises through diseases affecting the brain such as Alzheimer's, Parkinson's and Huntington's, or degeneration or damage through nutritional deficiencies or substance abuse.

Dementia is often categorized into phases, from early onset through to late stage dementia. In the early phase symptoms include memory loss, confusion and a lessening of communication skills, both oral and written. In the middle phase short and long term memory becomes impaired, a person can become completely disoriented in time to the extent that they do not know what day of the week or month it is and normal day to day functioning, such as cleaning teeth or cooking, becomes traumatic. Affected persons may also begin to lose memory of family. It is a heartbreaking condition, both for the person affected and for the people who love them.

So how do we deal with dementia? There are many articles, books and websites dedicated to dementia relating to diagnosis, causes, treatment, prevention and management (see www.ALZinfo.org). The most important aspects of dealing with dementia relate to the care of the patient and the health of their carer. Quite apart from physical and medical needs, psychological needs are often overlooked. A dementia affected person goes through personal anguish, experiencing feelings of confusion and vulnerability, low self-worth and depression as they realize what is happening. This applies particularly so when they are no longer able to undertake basic cognitive tasks such as feeding themselves and bathing. It is important for carers to ensure that a person's dignity, privacy and self-worth is maximized through this tortuous time.

It is often a family member who has primary responsibility for providing care. It is at the early stages that people who go on to be primary carers experience denial, grief and confusion about what is happening. Careful management, such as support and respite, is required to ensure the health and well-being of carers, to avoid depression and exhaustion. Often the carer is the spouse or child, who is usually not medically trained to care for needs of dementia patients. Carers have their own lives, especially in the case of a child, and many experience guilt relating to their capacity to provide care. In the case of spouses their own health may be compromised, given the average age when dementia can set in, usually after age 60. The carer has to deal with ongoing grief for his loved one, while attending to the dementia patient's care and well-being. This is the most difficult aspect confronting carers; seeing their parent or spouse decline from their previous healthy capabilities.

Ultimately, we do all we can do. Armed with knowledge of the diagnosis, symptoms and management, carers will have the best possible capacity for providing care while also allowing themselves to undergo the normal human process of grief, adjustment and, finally, acceptance.

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