A Review of The Different Types of Dementia

Dementia is an umbrella term used to describe a group of disorders that includes a continuous deterioration in cognitive function, which eventually ends in relentless cognitive impairment (Alzheimer’s Society.2007). Dementia is defined by a gradual decline in areas of function including decline in memory, reasoning, communication and the abilities to carry out the daily activities of living, this view is supported by the Department of Health (2009), adding on to this individual may develop behavioural and psychological symptoms, including depression, psychosis, aggressive behaviour and wandering (Department of Health.2009)

In the work of the National Audit Office (2008), they state end stage symptoms of Dementia include physical frailty, eating and swallowing problems, weight loss, incontinence and speech difficulties (National Audit Office. 2008).

The term Dementia has been used to describe people for decades by Doctors. There are a variety of types of Dementia depending up on the symptoms presented by a person. These include Alzheimer’s, Vascular, Picks and Lewy bodies Dementia. The symptoms experienced and presented by a person tend to be gradually progressive with time.

Alzheimer’s is the most common type of Dementia. It was first described in 1906 by a German neurologist, Dr Alois Alzheimer. This type of Dementia occurs usually in old people. It often results in a loss of memory, speech, movement and the ability to think clearly/logically. Alzheimer’s is caused by abnormal deposits of proteins in the brain. The National Institute of Aging (2011) claim 'in Alzheimer’s disease the loss of brain cells leads to the brain shrinking, bundles of protein known as “Plaques” and “Tangles” gradually form in the brain, these bundles are thought to be responsible for the loss of brain cells leading to a decline in a person's mental and physical abilities, including poor memory for short-term events, loss of concentration and decision making, disorientation and loss of ability to carry out daily activities of living which can include washing and dressing, mealtimes and lack of social inhibitions'. Alzheimer’s becomes progressively worse over time. People begin to lose skills such as been able to cook meals, manage money and look after their daily health (such as bathing and shaving). A person with Alzheimer’s may once have been easily able to make their own cup of tea, but through progression of the disease may now need supervision as they may forget to put water in the Kettle before putting it on to boil.

Vascular Dementia is the second most common type of Dementia. This type of Dementia is caused when the brain is starved of oxygen. The most common cause is from a stroke. Timo (2012) claims 'Vascular Dementia is caused by a decreased blood flow to the brain which damages and eventually kills the brain cells'. The person affected can often suffer damage to specific areas of the brain, such as Coordination, Communication or memory loss. A person with this type of dementia may be able to function normally in most aspects of their daily life, but struggle with something they didn’t previously. A person may have once been very able to hold good conversations about the past but as this type of dementia gets worse the person may struggle to remember details of the past and forget important events in their life. If Vascular dementia is diagnosed early enough by a Doctor the progression of it can often be slowed down by a combination of life style changes and medication.

Picks (also known as Frontotemporal or Frontal lobe) is a less common type of dementia than the others already mentioned. This type of dementia is caused by damage and shrinking in two areas of the brain, the temporal lobe, and the frontal lobe, this can often develop in the under 65’s and is sometimes hereditary, it is estimated 20% of cases have inherited a genetic mutation from their parents. (NHS.2015) This part of the brain is responsible for things such as a person’s behaviours, emotions and language. This is caused when nerve cells in the frontal and/or temporal lobes of the brain die and the pathways connecting the change. A person suffering this type of dementia may present aggressive behaviours or out bursts that they did not historically present over small things. People supporting someone with this will often see it as been out of character for the person and can be difficult to accept and understand the changes in the suffering person.

Another type of Dementia can be caused by Dementia with Lewy bodies, small circular lumps of proteins that grow inside brain cells. In the work of Howard (2007), it is stated, it is not clear how they damage the brain but they seem to have an effect on the brain’s normal functioning. This type of dementia is less common and shares symptoms with both Alzheimer’s and Parkinson’s disease. As it shares these common symptoms it can often go wrongly diagnosed. It is named after the German scientist who first identified it in 1912, Fredrick H.Lewy. It can often affect a person’s ability with balance, coordination and eye sight. A person with this type of dementia who has previously had good eyesight may begin to experience double vision or hallucinations. The symptoms can often include stiffness and slow actions (very similar to Parkinson’s disease).

Huntington's Disease is a rare genetic condition that causes gradual brain damage, Aids and Creutzfeldt-Jakob Disease (CJD).

In addition, Dementia or type like symptoms can be caused by the following conditions: Deficiencies in Vitamins B1, B2, B3, B6 and/or B12; Syphilis; Alcohol-related Dementia; Thyroid deficiency; Depression; Normal pressure Hydrocephalus (a build-up of fluid in the brain); Brain tumours (Dementia Partners.2008);These can be treated or prevented from progressing.

A person suffering with dementia can experience many changes that will affect their daily lives depending on the type and stage of dementia that they are suffering from. Often progressive the person will suffer from a decline or loss in memory as their dementia worsens. Memory is the persons ability to store and remember information they have learnt or been given. This can present its self in many ways. Early on the person may just struggle to find the correct word in a sentence or forget where they have placed something like their shoes. However as dementia progresses that can become much more prominent, severe and dangerous. The person may go out and forget where they are or how to get home. It can also have an affect on family emotionally as well as the person may no longer recognise family members. Dementia can cause a person to behave in ways that would not be seen by people close to them as usual or normal, such as changes in behaviours. Behaviour is the way that a person acts or presents them selves. The changes in behaviours can vary throughout the course of a person’s dementia. It is not uncommon for a person with dementia to become verbally or physically aggressive over things that would not have had that affect in the past. From an outsiders point of view it can often be seen as the person is been difficult or challenging, when actually they are trying to get a message across that they no longer have the ability to explain. This could be such as boredom or they need something. A person suffering dementia may have once been a jolly morning person but now is very agitated in a morning and verbally aggressive. There could be reasons for this however as the person may have always had a cup of coffee in a morning before getting dressed but they have lost the ability to make the coffee and this has spoilt there morning routine as the no longer do thing in the order that they like, as they need support from others. A person’s ability to reason can be affected by their dementia. Reasoning is a person’s ability to think about things and process them in a sensible and logic way.

A person may seem to become stubborn around their ways of wanting things or seen as selfish and not willing to adapt plans even if they make things easier for them. This can present in many ways. A person may be a wheelchair user and suffer from pain when they are hoisted. Instead of getting dressed before breakfast they may be adamant they want to be hoisted to their chair for their breakfast in a morning and go to the dining room before been hoisted again back to their bed to get dressed and then in to their chair for the start of their day. A much easier solution that would cause them less pain may have been to have their breakfast in bed before getting dressed or getting dressed and then having their breakfast, meaning they are hoisted and caused less pain. The person may have lost the ability to reason on this and think logically about the benefits it would have to them been hoisted less times. The abilities of a person suffering with dementia often fluctuate and decrease with time. Ability is the person’s skill to be able to do something. As time progresses with dementia, the person’s ability often decreases and thing they were once able to do easily becomes much more difficult or unachievable. The person may once have been able to walk to their local supermarket and carry a bag of shopping home. When their abilities decrease they may now only be able to walk to the shop at the end of the street and may need someone to support and help them carry the bag back home. The communication of an individual can vary hugely as a person dementia worsens. Communication is the person’s ability to send and receive information by a variety of means such as speaking and writing. This is often progressively worse with time. A person may lose the ability to hold a pen and write clearly and legibly. Other way this can be affected are, the person may start to struggle to find the correct words to use in a sentence and therefore find it difficult to communicate what they what to tell others in a suitable way. The processing of information is a vital part of people’s everyday life. It can be split down in to 3 simple parts, acquisition, storage and retrieval. Acquisition is the first part of this process. This is the bit where the person gets information in to their memory system, or learns information to be remembered. If information is not collected it can not be remembered for a later date. This part is very sensitive to interference and requires attention. If a person is sat in a safe and sees a group of men walk past dressed as super hero’s for a stag do, they may at a later date remember seeing the men walk past dressed up but not be able to remember what they were dressed as at the time. This is because they were not paying attention and there was interference as they were concentrating on their order coming to the table. The second part is the storage of information. This bit involves maintaining information in your memory over a period of time. The storage of memory relies on your storage capacity. It involves things like remembering your first family holiday. The third part is the retrieval of information. This part involves bringing out the information stored and using it in the now. Some of this is very easy to recall and seems to take no effort like remembering where you work, or your date of birth. Other that you may consciously be aware of the searching process to remember might be things such as remembering the street you first lived on. There are 2 types of memory short and long term memory. Short term memory can be described as working memory and is thought to be stored for around 20 seconds.

Long term memory is anything stored for longer than this and takes more conscious thought processes to retrieve the information. During dementia nerve cells in the brain gradually die this affects the person’s ability to be able to process information effectively. As these brain cells die with dementia the person may not be able to complete tasks in a structured order or process information to thing rationally about the best way to do things. As dementia has many signs and symptoms these can often be attributed to other conditions and not dementia. It is thought that people who suffer with long term depression that goes untreated are more likely to suffer with dementia in later life. As several of the symptoms of depression are similar to those affecting a person with dementia these can often be difficult to tell apart. Some of the common signs are anxiety, lack of appetite and sleeping more. Often looking or hearing small details can be the difference. Some one saying things like “I feel very lonely” or “I want to die” could lead more towards them suffering with depression then dementia. People who suffer with dementia can often end up with problems with their sight leading to misinterpretations, misidentification and illusions. Although these do not always mean the person is suffering with dementia. A person suffering from other eye conditions such as cataracts, glaucoma and muscular degeneration can present the same signs and symptoms. Urinal tract infections (UTI) can be mistaken for dementia in older people. Young people with a UTI often suffer symptoms like a painful stomach, back pain, chills or a fever. As people become older and their immune systems change these symptoms of a UTI also change. People can begin to experience side affects such as confusion, agitation or withdrawal. These are very similar to some of the signs and symptoms of dementia and therefore can be difficult to tell apart until a proper diagnosis from a doctor following tests. Long term use of drugs or medications can also have side affects on a person with present similar signs and symptoms to a person suffering from dementia. The person may lose certain bodily functions, such as bladder control or experience changes in behaviours over a period of time. Older people who have lived in the same house and environment for many years and then move house can often become confused and forget where things are in their new home. These signs of forgetfulness and disorientation are very similar to those experienced in dementia.

When a person suffers with dementia there will be a change or several changes in the person, this will depend upon the type of dementia they are diagnosed with and the stage at which their dementia is at. Each individual is unique in the changes that they will experience and present to others. It is important to get support from professionals when supporting an individual with dementia to ensure they get the help and support t the require but also to ensure the knowledge of the individual supporting the person allows them to provide person centred support and understand the changes the person is experiencing. With Alzheimer dementia the person will often start with mild symptoms and impairment to their abilities. The common impairments a person with Alzheimer’s will be affected by are remembering things, speaking (finding the right word), Thinking clearly (problem solving) and making rational decisions. People with the early onset may say a sentence with the wrong word used in it, so it does not make sense. They may not remember that they have agreed to meet a friend for coffee on Wednesday or that they have a doctor’s appointment. As the dementia becomes more progressive and worse these symptoms and abilities become worse and decrease. This type of dementia usually becomes progressively worse over a number of years. Towards the end there often becomes little in the way of speech and the person will be fully reliant on others to fulfil daily tasks. The person may only communicate through pointing or head movements towards later stages of this dementia. They will be unable to complete tasks such as maintaining their personal care and making meals, they will be reliant up on full support from family members and carers at this point. This is caused by the increased damage to the brain resulting in loss of brain cells, significant shrinkage in brain tissue and the increase in “tangles” and “Plaques” which cause brain cells to die off faster than in normal aging. Vascular dementia as discussed previously damages specific parts of the brain. As this is the case the person is likely to retain many of their abilities and will be more aware that they are in decline. Due to this a person suffering with Vascular dementia is more likely to be prone to suffering from depression. Due to this depression can often be confused with Vascular dementia as the symptoms are cross transferable in many ways.

As Vascular dementia is often the result of a stroke, leaving weakness in certain areas such as vision and speech, rehabilitation can promote some degree of recovery. Therefore the abilities of the person can vary depending on their recovery and severity of the dementia they are suffering. Dementia with Lewy bodies is often closely linked to Parkinson’s disease. People with Parkinson’s often develop this type of dementia. It mainly affects coordination and vision. As the signs and symptoms of these are very similar they can often be confused, especially in the early stages. As the person can also suffer from lucidity the person can be prone to also suffering from depression. In its early stages the abilities of the person can vary from hour to hour. In these instances the person can often be seen as been “lazy” or “difficult” due to a lack of understanding from the person supporting or from a lack of diagnosis. In one moment the person may be able to walk around their house freely but shortly afterwards the person may need to be supported using handrails. A person suffering from Pick’s dementia will often in the early stages have full memory but their personality and behaviours will change. They can lack empathy and ability to reason with other, becoming aggressive. This can make the person seem selfish. The person may be able to happily hold a conversation one moment yet become agitated and lack concentration the next. If dementia is diagnosed early it allows for future planning while the person still has capacity. It lets them have a say and express their wishes, on subjects like finances, their care and legal matters. This also opens up a range of treatments available. While there is no cure for dementia, early diagnosis can opens the door to some treatments and rehabilitation that can slow down the progression of dementia and allow the person to lead as normal a life as possible for as long as possible. The earlier the diagnosis the more support them and their families can receive in the planning, advice and guidance for the new challenges they will face. Although the person can be extremely shocked when diagnosed with dementia it will often allow them to receive the correct support and care required. Early diagnosis can often allow the person to continue to live in their own home for longer independently, without been admitted to a care home. There are a range of treatments available for someone who is diagnosed with dementia, some are drug related and some are not. These medications are called “anti-dementia drugs” and include Donepezil hydrochloride, Galantamine and Rivastigmine. These medications help increase the amount of chemicals in the brain that help health brain cells communicate. Although they do not cure dementia they can help slow down its progression. It is important that early diagnosis is made where possible so the correct care package can be put in place for the individual. This will also allow the individual to have input in to their care package and plan ahead for when their dementia becomes more severe and their care package requires increasing. Ensuring early diagnosis requires good reporting and evidence gathering. This will allow for the correct diagnosis to be made Page 7 of 11 and allow other conditions that can have similar signs and symptoms to be eliminated, such as depression, UTI and eye diseases.

There are two ways of supporting a person with dementia. The first is using a Person Centred approach. This approach was developed first in the field of dementia in the 1990’s, amongst others, by professor Tom Kitwood of the Bradford Dementia group. This approach looks at putting the person with dementia first. Meeting their needs and wisher before those of others. In this approach the person and not the dementia is put at the centre of everything that is done for the person.

The second way is to look at the dementia and the problems first and not the person behind the dementia. In this non person centred approach things will often be task orientated and not based around the individual’s needs and emotions. Some of the different way in which person centred and non person centred approaches are different are: 1. Seeing the person first and their dementia second – in a person centred approach the person would be the focal point of everything that is done, looking beyond the dementia and to the person behind it. In a non person centred approach the dementia would be seen as the problem and tasks would be completed in the quickest way regardless of the person’s wishes and emotional wellbeing.

1. Meeting psychological needs- in a person centred approach the person would be involved wherever possible, given a feeling of worth, belonging and a feeling of been loved. In a non person centred approach the person’s emotions and worth would not be at the forefront of their care. Focusing on task completing rather than the person.

3. Behaviours- in a person centred approach the person’s behaviours no matter how extreme or strange would be seen as a way of trying to communicate some thing and looked up on in a positive light. In a non person centred approach these behaviours would be seen as challenging and disruptive.

4. Understanding and promoting “personhood”- In a person centred approach the person would be treat as an individual and made to feel unique. In a non person centred approach the person would be looked at as just another person with dementia, treating them all as the same.

5. Promoting strengths and abilities- In a person centred approach the person’s choices, independence and dignity would be respected at all times. Their strengths would be focused on, used and worked towards. In a non person centred approach the choices would be made for them, their independence would be taken away and their dignity would not be respected. 6. Seeing dementia as a disability- in a person centred approach the care provided would be tailored to the person’s needs and wishes, treating each person as an individual. In a non person centred approach everyone would be treat the same and things would be done in the quickest way to complete tasks for the carer and not how the individual would be best suited and wished. When beginning working with dementia it is important that people understand the persons condition. The best way to do this is to read up on the condition. If working for a care agency, training on the specific dementia a person is working with should be provided to the carers by the company to allow the best understanding and support possible to be provided. Regular observations of practice from a line manager can be used to ensure the quality of support provided is of a high standard and consistent. Conducting regular supervisions with staff can help ally and reservations and worries the carer has. It can also help identify any changing needs of the person. Using support from other agencies to support care needs of the person is also advantageous, such as GP and Occupational therapists. Regular reviews of the person’s needs and wishes will allow the individual to have an individualised plan to meet their needs and wishes and also help to ensure a consistency of support provided. Carers should be provided with any specific training requires to meet a persons needs, for example stand aids. It can be the case that if a carer has not worked with people with dementia before they can need as much support and reassurance, especially in the early stages of working, as the person suffering from dementia.