CASE STUDY ON DEMENTIA

o Mavis is an 84-year old lady, referred in the memory clinic for

assessment of memory impairment. She attends in the company
of her son and daughter-in-law.
o On the pre-clinic questionnaire her son has reported a severe
deterioration in all aspects of her cognition over the past 12
months.
o The patient herself acknowledges that there have been memory
problems, but feels it is just her short term memory that is an
issue.

o  Mavis was able to give a moderately detailed biographical

history, but struggled with details extending as far back as the
location of her wedding, and also her main jobs throughout her
life.
o After prompting from her family, she was able to supply more
information, but it was not always entirely accurate.
o Her main hobby was knitting, and it was noted that she had been
able to successfully knit a bobble hat for her great-grand child as
recently as last month, although it had taken her considerably
longer to complete than it might have done a few years
previously, and it was a comparatively basic design compared to
what she has been able to create previously.
o She has a few children living in the area, who would frequently
pop in with shopping, but there had been times when they arrived
to find that she was packed and in her coat, stating that she was
“just getting ready to go home again”.
o She had been helping occasionally with the school run, but then a
couple of weekends ago she had called up one of her sons – just
before she was due to drive over for Sunday lunch – and said that
she could not remember how to drive to his house.
o Ever since then, they had confiscated her keys to make sure she
couldn’t drive. Although she liked to read the paper every day,
she could not recall any recent major news events.  
QUESTIONS:

1. What are the key features that Mavis is suffering from

dementia?

2. What specific features of memory decline that Mavis is

presenting?

3. How do you measure the impact of memory loss on

daily life of Mavis?

4. What are the best way to get a current overview of

memory?

5. How would manage Mavis condition as a caregivier.

DEMENTIA

Dementia is the loss of cognitive functioning — thinking,

remembering, and reasoning — to such an extent that it interferes
with a person's daily life and activities. Some people with dementia
cannot control their emotions, and their personalities may change.
Dementia ranges in severity from the mildest stage, when it is just
beginning to affect a person's functioning, to the most severe stage,
when the person must depend completely on others for basic
activities of living.

Dementia is more common as people grow older (about one-third of

all people age 85 or older may have some form of dementia) but it
is not a normal part of aging. Many people live into their 90s and
beyond without any signs of dementia.

Risk Factors for Dementia

Certain physical and lifestyle factors can raise your chances of
dementia,  including:

 Age
 Dementia in your family
 Illnesses including diabetes, Down syndrome, multiple sclerosis,
heart disease, and sleep apnea
 Depression
 Smoking, heavy alcohol use, poor diet, and lack of exercise

 Brain injury
 Strokes
 Infection of the brain (for example, meningitis and syphilis)
What are the signs and symptoms of dementia?
Signs and symptoms of dementia result when once-healthy
neurons, or nerve cells, in the brain stop working, lose connections
with other brain cells, and die. While everyone loses some neurons
as they age, people with dementia experience far greater loss.
The symptoms of dementia can vary and may include:

 Experiencing memory loss, poor judgment, and confusion

 Difficulty speaking, understanding and expressing thoughts, or
reading and writing
 Wandering and getting lost in a familiar neighborhood
 Trouble handling money responsibly and paying bills
 Repeating questions
 Using unusual words to refer to familiar objects
 Taking longer to complete normal daily tasks
 Losing interest in normal daily activities or events
 Hallucinating or experiencing delusions or paranoia
 Acting impulsively
 Not caring about other people’s feelings
 Losing balance and problems with movement
People with intellectual and developmental disabilities can also
develop dementia as they age, and recognizing their symptoms can
be particularly difficult. It’s important to consider a person’s current
abilities and to monitor for changes over time that could signal
dementia.

What causes dementia?

The causes of Alzheimer’s and related dementias can vary,
depending on the types of brain changes that may be taking place.
While research has found that some changes in the brain are linked
to certain forms of dementia, in most cases, the underlying causes
are unknown. Rare genetic mutations may cause dementia in a
relatively small number of people.
Although there is no proven prevention, in general, leading a
healthy lifestyle may help reduce risk factors that have been
associated with these diseases.

How is dementia diagnosed?

To diagnose dementia, doctors first assess whether a person has
an underlying, potentially treatable, condition that may relate to
cognitive difficulties. A physical exam to measure blood pressure
and other vital signs, as well as laboratory tests of blood and other
fluids to check levels of various chemicals, hormones, and vitamins,
can help uncover or rule out possible causes of symptoms.
A review of a person’s medical and family history can provide
important clues about risk for dementia. Typical questions might
include asking about whether dementia runs in the family, how and
when symptoms began, changes in behavior and personality, and if
the person is taking certain medications that might cause or worsen
symptoms.
The following procedures also may be used to diagnose dementia:

 Cognitive and neurological tests. These tests are used to

assess thinking and physical functioning. These include
assessments of memory, problem solving, language skills, and
math skills, as well as balance, sensory response, and
reflexes.
 Brain scans. These tests can identify strokes, tumors, and
other problems that can cause dementia. Scans also identify
changes in the brain's structure and function. The most
common scans are:
o Computed tomography (CT), which uses X-rays to
produce images of the brain and other organs
o Magnetic resonance imaging (MRI), which uses magnetic
fields and radio waves to produce detailed images of
 body structures, including tissues, organs, bones, and
nerves
o Positron emission tomography (PET), which uses
radiation to provide pictures of brain activity
 Psychiatric evaluation. This evaluation will help determine if
depression or another mental health condition is causing or
contributing to a person's symptoms.
 Genetic tests. Some dementias are caused by a person’s
genes. In these cases, a genetic test can help people know if
they are at risk for dementia. It is important to talk with a
genetic counselor before and after getting tested, along with
family members and the doctor.
 Blood tests. It is now possible for doctors to order a blood test
to measure levels of beta-amyloid, a protein that accumulates
abnormally in people with Alzheimer’s. Several other blood
tests are in development. However, the availability of these
diagnostic tests for Alzheimer’s and related dementias is still
limited.
Early detection of symptoms is important, as some causes can be
treated. However, in many cases, the cause of dementia is
unknown and cannot be treated. Still, obtaining an early diagnosis
can help with managing the condition and planning ahead.

TREATMENT AND MANAGEMENT OF DEMENTIA

“There is currently no cure for dementia,” But, a variety of treatment
options can help manage symptoms, improve quality of life, and slow
the progression of disease.
Dementia treatment options
Dementia treatment often consists of a combination of lifestyle changes,
medications, therapies, and behavior and symptom management
strategies.
Lifestyle changes for vascular health
 Research suggests that there is a connection between the risk of
developing dementia and the health of your heart and blood vessels.
Taking steps to improve vascular health can lower the risk of
developing dementia, and vice versa.
“What’s good for the heart is good for the mind,” Hashmi says. As such,
he encourages dementia patients to adopt healthy lifestyle changes, like
quitting smoking, establishing a daily exercise routine, and choosing
foods from a heart-healthy diet plan like the Mediterranean diet.
Drugs for memory and cognition
Certain medications can temporarily relieve and help manage dementia
symptoms related to memory and cognitive function.

Treatment for dementia behaviors

Treatment for dementia behaviors — like mood changes, sleep
problems, and aggression — may include a combination of approaches.
 Behavior management strategies can help caregivers provide a more
structured environment, identify and avoid triggers for problematic
behaviors, and learn how to gently redirect their family member’s
attention. Doctors generally prefer to try non-drug strategies for
difficult dementia behaviors first, Hashmi says.
 Medications such as sleep aids, mood stabilizers, antidepressants, anti-
anxiety drugs, anticonvulsants, or antipsychotics may help control
symptoms in some people. However, these medications can have
serious side effects, so it’s important to discuss their safety and risks
with an expert, says Hashmi. “As geriatricians, we try to use these
medications sparingly,” he says. “They need to be matched to the
behavior. It’s not one size fits all.”
Supportive therapies for dementia
A number of rehabilitative and alternative therapies may also help
manage dementia symptoms and improve quality of life.
 Cognitive rehabilitation. This type of rehab helps people in the early
stages of dementia maintain memory and cognitive function for as long
as possible. It also teaches compensation strategies to help people with
declining cognition.
 Physical activity. Studies show that people with dementia who have a
regular, light exercise routine can better perform daily tasks, and see
improvements in mood and depression.
 Occupational therapy helps seniors with mild to moderate dementia
by teaching coping behaviors and strategies to compensate for memory
loss and cognitive decline. It can also help families make their home
safer for a loved one with dementia and provide techniques to manage
difficult behaviors.
 Music therapy. Listening to soothing music or singing songs can
reduce agitation and aggression, according to research.
 Pet therapy may reduce anxiety, agitation, irritability, depression, and
loneliness. Many memory care communities provide pet therapy or
have a pet resident, often a dog or cat. Seniors in these communities can
enjoy companionship without the responsibility of caring for a pet.
 Aromatherapy is safe and may relieve agitation. Lemon balm or
lavender oil may be applied to the skin or sprayed in the air to create a
soothing environment that promotes relaxation.
 Massage therapy. Some studies show that massage and touch therapy
can help reduce agitation and encourage people with dementia to eat.
 Art therapy is believed to help slow cognitive decline and improve
quality of life, but more studies are needed to confirm benefits for
people with dementia.
Dietary supplements for dementia
Many dietary supplements have been studied for dementia treatment,
including ginkgo biloba, vitamin B, and omega-3 fatty acids. However,
results haven’t shown significant benefits. Talk to a doctor before giving
your loved one with dementia any dietary supplements or herbal
medicine. This will help prevent side effects and interactions with other
drugs.