Management and Care Systems in Alzheimer's Disease/Dementia

Introduction
With increasing age, the body undergoes an aging process including the brain. The brain will
experience changes in intellectual function in the form of difficulty recalling, reduced ability to
make decisions and act (slower). Symptoms of decreased brain function due to old age are still
physiological/natural ("normal aging brain").
Some of the elderly will experience dementia or senility. According to a 2000 report, it was
estimated that 18 million people had dementia and about two-thirds of the 12 million had
Alzheimer's disease. Although there are few studies on the prevalence of dementia in developing
countries, it is estimated that the prevalence ratio is the same as research conducted in developed
countries, namely 3% of the elderly over 60 years (World Alzheimer's Day Bulletin, September
21, 1997).
Elderly who experience dementia (senile) is not a natural thing (normal), but it is a disorder in
which brain cells are damaged and are progressive. Elderly people over 65 years of age are at
high risk of developing dementia and this does not depend on nation, ethnicity, culture, and
economic status. Common symptoms of dementia include impaired memory (memory), impaired
behavior, and reduced ability to function in daily life. If these symptoms are not treated
immediately, the symptoms will quickly worsen.
When is a person said to have dementia?
People are said to have dementia or senility if they show three or more of the symptoms in the
form of disturbances in: attention, memory, place and time orientation, construction skills, and
execution (such as making decisions, solving problems) without impaired consciousness. These
symptoms can be accompanied by symptoms of emotional disorders, anxiety, depression, and
aggressiveness.
Types of senility / Dementia
There are several types of dementia but the most common are two types of dementia: Multi-
Infarction Dementia caused by recurrent strokes and Alzheimer's Dementia, or a combination of
both.
Causes of Dementia
There are various causes of dementia. In the United States, the highest prevalence is Alzheimer's
disease (10% in persons over 65 years), followed by multi-infarct dementia or a combination
thereof. In Singapore, dementia prevalence in 2000 was estimated at 2.3% of the population with
6,200 cases (Alz News). The dementia in Alzheimer's disease can't be cured, but it can be slowed
down with medication.
Other causes of dementia are caused by organic factors such as vitamin deficiency, infection,
drug poisoning, head injury/trauma, depression or stroke. In this type of dementia, treatment can
be given to the cause.
Management of Dementia
Management of dementia in the form of: Giving medication and providing care
A. Giving medication
Recent studies have shown that there are certain drugs that can prevent and slow the
progression of Alzheimer's disease, such as donezepil (Aricept), high doses of vitamin E. If
there is an underlying disease of senility such as stroke or vitamin deficiency, medication for
the underlying disorder is given. If there are behavioral disorders such as anxiety, depression,
or hallucinations, sedatives and anti-depressants can be given.
B. Caregiving can be either training or care
The goals of treatment or care for dementia are:
 Improving the quality of life and dignity of people with dementia
 Optimizing existing capabilities
 Minimize difficult behavior
 Increase comfort
 Keep it safe
 Reduce stress from caregiver
 Provide satisfaction to caregivers
Memory impairment is one of the most common symptoms of dementia, which affects daily
activities, emotions and behavior of people with dementia. That is why caregivers/families
with dementia face a fairly heavy burden, which can cause emotional, physical, social and
financial stress. In general, the feelings faced by the family are anxiety, feelings of fear,
sadness, shame (if there is a behavior disorder), feelings of guilt. For this reason, care givers
need to be given information, education or training about the early symptoms that arise and
how to overcome them
The pattern of care for people with dementia can mostly be done at home by the caregiver
(spouse, family member, close friend, nurse or therapist). Apart from being carried out at
home, the pattern of care can also be carried out in day-care centers, nursing homes: short-
stay home, long-stay home, institutions such as abroad.
The provision of training and care depends on the severity of the person with dementia. For
this reason, the techniques and programs for handling each individual also need to be known
in addition to the level of severity, education, occupation, environment and hobbie.
Direct retraining
Direct retraining should already be given to people who already have mild cognitive
impairment, because these symptoms are intermediate symptoms between normal and senile.
Training methods include practical exercises that are repeated or provide strategies for how
to remember the information provided.
Perawatan
The key to managing this setback process is to focus on what people with dementia can still
do and enjoy. Efforts to reduce disability and behavior problems can help slow down further
levels of decline.
As caregivers, it is necessary to recognize the early symptoms and severity of dementia using
the Global Deterioration Scale (GDS) and Stages of Alzheimer's disease.
In SDG 4 or early symptoms of dementia/Alzheimer's disease, there have been setbacks
related to work and socialization. There are marked deficits such as the person getting lost
when going to the places he usually goes, or coworkers noticing the poor performance of the
person, or the person having difficulty finding words or names. At this level people with
dementia already need supervision.
Early symptoms of common dementia that caregivers (husband/wife, family members,
friends) need to know are:
 Difficulty remembering recent events, forgetting promises
 Disturbance in place and time orientation
 Forgot to put things or put them in the wrong place
 Forget commonly used words
 Personality changes, behavioral disorders
 Labile emotions
 Loss of initiative or motivation at work or home
 Difficulty in abstract thinking such as calculating, making decisions
Dementia due to Alzheimer's disease develops gradually and progressively
 Stage I/Initial which lasts about 2-4 years.
The main symptom of Alzheimer's disease is slow memory loss that gets worse over
time.
 Stage II/Intermediate lasts about 2-10 years.
When the patient has entered the intermediate stage, the severity of the previously felt
symptoms of Alzheimer's disease will increase. Patients who have entered this stage
require extra attention and need assistance in performing daily activities, such as bathing,
dressing, or eating.
 Stage III/End lasts about 1-3 years
After symptoms enter the final stage, people with Alzheimer's disease need full
supervision and assistance from others to carry out daily activities. Not only sufferers, the
people around them can also feel depressed.