Lost in oblivion

Proven content

When our loved ones begin to plunge into the abyss of oblivion, we face a really difficult problem. Dementia diseases not only disturb the functioning of the family and require taking up new responsibilities, but also destroy the relationship between the sick person and their loved ones forever. And that’s probably the hardest part of it.

For Jadwiga (62), the first serious signal that something was wrong with her mother was her 80th birthday. The whole family prepared to celebrate the round jubilee. Everything was as it should be, only … birthday girl was missing. When Jadwiga’s husband, Arek, went to get his mother-in-law, she did not let him into the apartment. She claimed that someone was sure to poison her at the party, that they were only waiting for an inheritance. The Ark’s explanation that it was not so was vain. The mother-in-law denied it.

Jadwiga was shocked: – Later I talked to my mother, she denied everything, said that she did not come for her birthday, because no one had come for her. I remember trying to explain to myself that maybe it was a result of some stress that I don’t know about. But the truth was different – I had already seen that she was less intellectually skilled, that she began to forget about various events, loses objects, has problems with association. I thought that he was simply “old” – remembers Jadwiga.

After that unfortunate birthday, Jadwiga took her mother for examination. During the tests, it turned out that Mrs. Eugenia was most likely suffering from dementia caused by progressive atherosclerosis. – Today I know that if I hadn’t ignored these early symptoms, my mother would have probably been fit for longer.

– When my father retreated into himself after the death of his mother, it seemed natural to me – says 45-year-old Wojciech. – I also experienced her death very much, but certainly not like Dad. However, over time, I noticed that my father not only does not try to continue living, but as if he was dying out. He became reticent, depressed, then he began to forget what he was doing a moment ago, he was not able to name a comb, a cup, a refrigerator, it happened that he spoke straightforwardly. I knew it wasn’t normal. I went with my father to a neurologist. After a long conversation and research, he made a diagnosis: pseudodementia with a depressive background – says Wojciech. As he looked on the internet to find out more about Dad’s illness, a stone fell from his heart. – It turned out that the drugs that dad was given should lead him out of depression, and these other symptoms were related to depression. Indeed, there has been an improvement, today Wojciech’s father enjoys good intellectual health, and he himself has the feeling that he has regained his father.

Atherosclerosis or depression are not the only causes of the so-called dementia syndrome. Dementia is a condition that almost everyone is afraid of. The elderly, noticing the first symptoms at home, are afraid of being surprised, addicted to third parties, and finally – living in a closed facility. The younger ones worry about what their life will be like if any of their immediate family members becomes ill. However, dementia, although it is irreversible in 80-90% of cases, can be inhibited, and even if this is not possible, it is possible to learn to live with the affected person without harming yourself and other family members.

Further and further into the past

Dementia (Latin dementi – without mind) is a group of symptoms of various causes, the main of which is the gradual loss of memory. The patient develops a general disturbance of mental functions, incl. abstract thinking skills, speaking, reading, counting skills, criticism impairment, personality changes – suspicion, aggression, emotions inadequate to the situation, while maintaining awareness. This means that a patient suffering from this type of disorder is aware – at least in the earlier stages of the disease – of his problems and, which is common especially in intelligent and adaptable people, hides dementia. This is dangerous because the later dementia is discovered, the less medicine can cope with the speed of its development.

Trouble with memory, the main symptom of dementia, is not sudden. The most recent memory records will disappear first. The sick person perfectly remembers the distant past, but forgets what he did a moment ago. The present becomes hostile to him, causes anxiety and discomfort. As the disease progresses, the destruction of memory records becomes more and more serious, eventually erasing information used to cope with even the simplest of life situations, such as preparing a meal, getting dressed, washing. The primary defense mechanism in dementia is denial of one’s handicap.

Various reasons

Dementia can take different forms depending on the background. The cause of the so-called true dementia are most often (in about 50% of cases) involutional (age) changes, in 30% atherosclerotic changes, in 15% a combination of degenerative changes and chronic ischemia. Unfortunately, these processes are irreversible and progress over time.

The same factors can also cause reversible dementia. Since the dementia process may be reversed in 10-20% of cases, it is extremely important to make a proper diagnosis. – Premature recognition of dementia as a permanent process is a serious mistake – says Dr. Małgorzata Nowosielska, geriatrician from the MediCenter Medical Center in Warsaw. – This is especially important in the elderly in whom, for example, acute psychoorganic syndrome (i.e. dementia) may be a symptom of an inflammatory process in the body. If we cure inflammation, we have a chance to eliminate, or at least reduce, the symptoms of dementia. Therefore, it should be emphasized that the exclusion of somatic causes of memory disorders is important for the treatment process – emphasizes Dr. Nowosielska.

Reversible dementia may be caused by a decrease in the stroke volume of the heart caused by myocardial infarction or arrhythmias, anemia, water and electrolyte disturbance, hypothyroidism, inflammation, hypoglycaemia, vitamin B12 deficiency, folic acid, as well as taking certain medications, e.g. hypotensive, hypnotic , ataractics and hypoglycemic drugs.

Not only tablets

Unfortunately, there is still no drug that can reverse dementia or stop it completely. However, in the first stage of the disease, drugs can be used to delay the transition to deep dementia (see box on treatment of Alzheimer’s disease), and symptomatic treatment of sleep disorders, agitation, anxiety, hallucinations, delusions and depression is also used simultaneously. In addition to pharmacological preparations, other types of treatment are also used.

– Excellent non-pharmacological means here are occupational therapies, e.g. needlework or DIY for men, music therapy, conversations, reading books, visiting museums, gardening, walking outdoors – but necessarily in silence and among greenery – advises Dr. Maria Zubrzycka, psychiatrist , head of the Ward in Rudziszki, branch of the Psychiatric Hospital in Węgorzewo. – However, it should be remembered that a person suffering from dementia is not able to learn anything anymore, so it is not allowed to choose activities for him that he did not know before, e.g. enrolling in a dance class where arrangements are practiced. I regret to see that family members of people with dementia most often just turn on the TV without giving the person a choice of what to watch, and the sick person stares at the screen for hours on end – this is not a good treatment option. He will certainly do better to the sick and to us if we just take him for a walk.

You should also pay close attention to the patient’s diet. Adjust it to the accompanying diseases, e.g. diabetes or hypertension. If necessary, additional doses of vitamins and minerals can be provided to the patient. – Diet supplementation, of course, will not hurt, but this form of supporting the body should not be overestimated – says Dr. Małgorzata Nowosielska. While dietary supplements can help in the earliest stages of dementia, even in the early stages, you can’t count on stopping symptoms. Of course, it’s a good idea to take care of older family members by buying them vitamin and mineral kits, as they often do not eat properly and therefore have nutrient deficiencies that, among other things, can also cause symptoms of dementia. An example may be a deficiency of folic acid, vitamin B12, iron. However, miracles should not be expected with this type of therapy, emphasizes Dr. Nowosielska.

Treatment of the dementia syndrome involves the cooperation of specialists from various fields. The coordinating role should be played by a geriatrician, family doctor or internist, but must use the knowledge of psychiatrists and psychologists. The latter should conduct therapy that supports the patient’s family and caregivers.

The role of a specialist

As Dr. Zubrzycka emphasizes, family members of people with dementia should not and cannot be left alone with the problem, especially since patients can be very agitated and behave unpleasantly (suspicion, irritation, sarcasm, obsessive

territorialism) or even aggressively. If the patient refuses to see a doctor, a psychiatrist’s home visit can be booked. The doctor will not only conduct an interview, conduct tests and prescribe appropriate treatment, but also tell caregivers how to deal with the patient in order to eliminate attacks of aggression. For further help, it is also worth contacting the nearest family support center or association or foundation for people caring for such patients (see box: Here you will find help).

Family support centers also have psychologists on duty to help caregivers of people with dementia. Their knowledge should be used, because if the caregiver is unprepared for this role, his relationship with the patient may turn into mutual psychological mutilation. – The most important thing to remember is that regardless of the cause of the organic changes in the brain, a person suffering from dementia is primarily a sick person – says Wiesław Lipski, a family therapist from the “Stu dla Rodzina” Association. – This means that the abnormal functioning is largely independent of the patient, but also that due to the disease, he may not be able to use the possibilities he has, even at a given time. The point is that the relationship of the caregiver with the elderly person does not turn into a war because of the senseless expectations of the former.

Legal troubles

If a sick family member acts in an irrational manner, e.g. suddenly declares that he has transferred the house to a neighbor, or becomes a threat to himself or others, we can, as his closest relatives, apply to the court for his partial or total incapacitation. – Each of these two types of incapacitation is decided by the court, taking into account the opinion of expert doctors – says lawyer Natalia Grzędzińska from Kochański, Rąpała, Zięba i Partnerzy sp.j. – If a sick person is partially incapacitated, a probation officer is assigned to him, e.g. a member of his immediate family. In the case of this type of incapacitation, the patient may perform simple life activities without anyone’s consent (e.g. grocery shopping), but cannot dispose of his property without the consent of the probation officer (e.g. sell real estate, buy a car). In the event of a ruling on total incapacitation, the sick person is assigned a guardian and may not perform any activities without his consent, even in minor everyday matters – adds Natalia Grzędzińska.

It should be noted that incapacitation is an extraordinary measure, adjudicated primarily in the interest of the incapacitated person, only in the cases specified in the Act (i.e. when due to mental illness, mental retardation or other mental disorders, in particular drunkenness or drug addiction, the person is unable to direct his / her behavior or needs help in deciding his / her affairs).

If it turns out that a person with mental disorders has already made, for example, an unfavorable transaction, then – after the ruling of incapacitation – the probation officer or guardian may use the provisions on the so-called defects in legal acts, in this case caused by mental disorders. If, after hearing the experts, the court finds that the incapacitated person acted in the absence of awareness, the given legal act will be invalidated. Before the ruling of legal incapacitation, only the parties to a given contract will be able to apply for its annulment. As Natalia Grzędzińska emphasizes, such cases may end up in either three or four hearings – in the case when a person with dementia passively submits to the development of events – or lasts for years, if in a flash of awareness she hired a lawyer or someone helped her, e.g. that neighbor to whom the house was transcribed.

It is also worth knowing that if the patient’s behavior threatens his or other people’s safety (e.g. he turns on the gas taps and forgets to light the fire), you can even detain him in a social welfare institution or a psychiatric hospital without his consent. However, Dr. Zubrzycka reminds that a psychiatric hospital is a last resort, because it is a less safe place for the patient than a social care facility. In a hospital, a sick person may come into contact with agitated patients who, for example, may cause him to fall or injure him. However, if a sick person does not pose a threat, it is worth trying to stay in a familiar environment for as long as possible and have the greatest sense of independence, because this will delay the development of the disease.

Difficult diagnosis

Is it Alzheimer’s disease?

Alzheimer’s disease is one type of dementia, but it should not be confused with what is known as dementia. senile dementia, which develops as a result of changes related to the aging of the body. This disease manifests itself much earlier – usually in the pre-retirement age. While it is possible to make a probable diagnosis, it cannot be determined with certainty until the patient dies, based on the changes found in his brain.

A growing body of scientific evidence shows that increased activity, both physical and mental, can protect against this disease. Researchers from the University of Illinois found that people who exercised regularly several times a week were easier to concentrate and pick up on new information. Jogging, cycling, all exercises, especially outdoors, improve blood supply and oxygenate the brain. However, we must not forget about exercising the mind as well. So it is important to perform tasks that absorb memory, numeracy, logical thinking and reading. Specially designed exercises and computer programs can be helpful in this.

When Alzheimer’s dementia develops, two types of drug therapy are used, preferably combined. While at the beginning, we can use lecithin supplementation (e.g. buerlecithin), in advanced cases, it is necessary to try to inhibit the development of the disease. Drugs that slow the course of Alzheimer’s disease are cholinesterase inhibitors. The two most popular drugs of this type in Poland are donepezil and rivastigmine. Rivastigmine appears to be more effective, especially in the later (though still relatively early) stages of the disease, and its disadvantages have recently been largely removed when it was introduced as patches that were applied once a day to areas where the patient cannot remove them ( e.g. on the back). Bypassing the gastrointestinal tract and ensuring a steady blood level (skin absorption is slow but steady) has resulted in the drug losing many of its unwanted side effects.

The second tactic is to combat the disturbance of perception and awareness in Alzheimer’s disease caused by information noise. The combination of rivastigmine and memantine currently appears to be the most effective method of slowing the progression of Alzheimer’s disease. New hopes are also raised by the development of genetic engineering and microsurgery.

Text: Maja Denisiuk

Consultation: dr Małgorzata Nowosielska, geriatrician, MediCenter, Warsaw

Source: Let’s live longer