What is Dementia?
Services Available - Psychiatry of Old Age
Carers and Relatives
What is Dementia?
Dementia is the umbrella term used for a range of symptoms, which manifest in a decline in intellectual functioning, caused by degenerative disease of the brain. This decline in functioning can lead to a progressive deterioration in memory, intellect, judgement, language, insight and social skills. It effects the persons ability to carry out daily activities and may also effect their mood and personality. There are many different types of dementia but Alzheimer's Disease and Vascular Dementia are the most common forms. The less common forms include: Lewy Body Dementia, Fronto-temporal Lobe Dementia and Pick's Disease. The incidence and prevalence of developing dementia increases significantly with advancing years. Below the age of 60, dementia is rare and is often associated with a strong family history.
The issue of finding a cure for Dementia continues to be extensively researched. We know that pharmacological interventions can sometimes slow down the progression of certain types of dementia (but it doesn't stop the dementia) and reduce the associated challenging behaviours. In recent times much attention is being paid to attempting to understand the subjective experience of dementia focusing on a more person centred care approach, emphasising the uniqueness and personhood of the individual rather then merely honing in on the signs and symptoms of dementia. Early diagnosis is important as treatments are available that may help some of the symptoms. Early diagnosis is also important as it allows the person and their families to make plans for their future needs including legal matters such as making a will.
It is estimated that currently there are over 35,000 people with dementia in Ireland. With the population ageing, however, this means that this figure will increase significantly over the next 20 years, as ageing remains one of the single strongest risk factors for Alzheimer's Disease, (the most common form of dementia).
back to top
Alzheimer's Disease is the most common form of Dementia. As there is no straightforward test for Alzheimer's Disease, making a diagnosis can be difficult, particularly in the early stages. A diagnosis is usually made by excluding other causes, such as infection. Alzheimer's disease generally progresses through three stages: mild, moderate and severe. People experience the three stages at different rates, and there can be an overlap in symptoms from one stage to another. The early signs and symptoms of Alzheimer's Disease may vary from person to person, however, they can include increasing memory loss over time which is sometimes characterised by the inability to remember names or recall recent events, this is often the first noticeable symptom.
The ten most common symptoms include:
- Memory loss
- Difficulty in performing everyday tasks
- Changes in mood and behaviour
- Changes in personality
- Disorientation in familiar surroundings
- Problems with language
- Poor or decreased judgement
- Misplacing things regularly
- Difficulty solving problems or doing puzzles
- Loss of interest in starting projects or doing things
Vascular Dementia (Multi Infract Dementia)
Is a type of dementia caused by small or mini strokes that may be so small that they go undetected, but eventually results in a stepwise deterioration of cognitive functioning. Similar risk factors to those of cardiac disease, it is more common in men then in women and less common in people after 75 years. It may also coexist with Alzheimer's Disease.
Lewy Body Dementia
This is a type of dementia, with a range of features including symptoms similar to Parkinson's Disease such as tremor, shuffling gait, rigidity and hallucinations, especially visual. People with this type of dementia are sensitive to neuroleptics, which are anti psychotic medications.
Fronto-Temporal Dementia (FTD)
This form of dementia is a rare degenerative condition caused by damage to the frontal lobe and/or temporal parts of the brain. In early stages of the disease it differs from Alzheimer's in that memory may not be badly affected. The areas of the brain affected by FTD are control, reasoning, personality, movement, speech, language and behaviour. FTD tends to effect younger people, i.e. those under the age of 65 and personality and behavioural changes are typical characteristics of the disease.
This is an inherited form of Fronto-Temporal Dementia. It is a disease affecting the frontal and temporal lobes of the brain and onset is usually between 40 and 65 years of age. There is a gradual dissolution of language in the first two years. People are usually aware of this deficit and are adept at covering it up. Later memory deficits, personality change and disinhibited behaviours become evident. Neglect of personal hygiene, loss of insight, apathy or obsessional traits may also develop.
If you are worried that a family member may be experiencing the early symptoms of dementia, you should contact your General Practitioner (GP). The GP may refer you on to a specialist, such as a geriatrician, neurologist or a psychiatrist in the psychiatry of old age, who will conduct a full assessment to try to establish the cause of symptoms.
back to top
Psychiatry of Old Age Services
Within the Health Service Executive, Psychiatry of Old Age is responsible for those persons who have developed functional psychiatric disorders such as depression or dementia associated with behavioural or psychological problems for the first time over the age of 65 years. The service consists of a multi-disciplinary team led by a Consultant Psychiatrist in the Psychiatry of Old Age together with an Assistant Director of Nursing, Community Mental Health Nurses, para-medical and support staff. It has a full range of community and hospital facilities available. The objective of this service is to provide prompt assessment together with active treatment in the persons home, thereby causing minimal disruption to their life.
This service is a community based service. Following assessment in the persons home, a treatment plan is drawn up consisting of the involvement of Community Mental Health Nursing services and/or attendance at a Day Hospital, depending on the severity of the illness. The Day Hospital service is a key component of the service, it provides treatment of mental health problems on an individual tailored care plan basis. This service is supported by access to acute care in a specialised psychiatric unit where appropriate.
Access to the service
- Referrals to the service are by the persons General Practitioner
- By consultant for patients in general hospitals at the time of referral
Other professionals who may be involved in assessing your needs and those of your carer at home include:
- Public health nurse
- Social worker
- Occupational therapist
- Speech and language therapist
These professionals can provide advice, support and counselling.
Other support services may include support groups, home help, day care or hospital facilities, respite care in a community hospital or a nursing home.
back to top
Carers and Relatives
All people with dementia will need help from other people at some point. In most cases a family member meets this need, taking responsibility for the care and support of the person with dementia. Carers themselves often need help from others too. Family and friends are an important source of support, as are formal day-care services, home care/home support services, carer support groups and respite care.
Family and care givers often have to make major changes to their lives to care for and support a person with dementia. The first step is to learn as much as you can about the condition and to consider and make plans for the future.
Caring for a family member or friend can be emotionally draining and wearing. When so much energy is going in to caring for someone else, it is so easy to neglect your own needs. It is vital to look after your own health and well-being and maintain hobbies and interests. This can help to lessen stress and help you to cope with the daily challenges you face.
Ward of Court
If a person with substantial assets becomes incapable of managing their own affairs due to dementia, family may apply through a solicitor to have the person made a ward of court. If there is no family sometimes the HSE makes the application. A committee (one or more people, usually the family) is appointed by the Court to manage their affairs. The person then becomes a ward of court. All applications are processed through The Wards of Court Office (Telephone: +353 1 872 5555). This office publishes an explanatory booklet and approximately 30% of all applications involve people with dementia.
For more information on dementia contact the Alzheimer Society of Ireland at www.alzheimer.ie and/or the Dementia Services Information and Development Centre at www.dementia.ie for information packs, services and support.
The Alzheimer Society of Ireland
National Helpline Freephone 1800 341 341
Monday to Friday, 10am - 4pm
Dementia Services Information and Development Centre
Top Floor, Hospital 4
St. James's Hospital
Telephone: 01 416 2035
The Carers' Association
Freephone 1800 240 724
Monday to Friday, 9am - 5.30pm
HSE National Information Line
Monday to Saturday, 8am-8pm
Call Save: 1850 24 1850
Citizen's Information Centres
LoCall: 1890 777 121
Free and confidential service