By DR MIKE NEVILLE
“If you find yourself dealing with a relative with dementia, chances are you will need help,” Phyllis Logan.
DEMENTIA. This term tends to bring a sense of dread to us all; an increasingly common condition that wreaks havoc on the sufferer and their families.
It is not really a specific illness, it is a description of a group of conditions that show a marked decline in mental activity particularly in memory and general cognitive abilities. The commonest form of dementia is Alzheimer’s disease. It is unclear exactly what causes this to occur but some form of interaction between our genetics and environment is the best we can say for the moment. There are no proven environmental causes and age seems to be the major link to the likelihood of developing the problem; as we are living longer this can explain why we see dementia more often than in the past.
Our brains are truly amazing organs with hundreds of billions of cells accounting for trillions of connections in the brain. Dementia represents complex death and destruction of these brain cells, usually beginning slowly and continuing relentlessly leaving an emptiness where a vibrant personality once stood.
There are many other forms of dementia with very different causes. Vascular dementia can occur with mini strokes caused for example by uncontrolled hypertension; it accounts for about ten per cent of cases and can often be diagnosed by imaging techniques.
Dementia with Lewy bodies can occur on its own or with Alzheimer’s disease. It has similar memory difficulties but is associated with sleep disturbances, visual hallucinations, tremors and difficulties walking. This form of dementia has similarities to the dementia sometimes seen in Parkinson’s disease.
Frontotemporal dementia as the name suggests affects the frontal and temporal lobes of the brain; this creates severe personality changes and speech difficulties. It tends to start at a slightly younger age and used to be called Pick’s disease named after Arnold Pick a professor of psychiatry in Prague.
Creutzfelt Jacob disease is a rare fatal brain disease caused by a malfunctioning prion that rapidly destroys the brain, it cannot be transmitted from person to person but the nerve tissue is infectious and could potentially be transmitted by use of surgical instruments.
It gained notoriety in the eighties when there was an outbreak of “mad cow disease” in the United Kingdom; the use of brains of dead cows in animal feed was blamed and whilst spread does not seem to occur by eating beef, the ingestion of brain or spinal cord tissue could cause the human variant Creutzfelt Jacob disease to occur.
Huntington’s Chorea (a rare genetic disorder), hydrocephalus (caused by a buildup of fluids in the brain) and Wernicke- Korsakoff syndrome (caused by thiamine deficiency associated with alcoholism) can all show severe forms of dementia.
There does not seem to be a clear pathway to prevention and as numbers continue to rise, how can we manage dementia? The medications available are limited in that they seem to help memory in the early stages but not as the condition advances. The major personality problems are sometimes treated with major tranquillisers but these increase cardiovascular risks, so pills and potions are very limited in the ability to help.
As the illness advances at least the patient is spared some of the suffering as they become blissfully unaware of what is happening. The family however are put in an unbearable position as they see the person they love sitting in front of them but no longer there.
The management of someone with dementia often falls to the family; whilst the geriatric hospital and some homes for the aged do stellar work there are not enough beds and waiting lists and frustration is often the reality. Therefore, read as much as you can; avoid confrontation, do not take bizarre insults personally and learn to distract. I have learnt so much about the history of the Bahamas from people who do not know what they had for breakfast but tell me fascinating stories from 50 years ago.
• Dr Mike Neville is a forensic psychiatrist who has practised for more than 40 years in the Bahamas, working at the Sandilands Rehabilitation Centre, the prison and in private practice. Comments and responses to firstname.lastname@example.org.