This is Part II in a blog series about the World Health Organizations’ recent report entitled, Dementia: a public health priority, released in early April 2012. Part I was posted on April 19th on this blog site.
So what is a current definition of Dementia?
The WHO report on Dementia: a public health priority provides the following detailed narrative of what neurological science considers dementia:
“Dementia is a syndrome due to disease of the brain - usually of a chronic or progressive nature - in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgment. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation. This syndrome occurs in a large number of conditions primarily or secondarily affecting the brain.
Alzheimer’s disease is the most common form of dementia and possibly contributes to 60 -70% of cases. Other major contributors include vascular dementia, dementia with Lewy bodies, and a group of diseases that contribute to frontotemporal dementia. The boundaries between the subtypes are indistinct and mixed forms often co-exist.
Dementia affects each person in a different way, depending upon the impact of the disease and the person’s pre-morbid personality. The problems linked to dementia can be understood in three stages:
early stage - first year or two:
middle stage - second to fourth or fifth years;
late stage - fifth year and after.
These periods are given as an approximate guideline only - sometimes people may deteriorate more quickly, sometimes more slowly. It should be noted that not all persons with dementia will display all the symptoms.”
The WHO report goes on further to list the following symptoms that are associated with each of the early, middle and late stages of dementia syndrome.
Early Stage
Becoming forgetful, especially regarding things that just happened
May have some difficulty with communication, such as difficulty in finding words
Become lost in familiar places
Lose track of time, including time of day, month, season, or year
Have difficulty making decisions and handling personal finances
Have difficulty carrying out complex householding tasks
Mood and behavior:
- may become less active and motivated and loose interest in activities and hobbies
- may show mood changes, including depression or anxiety
- may react unusually angry or aggressively on occasion
Middle Stage
As the disease progresses, limitations become clearer and more restricting, an individual becomes very forgetful, especially of recent events and people’s names
Have difficulty comprehending time, date, place and events; may become lost at home as well as in the community
Have increased difficulty with communication (speech and comprehension)
Needs help with personal care: (i.e. toileting, washing, dressing)
Unable to successfully prepare food, cock, clean or shop
Unable to live alone safely without considerable support
Behavior changes may include wandering, repeated questioning, calling out, clinging, disturbed sleeping, hallucinations, (seeing or hearing things which are not there)
May display inappropriate behavior in the home or in the community (e.g. disinhibition or aggression)
Late Stage
The late stage is one of nearly total dependence and inactivity. Memory disturbances are very serious and the physical side of the disease becomes more obvious.
The person is usually unaware of time and place
Have difficulty understanding what is happening around them
Unable to recognize relatives, friends and familiar objects
Unable to eat without assistance, may have difficulty swallowing
Increasing need for assisted self-care (bathing and toileting)
May have partial or complete bladder or bowel incontinence
Change in mobility, may be unable to walk or be confined to a wheelchair or bed
Behavior changes may escalate and include aggression towards caregiver, nonverbal agitation (kicking, hitting, screaming or moaning)
Unable to find his or her way around in the home
The preceding was quite a sobering list of symptoms outlined in the 3 stages.
The purpose of this report is to raise worldwide public awareness about the scope and breadth of this disease as well as advocating greater governmental action and involvement nationally and internationally.
Final comment
The Alzheimer’s Association of America released a projected statistic this past week about Alzheimer’s (which represents up to 70% of all dementia cases) that was stunning:
the cost of dealing with Alzheimer’s disease during the next 40 years will cost 20 trillion dollars.
Dementia which includes Alzheimer’s disease is a worldwide scourge that must be stopped.
Jeff Dodson
April 24th 2012
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