What is dementia?
The clinical syndrome of dementia is defined as an impairment of cognitive functions manifesting in damage to long-term and short-term memory, distraction, impaired judgment, change in personality, and change in speech (aphasia). These can become serious enough to significantly interfere with work or regular social activities or relationships with others. To date, there is no known cure for the disease.
The prevalence of dementia increases significantly with age and is estimated at 30% among 85 year olds. With the increase in life expectancy, the incidence of the disease also increases, and it is one of the main health problems affecting the elderly. The most common type of dementia is Alzheimer's. This disease was first described in 1907 in an article by a German physician named Alois Alzheimer. The estimation is that in Israel, there are approximately 120,000 people suffering from Alzheimer's and other dementia-related diseases.
A person with Alzheimer's undergoes a process of loss. The ability to learn and retain information, to make sense of the world around him, to plan and to carry out decisions – are all damaged and make daily tasks increasingly more difficult. The stages of Alzheimer's disease are classified as mild, moderate, and severe, mainly according to the person’s level of functioning in their day to day activities.
A condition that manifests in memory problems. The patient has difficulty remembering details of conversations or new names, has trouble thinking of certain words, performing calculations, and solving problems. His functioning gradually declines in his ability to work, perform household chores, and engage in his hobbies. At this stage the patient is still able to function independently, maintain personal hygiene, and exercise judgment regarding his environment.
A condition where independent functioning becomes dangerous. The patient is not as aware of his surroundings and situation, he is unable to put things away, he gets lost, and has a hard time with basic actions, such as getting dressed.
A condition where the ability to perform any day to day activities is damaged and the person requires full assistance. Remembering the names of objects and family members becomes impossible, attention span is very poor, language becomes limited to a few sentences or words, and eventually the patient loses their ability to speak altogether.
Normal brain Mild dementia Severe dementia
Dementia is also characterized by psychological-behavioral symptoms such as anxiety, depressed mood, hallucinations and delusions, as well as physical aggression, agitation, wandering, and inappropriate behavior. In patients with dementia, these symptoms cause considerable suffering to the patient and impose a substantial burden on the caregivers.
Alzheimer and Dementia diagnosis
Routine diagnostic stages of the disease include ruling out other ailments and identifying memory dysfunction, as well as a Computerized Tomography (CT) scan of the brain and a Magnetic Resonance Imaging test (MRI). Both of these tests scan the structure of the brain and are used to rule out other structural damage such as tumors, strokes, and more. When damage to cognitive function is suspected, there are tests for diagnosing and assessing function. The most commonly used is the Mini-Mental test (MMSE - Mini-Mental State Examination), which is a brief questionnaire with 30 questions aimed at diagnosing the existence of dementia and tracking the patient's cognitive status throughout the disease. A final diagnosis involves an examination of brain tissue during an autopsy.
Alzheimer's disease develops slowly. The symptoms and complaints appear gradually, and several years pass from the beginning of the disease until its severe symptoms manifest, indicating the degeneration of brain tissue. However, it is very important to identify the disease in its early stages. Early detection gives the patient and his family time to plan for the advanced stages of the disease. In addition, current medication can delay the progression of the disease and is useful mainly in its early stages.
Medication for Alzheimer's Patients
There is currently no cure for the disease, but there are drugs that affect various symptoms. These treatments can preserve function or cognitive skills and delay the progression to advanced and more severe stages of the disease. Medication for Alzheimer's is divided into prophylactic treatment to stop and slow down the destructive process affecting the brain, and the treatment of clinical symptoms of the disease.
One avenue of drug research is based on the attempt to delay and neutralize the activity of substances that have been proven to be harmful to nerve tissue cells. One of the pathological manifestations characteristic of Alzheimer's disease is the presence of amyloid (insoluble protein residue) in nerve tissues. In attempts to prevent the formation of substances that are harmful to the nervous system, efforts are being made to develop a preparation that will prevent the formation of the beta-amyloid protein.
Another avenue is based on epidemiological data. A review of this data shows that the incidence of the disease among patients taking preparations containing estrogen and among patients taking anti-inflammatory drugs, is lower than expected compared to other patient populations. Hence, it is likely that these drugs have some element that “protects” from Alzheimer's disease.
However, despite extensive efforts to find a cure for the disease, medications being used have not yet proved efficacy in changing the course of the disease or slowing it down over time.
Non-medicinal treatment of cognitive and behavioral symptoms
The main cognitive symptoms experienced by Alzheimer's patients are loss of memory and speech. Today, non-medicinal treatments of cognitive symptoms focus on strengthening memory in order to maintain the patient’s independence as much as possible. The purpose of these interventions, including procedural memory training and various compensatory strategies, is to maximize and expand the cognitive and functional capabilities as much as possible.
Coping with the behavioral symptoms that accompany the disease is a major challenge for those caring for the patient. Various techniques that use proper communication, change of environment, and others, help to address this.
Various studies have found that non-medicinal interventions contribute to reducing agitation in Alzheimer's patients. These interventions include adjusting the physical and social environment, including: maintaining a structured routine that includes appropriate activities that lower the patient’s stress level, tailoring music or other sensory stimulation, exercise, reminiscence and memory recollection, strengthening the social relationships among the patients in the institution, sharing through art activities, and more. The importance and the main purpose of these non-medicinal treatments is to improve the quality of life of the patient and his family members.
Therapy with the various arts - such as movement, art, music and drama therapy -are applied to Alzheimer's patients with the primary goal of addressing the patient's emotional difficulties, strengthening preserved capabilities, and providing optimal quality of life. With the deterioration of the disease and the loss of speech, various art therapies provide alternative means of expression for Alzheimer's patients, strengthens the patient's preserved capabilities, and emphasizes the non-verbal connection between himself and his environment.