UNIT 533

Understand the Process and Experience of Dementia

1. Understand the neurology of dementia

1.1 Describe a range of causes of dementia syndrome?
Fixed cognitive impairments are due to a single event. Traumatic brain injury
may cause generalized damage to the white matter of the brain or localized
damages. A temporary reduction in the supply of blood and oxygen to the
brain may lead to this type of dementia. A stroke or brain infection can also be
the cause of dementia. Excessive alcoholic intake results in alcoholic dementia.
Use of recreational drugs cause substance induced dementia. Once the over
use of these drugs are stopped he impairment persists but may not progress.
Dementia which begins gradually and worsens progressively over several years
is usually caused by neurodegenerative disease; that is, by conditions affecting
only or primarily the neurons of the brain and causing gradual but irreversible
loss of function of these cells. Less commonly, a non-degenerative condition
may have secondary effects on brain cells, which may or may not be reversible
if the condition is treated. The causes of dementia depend on the age at which
symptoms begin.
In the elderly population, a large majority of cases of dementia are caused by
Alzheimer’s disease, vascular dementia or both. It is rare to have dementia in
young people, Among youngsters also the major dementia observed is
Alzheimer’s disease. People who are affected by frequent head trauma, like
boxers and football players are risk of dementia. Other than alcohol, drugs and
psychiatric reasons certain genetic disorders also can cause dementia
1.2 Describe the types of memory impairment commonly experienced by
individuals with dementia?
People with Dementia lose their memory of day to day things but still
remember things from their past. As the disease gradually gets worse
individuals start to forget about their personal hygiene, personal wellbeing,
how to cook or clean in their own home, they forget how to stay safe within
their own environment. People with Dementia gradually lose their memory of
being able to function as a functioning human being, it’s as if they go back to
childlike and cannot remember anything on how to function
Alzheimer's disease
Alzheimer's disease is the most common form of dementia, accounting for up
to two-thirds of all diagnosed cases. If your dementia symptoms are the result
of Alzheimer's disease, medications can delay the onset of more debilitating
symptoms. Early diagnosis can prolong independence and is the first step
towards treatment, management, and living life fully.

10 Warning Signs of Alzheimer’s Disease

1. Memory loss sufficient to disrupt daily life – such as forgetting recently learned informati
or events, asking for the same information over and over, relying more and more on memo
members.

2. Problem-solving difficulties – An inability to follow plans, work with numbers, follow reci
bills.

3. Trouble completing familiar daily tasks – Driving to a familiar location, remembering rule
completing assignments at work.

4. Confusion over time or place – Losing track of dates and seasons, or forgetting where yo
there.

5. Difficulty understanding visual images – Trouble reading, judging distances, colors, or co

recognizing your own reflection.

6. Problems with spoken or written words – Difficulties following a conversation, finding th

calling things by the wrong name.

7. Misplacing things – Putting things in unusual places, unable to retrace steps, accusing oth

8. Poor judgment – Decline in decision making, giving away large sums of money, paying les
personal grooming.

Vascular dementia
Vascular dementia results from a series of small strokes or changes in the
brain's blood supply. Sudden onset of symptoms may be a sign of this
dementia. Vascular dementia severely impacts memory and cognitive
functioning. However, there are ways to prevent and reduce its severity.
Mixed dementia
Mixed dementia is a condition in which Alzheimer's disease and vascular
dementia occur simultaneously. The combination of the two types of dementia
most commonly occurs in people of an advanced age, often indicated by
cardiovascular disease and dementia symptoms that get worse slowly over
time.
Less common forms of dementia
Pick's Disease – Pick's disease affects personality, orientation and behavior. It
may be more common in women and occurs at an early age.
Creutzfeldt-Jakob Disease – The disease progresses rapidly along with mental
deterioration and involuntary movements.
Huntington's Disease – Huntington's is an inherited, degenerative disease. The
disease causes involuntary movement and usually begins during mid-life.
Parkinson's Dementia – Parkinson's is a progressive disorder of the central
nervous system. In later stages of Parkinson's disease, some patients develop
dementia.
Lewy Body Dementia – This disease causes symptoms similar to Alzheimer's
disease. Individuals with Lewy Body dementia experience hallucinations and
can become fearful.

1.3 Explain the way that individuals process information with reference to
the abilities and limitations of individuals with dementia?
People with dementia often confuse the generations, mistaking their wife for
their mother, for example
This may be very distressing for their family members, but it’s a natural aspect
of their memory loss. The person with dementia may be trying to interpret a
world that no longer makes sense to them because their brain is processing
information incorrectly. Sometimes the person with dementia and those
around them will misinterpret each other’s attempts at communication. These
misunderstandings can be difficult, and may require some support. Difficulties
with communication can be upsetting and cause confusion and can lead to
aggression.
1.4 Explain how other factors can cause changes in an individual’s condition
that may not be attributable to dementia?
Other Factors can cause changes in an individual’s condition, such things like
change of diet or medication, change of habitat or area. Change of
surroundings within their own home. Changes in their day to day health,
changes of people, meaning changes of carers on a regular basis, therefore not
being consistent.
1.5 Explain why the abilities and needs of an individual with dementia may
fluctuate?
The needs of an individual with dementia may fluctuate because of a number
of factors.
The main cause of dementia causing an increased fluctuation is as the
condition progressives their capabilities and capacity of understanding will
decline over time. Other causes are that the individual may be experiencing
difficulties with understanding their nights and days, this leads to the person
becoming fatigued during the day due to not sleeping properly. This fatigue
levels can effect there cognitive abilities, social skills , coordination and
become more uncoordinated with tasks. The individual with dementia may
receive care from a care provider who does not maintain a good standard of
continuity with their staff. This is a very important aspect to a person with this
condition as they must become familiar with the people who care for them to
gain trust and familiarity with routines such as personal care and medication.
Poor staff training and risk managements strategies, care plans and guidelines
not been put in place so all support workers are working differently causing the
individual to become easily confused as no structured routines are in place, As
there condition deteriorates they will become less in control of their toilet
habits, requiring personal care support and incontinence aids.
This can cause fluctuations in the person’s behaviour as perhaps they are
frustrated that they can no longer take care of their personal needs. When
soiled the person is uncomfortable requiring assistance, this can cause
understandable distress and negative behaviours displayed. Communication
could be not structured correctly for the person who causes confusion and lack
of understanding as they are unable to comprehend what is expected of them.
Infections, change of medication, change of environment, pain and stress. They
are also areas that cause an individual with dementia to show signs of their
mobility, social skills, understanding and interaction levels to decrease and
fluctuate. And lastly are they experiencing a type of abuse from someone
around them, physical, mental, institutional, sexual, financial, neglect, verbal
and they are not being able to communicate this to report it.
2. Understand the impact of recognition and diagnosis of dementia
2.1 Describe the impact of early diagnosis and follow up to diagnosis?
Early diagnosis enables a person with dementia and their family to receive help
in understanding and adjusting to the diagnosis and to prepare for the future
in an appropriate way. This might include making legal and financial
arrangements, changes to living arrangements, and finding out about aids and
services that will enhance quality of life for people with dementia and their
family and friends. Early diagnosis can allow the individual to have an active
role in decision making and planning for the future while families can educate
themselves about the disease and learn effective ways of interacting with the
person with dementia.
Changes in memory and thinking ability can be very worrying. Symptoms of
dementia can be caused by several different diseases and conditions, some of
which are treatable and reversible, including infections, depression,
medication side-effects or nutritional deficiencies. The sooner the cause of
dementia symptoms is identified, the sooner treatment can begin. Asking a
doctor to check any symptoms and to identify the cause of symptoms can bring
relief to people and their families. There is evidence that the currently
available medications for Alzheimer’s disease may be more beneficial if given
early in the disease process. These medications can help to maintain daily
function and quality of life as well as stabilise cognitive decline in some people;
however, they do not help everyone and they are not a cure. Early diagnosis
allows for prompt access to medications and medical attention. Receiving a
diagnosis can also help in the management of other symptoms which may
accompany the early stage of dementia, such as depression or irritability.
Also reviewing management of other medical conditions is critical, as memory
problems may interfere with a person remembering to take important
medications such as for diabetes, heart disease or high blood pressure
2.2 Explain the importance of recording possible signs or symptoms of
dementia in an individual in line with agreed ways of working?
The health and well-being of a person should be monitored on a regular basis
to ensure any resulting needs can be actioned without delay. When monitoring
somebody’s condition, it is important to record any findings in line with your
organisation’s policies and procedures. When supporting somebody with
dementia, it may be of benefit to involve the family.
As a family member, they may not see the person as much as the support
worker does and therefore they can help to give you a better picture of the
person and their needs. The diary that the support worker compiles could help
them and you to identify changes in the person that may be otherwise missed.
The diary could also aid in monitoring any current interventions and the
resulting benefits to the person deteriorating. The service user’s GP or
neurologist may benefit from the information recorded in altering any
medications or treatment the person receives. The following areas are those
which it is important to monitor and record is the person, as these will show
what changes have occurred and over what period:
• memory
• behaviour
•personality
•ability to cope with daily living skills
•care-giving strategies – have they worked?
•activities the person enjoys
•any medications they have taken that day (including prescriptions, over-the-
counter and herbal remedies) with details of medication name, dosage, and
when and how many taken daily.
2.3 Explain the process of reporting possible signs of dementia within agreed
ways of working
Any possible sign of dementia must be recorded in the Care Plan and must be
reported to the person in charge to make sure they are aware of the
individual’s change of condition. This will trigger an alert signal and the patient
will be closer monitored by every one of the members of the staff to find if the
signal was random or does exist a pattern in his behaviour. This will be
recorded in Observation Charts and all the information gathered in a specific
amount of time will be reported to the GP to seek further advice.
2.4 Describe the possible impact of receiving a diagnosis of dementia on: the
individual their family and friends
The impact of receiving a diagnosis of dementia is huge on the individual and
on the people around him as well, because this will involve a new life style for
all of them and they need to prepare for the outcome of the diagnostic.

An individual with dementia has to be prepared to seek for help when he is in

need, to admit to himself that he needs help and to accept it. For this they
need to be carefully advised by professionals to help them to understand that
at one moment they will not be able to do most of the common tasks that
usually are doing by themselves and to accept the help that others can give
him. This diagnosis needs to be taken serious and they need to plan ahead in
the future what will happen with them and who will be their legal
representative.

The family and friends of someone diagnosed with dementia need to be

prepares as well to recognise the symptoms and to know the evolution of the
illness in order to be able to help the individual when will be needed and to
understand that all the reactions coming from him are the result of the
person’s condition.

3. Understand how dementia care must be underpinned by a person centred

approach
3.1.Compare a person-centred and a non-person-centred approach to
dementia care.
Person centred care is about caring for the person, rather than the illness. By
the time a person with dementia needs care, they’ve been stripped of a lot of
their dignity, are surrounded by strangers, and are very confused by the world
around them, which can lead to problem behaviour. Person-centred caring is
about maintaining the persons dignity. It’s about learning what things the
patient responds well to, and treating them like a human being, rather than
just an oversized toddler.

A non-person centred approach is about dealing with the illness and treats the
individual like an object considering that all the individuals react the same to
the same stimulus. This way of dealing with dementia not only that is
disrespectful for the person’s dignity but is not helping to slow down the
evolution that the condition is having for the individual.
Every person should be treated as an individual. Even they are members of the
a group with things in common they still are individuals with separate needs,
likes and dislikes.
3.2 Describe a range of different techniques that can be used to meet the
fluctuating abilities and needs of the individual with dementia
People with dementia have their abilities and needs is a continuous change.
Sometimes they can feed themselves when other times they cannot figure out
how to do it, even if the hunger feeling is present. A good observation by the
staff members of his behaviour and recording regular in the Care Plan about all
the small changes can help the person to be spotted when is in need and to
give him the necessary aid to accomplish the task they need to do (help them
eating when needed, help dressing, etc.)
3.3 Describe how myths and stereotypes related to dementia may affect the
individual and their carers
Around people with dementia are lots of stereotypes, especially in a closed
environment like a care home. Supposing that all the individuals need help
when dressing or eating and doing the task for them is restricting their
independence and can accelerate the decrease of the cognitive and motor
skills in a dramatic way. The individual needs to be assessed at the time when
is doing something and only when is needed the carer should intervene to help
them. This will improve their life and will reduce the risk of making their
condition worse. In the same time this helps the carers to be more relaxed in
their work and to focus more on the important details which otherwise will be
ignored.
3.4 Describe ways in which individuals and carers can be supported to over
One of the fears people with declining memory loss often think of is that they
will be vulnerable to abuse either from their family or careers. Ill-treatment of
people with dementia can have a lasting effect on them.
People with dementia can display certain behaviour deemed inappropriate and
unacceptable, such as shouting, excessive screaming, insultive and
inappropriate touching. Such behaviours should be seen as a result of the
person’s conditions and handled in an empathetic and polite manner.
Shouting at a dementia patient just because they are screaming can cause
further distress and confusing them. Not paying attention to them when they
make a request can make them feel like a burden to the system and their
careers, thus preventing them from willing to use the service the way they
should.
A person with dementia may simply forget to go to the toilet, or may forget
where the toilet is. They may also have lost the ability to tell when they need
the toilet. Careers blaming them for their incontinences can make them feel
sad and ashamed of the situation and themselves. Carers should encourage
and reassure them instead of blaming them for anything that goes wrong.
People with dementia should be encouraged to be part of their daily care
routine if they can. Just by asking the patient to help hold a towel whilst carer
pick other items can make them feel useful and helpful and part of their care.
Staff doing everything and not attempting to get help from the person can
make the person feel like a burden and useless.
All this fears can be avoided by a better understanding of the evolution of the
illness and by a continuous training with the staff.