Wednesday, 16 January 2019

Care Partner Wednesday--Under the Umbrella


Picture an umbrella.

It's black and appears that it could provide shelter to a small village. This umbrella is called dementia.

If you hear that someone has cancer, one of your first questions is going to be, "What kind?" We understand that there is a myriad of different kinds of cancer, and each one affects the body differently. They have a different prognosis, different treatments and affect people in unique ways.

So with dementia. Dementia is an umbrella term. Under the umbrella live many different diseases. It's complicated, because there are so many, and each has aspects that are a little different from the others. As Dr. Bill Thomas says, if you've met one person with dementia, you've met one person with dementia. A diagnosis is a start, but factors like personality, medications, other health issues and environment can make an impact on how the disease affects each person. We're not trying to put people in diagnostic boxes, but rather use the diagnosis as a starting point for understanding.

So let's look at some of the different types of dementia.

Alzheimer's Disease
If we think of the umbrella again, a large section of it would be called Alzheimer's disease, as it's by far the most common diagnosis. Alzheimer's is progressive. Although someone with the disease may have a day where they are exceptionally cognitively alert and function well, the decline in their cognitive status can be seen clearly over a period of months and certainly years. Depending on the age at diagnosis, people can live with Alzheimer's for 20 years, although eight to ten is more common. Prevalent aspects are memory loss, especially short-term memory, poor judgement, word finding difficulty, and the need for more help in the areas of hygiene, eating, dressing and all aspects of daily living.

Vascular Dementia
Although the symptoms may look the same, vascular dementia progresses differently from Alzheimer's. Its source is from a stroke or a series of small strokes called transient ischemic attacks (TIAs) or unnoticed small vessel disease. Because its progression is based on a series of "events,"  it looks like a series of downward steps. The person with vascular dementia will continue stable for a period of time and then will have an "event" which causes a change. People often recover from TIAs, but usually have more than one, and they take their toll on cognition. Each TIA has the potential to cause permanent damage to the brain. The prognosis varies greatly.

Lewy Body Dementias

I'm sorry, but whenever I hear of this, I think of a little bald guy named Louie.
"Lewy bodies are abnormal aggregates of protein that develop inside nerve cells, contributing to Parkinson's disease (PD), the Lewy body dementias (Parkinson's disease dementia and dementia with Lewy bodies) and some other disorders."1 Lewy Body Dementia (LBD) is another umbrella term for a whole group of diseases where these Lewy bodies are present. Parkinson's dementia is one of these diseases. Lewy body dementia is another.

Parkinson's Disease Dementia

Not everyone who has PD will develop dementia, but about 70% do. The combination of the motor and other challenges of PD and the mental difficulties of dementia make this especially burdensome. Some people experience hallucinations, delusions, paranoia, vivid dreams and other difficulties. Cognitive symptoms begin at least a year after the motor symptoms and usually develop gradually.

This paints a bleak picture, but I know and have known some delightful people with Parkinson's dementia. They retained their sense of humour and love of people and blessed me whenever I was with them.

Dementia with Lewy Bodies

Under the umbrella of  Lewy Body Dementias, is Dementia with Lewy Bodies. Confusing, right? Someone should have come up with a different name. LBD involves both motor and cognitive decline. LBD is the second most common dementia after Alzheimer's and a correct diagnosis is important. One reason for this is that some medications that are used to control behavioural symptoms in Alzheimer's can actually make the symptoms of LBD worse. With correct medication and treatment, someone with LBD can improve and experience a good quality of life.

Next week we'll explore several other dementias, but I would like you to go with two takeaways.

Although dementia is an umbrella term, there are many specific and different diseases under the umbrella. Correct diagnosis is important to get the kind of help you need.

I'll end with Dr. Bill Thomas' words again, "If you've met one person with dementia, you've met one person with dementia." Even though the different forms of the disease present in a unique way and people react differently, they are still people. After the diagnosis and treatment, they still need to be treated with respect, caring and love.

1. https://en.wikipedia.org/wiki/Lewy_body

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Care Partner Wednesday--Under the Umbrella

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