Signs and Symptoms of Dementia
Though there have been several advancement processes in the treatment of chronic diseases during old age, dementia remains one of the most significant old-age health-related problems and challenges (Kivipelto et al., 2018). Dementia is an old age-related mental health disorder that leads to loss of cognitive functioning, remembering, reasoning, and thinking to an extent that tends to interfere with the daily activities of old people making them dependent on caregivers and family members (Kivipelto et al., 2018). Elderly individuals suffering from dementia have difficulties in controlling their emotions and it may also lead to a change in their personality. The literature review aims at discussing some of the interventions that are used to treat the issue of dementia in old age while highlighting its signs and symptoms along with some of the barriers present in treatment interventions for dementia.
Dementia occurs due to physical changes in the brain and is considered to be a progressive disease, that is, its symptoms worsen over time. The progress of the disorder strongly depends on the underlying cause of dementia (Yunusa & El Helou 2020).
Research suggests that when elderly people suffer from the issue of memory problems especially when they find it difficult to recollect recent events then an immediate check-up for dementia should be made with the concerned clinician or expert (Yunusa & El Helou 2020). Some other signs and symptoms of the disorder include increased confusion, reduced concentration, disorganized or repetitive speech, and changes in behaviour as well as personality (Zhou et al., 2019). The signs also go on to include apathy, withdrawal or depression, finding it difficult to engage in everyday tasks, and becoming increasingly dependent on others for small activities like eating, bathing, dressing, going out, and others (Zhou et al., 2019).
It has been clear through studies and research that there is no cure for dementia, however, scientists and researchers as well as development teams working in this area, are trying to identify treatment interventions that will help in delaying the onset and slow progression of dementia among older adults (Irazoki et al., 2020). Cognitive stimulation is a non-specific exercise that focuses on cognitive along with social functioning reinforcement. Discussion, reality orientation as well as reminiscence therapy are some of the techniques of cognitive stimulation (Irazoki et al., 2020). The intervention has proved to have a positive impact on people suffering from mild to moderate dementia.
Cognitive training is another treatment intervention that is gaining wide popularity in recent decades since it aims at improving a specific aspect of cognitive functioning like memory or concentration through structured practice that is either carried out in a group or individually (Bahar et al., 2019). Cognitive rehabilitation is another intervention technique aimed at treating or coping with dementia that is considered to be an individualized intervention focusing on personal needs (Bahar et al., 2019). The emphasis of the technique is to help the older population improve their cognitive abilities that are related to their everyday performance which thereby helps in greater support and enhanced independent living having a positive impact on the self-esteem, morale, and confidence of elderly people (Yun et al., 2020).
Treatment Interventions for Dementia
Cognitive rehabilitation is considered to be one of the most effective treatments or interventions since it helps in slowing down the progression of cognitive decline in people suffering from dementia (Yun et al., 2020).
Several non-pharmacological treatments have been involved in treating and coping with the issue of dementia. Reminiscence therapy is one such approach that have been used to help people cope with their problem of dementia. It should be noted that a common symptom of dementia is short-term memory, thus the therapy focuses on keeping the long-term intact by helping elderly individuals suffering from the disorder to re-live their past and pleasurable experiences (O’Philbin et al., 2018). Thus, the therapy aims to target specific parts of the brain that stimulates parts that deal with long-term memory as well as cognition.
The therapy aims at discussing memories that have been stored and thereby stimulates them through sensory organs. Thus, the chosen intervention helps the brain to exercise itself and also helps in improving the communication skills of elderly individuals suffering from dementia (O’Philbin et al., 2018). It helps in making them feel valued and heard, improves a person’s mood and well-being, and also aims at providing them with meaningful activities.
ADL is another treatment intervention that has proved to be quite effective and beneficial for individuals suffering from the problem of dementia. ADL aims at promoting independence in personal care tasks like dressing, feeding as well as washing which thereby helps in maximizing the use of skills and participation in personal care (Mao et al., 2018). From the various research on dementia, it is quite evident that individuals suffering from the disorder suffer from the reduced physical ability to do simple and daily activities independently like eating, washing, dressing, walking, and others (Mao et al., 2018).
Thus, ADL skills training for these individuals will help in treating the dementia problem of physical dependence by effectively assessing people’s abilities, impairments as well as task performance that will help in understanding underlying physical, psychosocial along with neurological factors (Roehr et al., 2019). Here the caregiver should provide the least amount of assistance in helping individuals to complete each of their tasks. Some of the strategies of ADL might include, verbal as well as visual cues, physical guidance, partial problem-solving, and physical guidance along with demonstrations (Roehr et al., 2019).
ADL will also help the caregiver to understand the strengths and challenges of the dementia-ridden patient and thereby come up with actionable plans that will be clearly aligned to his/her strengths, preferences, and abilities that will help in offering meaning in treatment and interventions (Maresova et al., 2020).
It has been suggested by some researchers that the issue of dementia can be effectively modified by the management of risk factors. It has been said that focusing on depression as well as depressive symptoms will help in focusing on treating cognitive decline along with dementia (Rensma et al., 2018). The onset of dementia can be effectively modified by the management of potential risk factors. There is an association between depressive symptoms and the risks of dementia. Thus, treating of focusing on the treatment of depression, will act as a positive intervention for dementia (Rensma et al., 2018).
Reminiscence Therapy
For instance, antidepressants, have neuroprotective effects on humans and also protect them against the hippocampal volume loss that is directly associated with episodes of depression (Dafsari & Jessen 2020). Evidence has shown that normalizing the 5 -HT activity in depression has beneficial effects on cognition and SSRIs reduce the risk of dementia in depressed elderly individuals (Dafsari & Jessen 2020). It has been noted that long-term continued treatment with antidepressants promotes neurogenesis within the human hippocampus which thereby helps in treating or coping with the risk and symptoms of dementia (Dafsari & Jessen 2020).
One of the greatest barriers to the treatment of dementia is financial constraints that are suffered by elderly people. It should be noted that economic instability is one of the greatest social issues suffered during old age and it is due to a lack of finances that elderly people are unable to make effective and efficient use of the programs and resources that do help them to cope with their illness (Nielsen et al., 2019).
Most elderly individuals lack knowledge and education regarding dementia and are unaware of its signs and symptoms, treatment programs, and interventions that do not allow them to access health facilities (Nielsen et al., 2019). Apart from this, when health and social care providers lack knowledge, skills, and expertise in helping patients treat and cope with dementia then they are not able to provide effective and efficient treatment and interventions to their patients or clients which thereby aggravates their mental health problem (Kormelinck et al., 2021).
The lack of government funding for dementia research and institute is another barrier that is not allowing scientists and researchers to effectively do research in the area thereby preventing them from coming up with advanced technologies which would help in doing more research into dementia prevention as well treatment (Kormelinck et al., 2021).
Recommendation and Conclusion
To conclude it should be noted that when the above aspects, issues, or barriers are effectively mitigated or reduced then it will help in improving treatment for dementia and will at the same time, also allow paving the opportunity for elderly individuals to live and conduct their daily activities independently. When the above barriers are addressed then effective treatment pertaining to dementia can be effectively developed that will further help elderly individuals to cope with the signs as well as symptoms of the disease.
References
Bahar?Fuchs, A., Martyr, A., Goh, A. M., Sabates, J., & Clare, L. (2019). Cognitive training for people with mild to moderate dementia. Cochrane Database of Systematic Reviews, (3). https://doi.org/10.1002/14651858
Dafsari, F. S., & Jessen, F. (2020). Depression—an underrecognized target for prevention of dementia in Alzheimer’s disease. Translational Psychiatry, 10(1), 1-13. https://doi.org/10.1038/s41398-020-0839-1
Irazoki, E., Contreras-Somoza, L. M., Toribio-Guzmán, J. M., Jenaro-Río, C., Van der Roest, H., & Franco-Martín, M. A. (2020). Technologies for cognitive training and cognitive rehabilitation for people with mild cognitive impairment and dementia. A systematic review. Frontiers in psychology, 11, 648. https://doi.org/10.3389/fpsyg.2020.00648
Kivipelto, M., Mangialasche, F., & Ngandu, T. (2018). Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease. Nature Reviews Neurology, 14(11), 653-666. https://doi.org/10.1038/s41582-018-0070-3
Kormelinck, C. M. G., Janus, S. I., Smalbrugge, M., Gerritsen, D. L., & Zuidema, S. U. (2021). Systematic review on barriers and facilitators of complex interventions for residents with dementia in long-term care. International psychogeriatrics, 33(9), 873-889. https://doi.org/10.1017/S1041610220000034
Mao, H. F., Chang, L. H., Tsai, A. Y. J., Huang, W. N. W., Tang, L. Y., Lee, H. J., & Chiu, M. J. (2018). Diagnostic accuracy of Instrumental Activities of Daily Living for dementia in community-dwelling older adults. Age and ageing, 47(4), 551-557. https://doi.org/10.1093/ageing/afy021
Maresova, P., Hruska, J., Klimova, B., Barakovic, S., & Krejcar, O. (2020). Activities of daily living and associated costs in the most widespread neurodegenerative diseases: A systematic review. Clinical interventions in aging, 15, 1841. https://doi.org/10.2147/CIA.S264688
Nielsen, T. R., Nielsen, D. S., & Waldemar, G. (2020). Barriers to post-diagnostic care and support in minority ethnic communities: A survey of Danish primary care dementia coordinators. Dementia, 19(8), 2702-2713. https://doi.org/10.1177/1471301219853945
O’Philbin, L., Woods, B., Farrell, E. M., Spector, A. E., & Orrell, M. (2018). Reminiscence therapy for dementia: an abridged Cochrane systematic review of the evidence from randomized controlled trials. Expert review of neurotherapeutics, 18(9), 715-727. https://doi.org/10.1080/14737175.2018.1509709
Rensma, S. P., van Sloten, T. T., Launer, L. J., & Stehouwer, C. D. (2018). Cerebral small vessel disease and risk of incident stroke, dementia and depression, and all-cause mortality: a systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 90, 164-173. https://doi.org/10.1016/j.neubiorev.2018.04.003
Roehr, S., Riedel?Heller, S. G., Kaduszkiewicz, H., Wagner, M., Fuchs, A., van der Leeden, C., & Luck, T. (2019). Is function in instrumental activities of daily living a useful feature in predicting A lzheimer’s disease dementia in subjective cognitive decline?. International Journal of Geriatric Psychiatry, 34(1), 193-203. https://doi.org/10.1002/gps.5010
Yun, S. J., Kang, M. G., Yang, D., Choi, Y., Kim, H., Oh, B. M., & Seo, H. G. (2020). Cognitive training using fully immersive, enriched environment virtual reality for patients with mild cognitive impairment and mild dementia: Feasibility and usability study. JMIR Serious Games, 8(4), e18127. https://doi.org/10.2196/18127
Yunusa, I., & El Helou, M. L. (2020). The use of risperidone in behavioral and psychological symptoms of dementia: a review of pharmacology, clinical evidence, regulatory approvals, and off-label use. Frontiers in Pharmacology, 11, 596. https://doi.org/10.3389/fphar.2020.00596
Zhou, G., Liu, S., Yu, X., Zhao, X., Ma, L., & Shan, P. (2019). High prevalence of sleep disorders and behavioral and psychological symptoms of dementia in late-onset Alzheimer disease: A study in Eastern China. Medicine, 98(50). https://doi.org/10.1097/MD.0000000000018405
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