Cultural Shifts in England/A Carer copes
Today’s society is changing. Those who are retired – the over sixty-fives, are living longer, fitter, healthier lives. They are taking a greater part in the life of the nation, stimulated by their television, radio, and music player; handling their latest wireless handheld gadget under the tutelage of their grandchildren. Unfortunately living longer gives debilitating illnesses time to take root and grow… especially fatty deposits that thicken the artery lining. One of these common illnesses is multi-infarct (number of small strokes) dementia, which damages the central nervous system (cerebral thrombosis). The present UK population is sixty-two and a half million… over sixteen percent are over sixty-five. It is believed that that will increase to twenty-three percent, by 2034. The disparity between the sexes - of those reaching one hundred, is closing. The figures for all dementia sufferers will rise proportionally - as the aging population grows. No paper on the subject can be devoid of medical terminology… any research exposes descriptions of steps, tests and effects, different, but meaning the same. I hope I have given a layman’s understanding in a way that helps interested readers, sufferers and carers.
This peripheral vascular disease – a disability described as short-term memory loss (impairment of cognitive ability), expresses itself as a mental problem. The illness is mainly age-related although can occur to younger adults. The patient experiences problems associated with: anxiety, depression, panic attacks, muscle-spasms, and convulsions. This paper is directed towards carers looking after aged citizens who have retired from work, and deals with a condition known as: 'multi-infarct' (circulatory matters) 'vascular' (blood related) 'dementia' (brain damaged). There are a number of other diseases and syndromes that can be confused with this complaint. However, a CT scan of the brain, and a number of suitable, clinical, diagnostic tests - day-to-day functionality tests, give signs and symptoms of the illness. The test results are a record of: time needed to make a decision; the concentration afforded to the task, the amount of study given, and the behaviour exhibited afterwards. These investigations give an indication as to which dementia it might be. However, it must be appreciated that early on there are no tests to make a definitive diagnosis - for other under-laying conditions may be present - only time points towards certainty. Changes in behaviour are often remarkably difficult to identify and in this instance the regression is slow.
An individual can age, without being aware that they may be susceptible to vascular dementia. All individuals have inherent weaknesses that can lay dormant, be undetected, until old age degenerates, or the person falls seriously ill. Hereditary illnesses - weaknesses, and physical abnormalities, play a part in every person’s make-up. Some individuals never suffer from vascular dementia until very late in life, others not at all, and some have the problem in middle-age. The problems, when discussing this particular dementia, are the linings of the arteries - that feed blood to the brain. In other dementias the heart and legs are affected. The arteries become coated with fatty deposits (plaques)… which build up and thicken, narrowing the vessel… and over time… harden. The hardened cholesterol, plaque deposits, crack… blood cells (platelets) gather together, forming clots - around the cracks… bits drop off become lodged and the artery becomes choked. The one time free passage of blood is now prevented from feeding the cells with oxygen and nutriments. The progression of fatty build-up in other arteries continues, sufficient to starve more cells. It is believed by neuroscientists that some brain cells can grow new neurons although the growth occurs mostly when young – and then only when receiving the optimum oxygen and nutrients. Once damaged, by blood starvation, however momentary, they die. Aging and stress cause progressive deterioration and impairment, the damaged cell structure cannot reform nor be replaced and the cortex of the brain irreparably damaged.
Function of blood
Blood is the transporter of oxygen to the body’s tissue. It receives oxygen in the lungs which is the function of erythrocytes (red blood cells). Fifty-five percent of the blood is plasma (albumin, globulin and fibrinogen) - the protein, a yellowy coloured fluid… is the medium by which the blood cells are transported round the body - consisting of just over ninety percent water… which diffuses carbon dioxide. The other forty-five percent are the blood cells (electrolytes) - sodium chlorine, potassium, manganese, and carbon irons. The controlled movement of blood (homeostasis): controls body temperature, maintains the correct balance of alkalinity and electrolytes, and carries hormones around the body. The white blood cells are to do with producing anti-bodies, dealing with bacteria, worms, histamine, serotonin, heparin – releasing enzymes; detecting and defending the body’s tissue. It is the lymphocytes within the white cell structure which produce memory cells. As a simple explanation of body needs: food is its nutriments, the liver converts this into energy, bone marrow produces blood cells, the cells: transmit, insulate, protect and nourish; the lungs oxygenates the blood, that produces water… which releases energy; blood transports the cells around the body, the heart pumps the blood, and liver cleans it. It is clear from this simple explanation that anything which restricts the flow of blood is serious.
Restriction of blood
Any action or deficiency that restricts the normal flow of blood is serious… These are some illnesses, deficiencies and congenital problems that have a particular link to vascular dementia: heart problems, high blood pressure, irregular heart beats, high cholesterol levels, strokes, hemorrhagic lesions, diabetes (insulin resistance), and damage brain’s cells. Ageing, alcohol consumption, cancer, dietary matters, sedentary life-style, and stress - that reduces neutrophils – allows bacteria to grow, all play a part in the degeneration process. Preventing the free flow of blood exacerbates underlying conditions… many individuals who suffer from a restricted blood-flow eventually experience some form of dementia.
If the flow of blood to the brain is seriously constrained the brain cells do not receive rejuvenating glucose and oxygen and start to die. This process cannot be prevented but can be slowed down. The unpreventable deterioration is observed by the persons: behavioural dysfunction, change of personality, intellectual deterioration, and memory loss. These changes are experienced by: feelings of insecurity, lacking confidence, of being unloved, threatened – not being cared for - being bypassed - left out, and not wanted. The patient lashes out verbally, accusing those nearest of being unfaithful and uncaring. The unhappy patient gives way to: sleeplessness, jealousy, becomes depressed, feels sad and lonely, starts to become disinterested in food - feels unchallenged and unrewarded… all these depressive feeling reduces self-worth; this further reduces confidence… leads to indecision… and eventually to loss of control.
There is a natural loss of memory as a normal process of aging. Dementia is one or a number of mental skills coming on top of the normal degeneration process – affecting short-term memory, concentration, speech, and logical progression. The degeneration, when is does occur, is more obvious when more difficult mental tasks are attempted. Stress, suffered from failure, further pushes the patient’s remaining confidence even lower. Lapses in memory and reasoning are followed by periods of stability… these give way to further lapses. The gradual downward spiral can be brought up short by a stroke – interruption of blood supply to specific parts of the brain, the results being sudden and permanent: paralysis, speech defect, or seizures. The damage to the vascular system is mainly due to hardening of the arteries… deposits of fatty deposits that restrict the flow of blood… an action that affects the heart (cardiovascular disease, which if blocked causes myocardial infarction - a heart attack); brain (cerebrovascular) disease, blocked arteries causes cerebral thrombosis, and legs (claudication) experience cramps, tingling, numbness, and swollen joints…
Vascular Dementia is to do with a shortage of blood to some brain cells that damage the cortex. The cause is by fatty particles momentarily blocking tiny blood vessels, called the vascular system, carry oxygen and nutriments to the brain. Without the blood’s life giving properties, even for just a few seconds, the receptor cells in the brain die, never to be activated again… the cortex is that part of the brain associated with mental ability – memory, problem solving, control, alertness and behavioural changes. There is no set progression rate for speed of regression; it depends upon which cognitive effect, or effects, are being experienced. The cause of the constriction to the vascular system can be attributed to: a damaged heart, high cholesterol and diabetes. Which of these, and it could be more than one, needs identifying, for remedial help can slow the degeneration?
Diagnosis of vascular dementia
Recognising that you have a mental problem – difficulty managing day-to-day living, sorting out your financial matters, or remembering a sequence of events – is upsetting, disturbing, and notoriously difficult to evaluate. The onset of one or other of these may extend over a long period, to the extent that you may not notice a difference, perhaps you may think it’s just something to put up with – link it to old age, and compensate by being more organized. Your change in behaviour maybe recognised by someone close who can see the difference. Whatever route taken to recognise and accept your deterioration you must do something about it.
There are a number of very good reasons why you should make an effort to find out what the problem is. First, there are chemical procedures that will improve your mental state. These will not present a problem for you to take nor will they remove any other physiological function. There are support groups, and early diagnosis will allow you to make provision for housing, day-to-day living assistance, adapting your life-style and rectifying any bad habits.
Your first immediate action
Your mental health concerns will interest your doctor, who will give you a simple question and answer functionality test. His evaluation, if your fears are correct, will suggest a diagnostic screening to make certain of his diagnosis. First though, he will ask for a urine and blood test to check for mineral deficiencies and infections. He may well offer you a low dose of a named sedative for short term relief. The radiologist will carefully compare and observe the scans, checking for imperfections - giving title to your medical condition… this will confirm some, if not all, of your doctor’s opinions. The neurologist may then give you his opinion on the observations of the radiologist - about your nervous system; a geriatrician or psychologist will advise your doctor on the amount of mental impairment using a series of mini-mental state examinations and abbreviated mental tests… Based on these tests and their scores your doctor will confirm the diagnosis and prescribe a course of antidepressants to lower anxiety, this will slow down the degeneration process, taking away some of the stress and anxiety. A psychiatric nurse will visit on a weekly or fortnightly basis to afford security and well-being.
There are two main types of vascular dementia: those caused by a stroke and a small vessel disease where the tiny arteries are partially or totally blocked. There are others where the patient has a combination of these two. Included are a number of other named types all to do with an interruption of blood to the brain. Starving blood to the brain can occur: slowly and evenly, over a relatively long period of time; in a series of intermittent step-by-step actions, or by a sudden heart attack. If the impairment has been caused by a blow to the head, the effect may not be progressive or fatal but prove to be a permanent disability. A caring sympathetic observation of the patient dressing, putting on and tying shoes, washing, flushing the toilet, and problems of incontinence, will indicate where outside help is eventually required. Evaluating these five daily tasks give The Barthel Index of a person’s functionality.
All medicines can cause side effects. Taking a new treatment should be carefully monitored by the doctor but if at all possible by the patient and carer as well… noting changes in behavior and physical condition. It is essential that both the doctor and patient discuss the benefits against possible side-effects. The main treatments - tablets or/and drops, are prescribed for depression – feeling nervous, confused, lack of motivation and apathy… panic attacks - sweating – feelings of fear, anxiety, palpitations of the heart, trembling, pins and needles in arms or head, fast shallow breathing and unnecessary worry about feelings of insecurity and agitation. Talking therapy, is as important as chemicals – directed conversation by the carer refreshes memory - stimulates, distracts, and interests, the best daily prescription… Communication is essential to promote consciousness, awareness, and positive sensations. If possible try and encourage the sufferer to jot down daily thoughts, reminders, and feelings, without laying too much emphasis on what is written. Both talking and writing therapy is wearing on the carer for any negative remarks or doubtful disclosures cause depression and sets back any confidence built up. Doing jobs in company with the carer is very beneficial. It is clear that in time the patient has to be closely overseen and a referral sought to find a home to make their safety paramount. Relatives must not be overly worried if their loved one seeks and forms an attachment with another resident. It is the job of the care home to act as chaperon for their charges - to see that the attachment does not get out of hand. The Prime Minister sets out a proactive approach for Dementia Strategy to prevent a crisis. He wishes to push forward early diagnosis for suspected sufferers. The latest treatment Acetylcholinesterase Inhibitors (Achei's) have been produced to slow down the progressive decline principally for Alzheimers but also used in some vascula dementia sufferers. There are four brands which are on the market some in tablet and patch form one given in later stages but now being considered for early treatment in conjunction with other Achei's.
Dementia: Alzheimer’s and other Dementias at your fingertips (paperback) By Harry Cayton, Nori Graham, James Warner. Class Publishing: 3rd Edition. Hodkinson, H M (1972) “Evaluation of a mental test score for assessment of mental impairment in the elderly.” Office for National Statistics: Population Estimates. Revised 2002 – 2008 – 2010. Functional Evaluation, The Barthel Index. Florence I Mahoney MD and Dorothea W Barthel BA PT. Maryland State medical Journal 1965. The Dementia Centre provided by Personal Services Society UK. The Dementia Services Development Centre, University of Sterling. Alzheimer’s Society information UK – Progression of dementia. Baddeley A D (1986) Working Memory; Oxford University Press. The Structure and Functions of Blood – Vascular System <ivy-rose.co.uk>