Dementia is a disease that causes the loss of cognitive functioning and behavioral abilities to a degree that it affects a person's day-to-day life. This syndrome affects a person’s memory, language skills, problem-solving, self-management, and the ability to focus. Dementia mainly has an effect on older people, and the risk of dementia continues to increase as age increases. Some individuals that have dementia cannot control their emotions, and their personalities may change from time to time. Dementia ranges in severity from the mild stage, which is when it is just starting to affect a person's functioning, to the severe stage, when the person is dependent on others for basic functions of life. The impact of the disease is substantial. The impact on the individual, they lose their grip on their life. For their family members who care for a person with dementia and have to see them deal with the disease. And for society, that has this increasing group of people that need certain care and support. Individuals in general should have dementia on their radar because it affects older people and age is inevitable. This paper will focus on Dementia as a disease and the importance of early diagnosis and early intervention. Dementia refers to a group of diseases that have their onset in old age and in which there is a progressive loss of cognitive functioning that eventually affects all aspects of self-care(Gatz). Alzheimer's disease extinguishes the mind and body through a vicious progression from mental lapses, memory loss, and dementia to the final failure of the brain to support survival (Harder). Because effective treatments are sparse, preventive strategies are needed to delay the onset of dementia or reduce its incidence (Kurth & Logroscino). Dementia is a life-changing disease. It can affect an individual's life, from being completely independent to dependent. Early diagnosis and timely intervention can lead to treatment and possibly prevention of Dementia. Therefore, society as a whole should place an emphasis on early diagnosis and timely intervention of Dementia.
Dementia and the importance of early intervention and timely diagnosis should be of importance to all people. The disease affects the older population. Individuals from the ages 40-60 should be aware of the disease because they are in the prime age of getting Dementia. Individuals from the ages 20-40 should educate themselves about Dementia because it could be possible that their parents could be showing signs of the disease. A question to think about is, even with early intervention and timely diagnosis can that prevent the onslaught of Dementia?
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Before any thoughts of intervention and diagnosis, individuals should know more about the disease. Burns & Iliffe touch on in this article about what AD is, the unknown cause of it and what type of treatments can be done. AD is a chronic progressive disorder that is characterized by three groups of symptoms. The first group, which is a cognitive dysfunction, includes memory loss, language difficulties, and executive dysfunction. The second group consists of psychiatric symptoms and behavioral disturbances, like depression, hallucinations, delusions, and agitation. The third group is difficulties with performing activities of daily living. The symptoms of Alzheimer's progresses from mild symptoms of memory loss to very severe dementia.
The cause of AD is not known, but there are several risk factors that come with the disease, including age, family history, apolipoprotein E4 status, head injury, depression, hypertension, diabetes, high cholesterol, atrial fibrillation, presence of cerebral emboli, and low physical and cognitive activity. Some of the risk factors can be modifiable. Neurotic plaques and neurofibrillary tangles are the main histological features of Alzheimer's disease. And the presence of phosphorylated tau and the deposition of the insoluble protein amyloid have both been correlated with the features of dementia.
Psychosocial interventions are appropriate for dementia regardless of its cause. Non-drug interventions should be tried first, especially when symptoms are not causing distress or putting a person at risk. Therapeutic interventions for an individual that establish a good relationship with the person with dementia are key. Continuous clinical care may also be beneficial. General practitioners will have an understanding of their patients, and the work between specialists and general practitioners is essential.
The strength of this article is that it goes into depth about the different risk factors. The authors also touch on the possible treatment options for individuals with dementia. Also, Burn & Iliffe give a clear look at what AD is. A limitation of this article can be that there aren’t any concrete statistics and experimental findings to go along with how informative the article is.
Early intervention and timely diagnosis can play a part in combating this disease. Robinson, Tang, & Taylor went into depth in this article about how important timely diagnosis and early intervention are when dealing with individuals who have Dementia. Also, the several factors of diagnosing Dementia and the possible options after the diagnosis. At the beginning of this article, it focuses on why timely diagnosis is important. In other countries, there’s an introduction of a Dementia strategy which has led to more of an emphasis on earlier diagnosis, even though population-based screening is not recommended because dementia does not fulfill the criteria of a condition that is suitable for screening. With evidence from a number of large longitudinal cohort studies (Buschke, Kuslansky, & Katz), it’s showing that the prevalence of Dementia is increasing globally, so now there is a greater emphasis on prevention and risk reduction.
Dementia can be difficult when trying to diagnose due to the symptoms being similar to normal aging. The symptoms include memory loss, and a number of other symptoms, for instance, having difficulty in finding words or making decisions. What also should be considered is a person’s ability to possibly deny their symptoms in the early stages of the disease. The family could also notice difficulties in communication and personality or even mood changes in their loved ones. If there is an increase in an individual’s visits to their general practice, missed appointments, or confusion over drugs, those can also be warning signs.
An option after diagnosis could be clinically and cost-effective drugs. There is an emphasis on improving the function after neuronal damage instead of altering the underlying pathogenesis that leads to dementia. There are two classes of drugs that are currently recommended for symptomatic, which is Alzheimer’s disease and mixed, dementia. The drugs are acetylcholinesterase inhibitors donepezil, galantamine, and rivastigmine, and N-methyl-D-aspartic acid receptor antagonists like memantine. Acetylcholinesterase inhibitors are the only options that are recommended to manage mild to moderate Alzheimer’s disease and there is no evidence to say that one is more effective than another. There is a large randomized controlled trial that recently has shown that treatment with donepezil is associated with cognitive benefits in moderate to severe dementia (Prince, Bryce, & Ferri). Memantine has also been approved for individuals with moderate to severe Alzheimer’s or those individuals that have an intolerance to acetylcholinesterase inhibitors. It also has been used in mild Alzheimer’s disease however, there is little evidence for this.
Another option after diagnosis is non-drug approaches. There is growing evidence for non-drug interventions in the care of dementia, even though further research in many areas is still needed. In a large systematic review that evaluated both drug and non-drug interventions in dementia care, cognitive stimulation therapy was as clinically and cost-effective as the acetylcholinesterase inhibitors (Knapp, Iemmi, & Romeo). Reminiscence therapy is another option that is recommended in national guidelines. However, the evidence for innovative service provision like case management, where a case manager, most of the time a nurse or social worker, will act as the main care coordinator between key stakeholders, including primary and secondary care.
The strength of this article is how informative it is. The article can definitely bring to a reader’s attention how beneficial early intervention and timely diagnosis can be pertaining to someone with dementia. It gives very clear options about what an individual can do after being diagnosed with Dementia. A limitation of this article can be seen as not actually having a study or an experiment to go along with the information. However, the article is still helpful because it supports the assertion that early intervention and timely diagnosis can be beneficial when dealing with dementia.
Palmer, Backman, Winblad & Fratiglion conducted a three-year population-based cohort study in Sweden. The purpose of the study was to evaluate a three-step procedure that identifies individuals, that are in the general population, and who are in the preclinical phase of AD and Dementia. Palmer et al. (2003) used data from baseline, three, and six-year follow-up examinations in the Kungsholmen project, which was a longitudinal study of people aged 75 and older living in Sweden. The authors didn’t include 225 participants with dementia, 31 people that had a low cognitive performance, and 9 people because of their educational background or they were older than 95. The remaining 1435 individuals were used for the study population.
Palmer et al. (2003) assessed memory complaints by asking the question, 'Do you currently have any problems with your memory?' Global cognitive impairment without dementia was scored as one standard deviation below the age and education specific mean on the mini-mental state examination. There were three domains of cognitive functioning that were assessed in neuropsychological testing. They were episodic memory, verbal fluency, and visuospatial skill.
The main outcome measure at follow-up was the presence of Alzheimer's disease or dementia. They diagnosed Alzheimer's disease and dementia by using the Diagnostic and Statistical Manual of Mental Disorders. All of the survivors were examined by a physician, they had neuropsychological testing, and they were assessed by nurses. The authors then looked at the death certificates and medical records of those who had died to determine the presence of dementia. They calculated the sensitivities and specificities for dementia for each measure, and they also calculated the positive predictive values and negative predictive values, and 95% confidence intervals. Different combinations of the three measures were also investigated.
The results indicated that the three instruments were sufficiently predictive of Alzheimer's disease and dementia when they were administered separately. After the screening for memory complaints and global cognitive impairment, there were specific tests for word recall and verbal fluency and they had positive predictive values for dementia. However, only 18% of future dementia cases were identified in the preclinical phase by this three-step process. Memory complaints were the most sensitive indicator of Alzheimer's disease and, but only half the future dementia cases were reported. The authors believe that the three-step process, has a high positive predictive value for dementia, although only a small number of future cases can be identified.
There are a number of strengths in this study. One strength is that this procedure emulates what would happen in a clinical practice and the study had a high positive predictive value for Dementia. Another strength is the number of individuals that participated in this study. A limitation of this study can be seen as, in the study only a small number of future cases could be identified.
Ritchie, Carriére, Ritchie, Berr, Artero, & Ancelin had the question of, what would be the percentage of reduction in the incidence of dementia if there were potential reversible exposures that were eliminated? Ritchie et al. (2010) conducted a study to answer this question. The study took place in the south of France and Ritchie et al. (2010) recruited 1,433 people, at random, in the community who were all over the age of 65 and the mean age was 72.5. All of the participants gave written consent. The study started with a neurologist that examined all the participants at baseline and at two, four, and seven years of follow-up. In the first part of the study, a neurologist examined the participants by using a standardized interview that brought together cognitive testing to identify dementia and mild cognitive impairment. In the second part of the study, a nurse used a standardized examination to gather information on several different topics. Those topics were sociodemographic status, crystallized intelligence, nutrition, exposure to anesthesia, herpes infections, asthma, diabetes, hypertension, stroke, heart disease, drug use, hormonal replacement therapy, depressive symptoms, and blood pressure. took biological samples to assess apolipoprotein E c4 genotype and concentrations of fasting blood glucose and cholesterol
Ritchie et al.(2010) constructed Cox models to find hazard ratios and to find confounding and interaction effects for the potentially modifiable risk factors of dementia. The authors found the mean percentage population attributable fractions. These fractions were gathered with 95% confidence intervals taken from multiple sampling for a seven-year incidence of mild cognitive impairment or dementia. In the final model, Ritchie et al. (2010) found that crystallized intelligence had a population-attributable fraction of 18.1% and the 95% confidence interval was from 10.9% to 25.4%. In depression, the fraction was 10.3% and the interval was from 3.7% to 17.2%. For fruit and vegetable consumption the fraction was 6.5% and the interval was from 0.2% to 13.1%. In diabetes, the fraction was 4.9% and the interval was from 1.9% to 8.0%. And lastly, Ritchie et al.(2010) found that apolipoprotein E F4 allele, the fraction was 7.1% and the interval was from 2.4% to 12.0%. The authors reasoned that an increase in crystallized intelligence and fruit and vegetable consumption, plus eliminating depression and diabetes, would likely have the biggest impact on reducing the incidence of dementia.
One strength of this study can be seen as that Ritchie et al.(2010) had actual neurologists contribute to the study. Another strength of the study is that the authors accounted for a large number of risk factors for Dementia. A limitation could be that the study should be experimented with in other populations.
Overall, Dementia is seen as a very serious disease that society should take seriously. As more and more research is done on Dementia, the main focus should be on the early intervention of the disease. The articles used in this paper show how life-changing Dementia is. Also, the articles show the effect that intervention and diagnosis could have on an individual with Dementia. I would like to find more articles that show that the early diagnosis actually slowed down the progression of Dementia because that is the goal. I am interested in and very invested in this topic. I will continue to read articles and try to learn as much as I can about Dementia. It is something that affects the older population and had affected older members of my family and one day I will be a part of the older population. So I want to be prepared if one day I have to deal with this disease.
References
- Burns, A., & Iliffe, S. (2009). Alzheimer's Disease. BMJ: British Medical Journal, 338(7692), 467-471. Retrieved from www.jstor.org/stable/20512146
- Buschke H, Kuslansky G, Katz M, et al. (1999) Screening for dementia with the memory impairment screen. Neurology;52:231-8
- Gatz, M. (2007). Genetics, Dementia, and the Elderly. Current Directions in Psychological Science, 16(3), 123-127. Retrieved from www.jstor.org/stable/20183178
- Harder B., (2004). Delaying Dementia. Science News, 165(19), 296-298. Retrieved from www.jstor.org/stable/4015156
- Kurth, T., & Logroscino, G. (2010). Can dementia be prevented? Modifiable risk factors exist, but targeted public health programs are not yet warranted. BMJ: British Medical Journal, 341(7768), 310-311. Retrieved from www.jstor.org/stable/20766053
- Palmer, K., Bäckman, L., Winblad, B., & Fratiglioni, L. (2003). Detection Of Alzheimer's Disease And Dementia In The Preclinical Phase: population-based Cohort Study. BMJ: British Medical Journal, 326(7383), 245-247. Retrieved from www.jstor.org/stable/25453538
- Prince M, Bryce R, Ferri C. World Alzheimer report (2011): the benefits of early diagnosis and intervention. Alzheimer’s Disease International, 2011
- Ritchie, K., Carrière, I., Ritchie, C., Berr, C., Artero, S., & Ancelin, M. (2010). Designing prevention programs to reduce the incidence of dementia: Prospective cohort study of modifiable risk factors. BMJ: British Medical Journal, 341(7768), 336-336. Retrieved from www.jstor.org/stable/20766089
- Robinson, L., Tang, E., & Taylor, J. (2015). Dementia: Timely diagnosis and early intervention. BMJ: British Medical Journal, 350. Retrieved from www.jstor.org/stable/26522042
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