Dealing with Dementia: A Guide to Alzheimer's Disease and Other Dementias

272 Pages·2004·3.46 MB·English

by  Brian Draper

dementia a4 10/11/03 05:53KET Page 1
"This is a comprehensive and accessible guide to DDEEAALLIINNGG
Alzheimer's and other dementias for families and
carers. Strongly recommended."
PROFESSORHENRYBRODATYAO
WWIITTHH
D
W
e live in an ageing world. The average life expectancy in E
Australia is now far beyond the allotted ‘three-score years A
and ten’. Age-related conditions are increasingly impacting L DDEEMMEENNTTIIAA
I
on our community, with enormous personal, social and
N
economic costs.
G
Around 165000 people in Australia are now suffering

from dementia and the prospect of becoming senile is one
W
that genuinely terrifies people contemplating a lengthy
I
old age.
T
It is important to remember, however, that while most
H
dementias are currently irreversible, this does not mean that
they are untreatable. Dealing with Dementiaoffers a down-to- D
earth, comprehensive and compassionate resource for
E
anyone struggling to come to terms with a diagnosis of
M
dementia and what it means.
E
Filled with practical advice on drug treatments,
N AA GG
complementary therapies and residential or respite care, UUIIDDEE TTOO
Dealing with Dementia will be an invaluable tool for anyone T
worried about their own symptoms or those of a loved one. I AA ''
A LLZZHHEEIIMMEERR SS
Dr Brian Draper is an old age psychiatrist (psychogeria-
DDIISSEEAASSEE AANNDD
trician) from the Academic Department for Old Age
D
Psychiatry at Prince of Wales Hospital, Sydney and Conjoint
r
Associate Professor of Psychiatry at the University of New B OOTTHHEERR
South Wales. He has published widely on the behavioural r
i
a
and psychological symptoms of dementia, depression in old n DDEEMMEENNTTIIAASS
age and carer stress.
D
r
A L L E N & U N W I N a
Cover design: Bruno Jean Grasswill p
e
r
Dr Brian Draper
HEALTH www.allenandunwin.com
Dealing with Dementia 12/9/03 10:59 AM Page i
DEALING WITH DEMENTIA
Dealing with Dementia 12/9/03 10:59 AM Page ii
Dealing with Dementia 12/9/03 10:59 AM Page iii
DEALING WITH DEMENTIA
A guide to Alzheimer’s disease
and other dementias
BRIAN DRAPER
Dealing with Dementia 12/9/03 10:59 AM Page iv
To my family—Debbie, Leah and Sally
First published in Australia by Allen & Unwin in 2004
Copyright © Brian Draper 2004
All rights reserved. No part of this book may be reproduced or transmitted in any form
or by any means, electronic or mechanical, including photocopying, recording or by any
information storage and retrieval system, without prior permission in writing from the
publisher. The Australian Copyright Act 1968(the Act) allows a maximum of one
chapteror 10 per cent of this book, whichever is the greater, to be photocopied by any
educational institution for its educational purposes provided that the educational
institution (or body that administers it) has given a remuneration notice to Copyright
Agency Limited (CAL) under the Act.
Allen & Unwin
83 Alexander Street
Crows Nest NSW 2065
Australia
Phone: [phone]
Fax: [phone]
Email: [email protected]
Web: www.allenandunwin.com
National Library of Australia
Cataloguing-in-Publication entry:
Draper, Brian.
Dealing with dementia: a guide to Alzheimer’s disease and other dementias.
Includes index.
ISBN 1 86508 853 6.
1. Dementia. 2. Dementia—Diagnosis. 3. Dementia—Patients—Care. 4. Alzheimer’s
disease. 5. Alzheimer’s disease—Diagnosis. 6. Alzheimer’s disease—Patients—Care.
I. Title.
616.83.
Set in 11/13.5 pt Janson by Midland Typesetters, Maryborough, Victoria
Printed by and bound by SRM Production Services, SDN, BHD, Malaysia
10 9 8 7 6 5 4 3 2 1
Dealing with Dementia 12/9/03 10:59 AM Page v
C
ONTENTS
List of illustrations x
List of tables xi
Preface xiii
CHAPTER 1 WHAT IS DEMENTIA? 1
Defining dementia 1
How does dementia differ from normal ageing? 2
What are the main types of dementia? 6
How common is dementia? 7
Is dementia becoming more common? 8
What is the impact of dementia upon society? 9
Summary 11
CHAPTER 2 PREVENTION OF DEMENTIA I 12
Disease prevention 12
Public health model of prevention 15
Universal dementia prevention strategies 16
Age and the role of antioxidants 16
Education, intelligence and brain reserve 18
Cerebral blood flow 22
Nutrition 22
Summary 24
CHAPTER 3 PREVENTION OF DEMENTIA II 26
Selective dementia prevention strategies 26
Genetic factors 26
Vascular risk factors 29
Nutrition 32
Gender: The role of hormone replacement
therapy 34
Inflammation: The role of anti-inflammatory
medication 35
v
Dealing with Dementia 12/9/03 10:59 AM Page vi
vi DEALING WITH DEMENTIA
Occupational exposures: Electromagnetic
radiation, fumigants/defoliants 36
Delirium (acute confusional state) 37
Indicated dementia prevention strategies 38
Cognitive impairment 38
Depression in old age 39
Some unproven factors 39
Summary 41
CHAPTER 4 THE SYMPTOMS AND COURSE OF DEMENTIA 45
Pre-dementia: Mild cognitive impairment 45
Early or mild dementia 46
Moderate or middle stage dementia 52
Severe or late stage dementia 63
Advanced dementia 69
Summary 70
CHAPTER 5 TYPES OF DEMENTIA 71
Alzheimer’s disease 74
Vascular dementia 78
Dementia with Lewy bodies 80
Frontotemporal dementia 82
Other neurodegenerative causes of dementia 84
Other dementias 85
Summary 87
CHAPTER 6 DEMENTIA ASSESSMENT 88
What is dementia assessment? 89
Who should perform the assessment? 89
What else may be causing memory changes?
Thedifferential diagnosis of dementia 97
Making the diagnosis 102
Initial management 104
Summary 105
CHAPTER 7 DRUG TREATMENTS 106
Some general principles 106
Memory and cognition: The cognitive
(memory) enhancing drugs 107
Dealing with Dementia 12/9/03 10:59 AM Page vii
CONTENTS vii
Cognitive (memory) enhancing drugs not
yet available in Australia 113
Some unproven cognitive (memory)
enhancing drugs 114
Drugs for the behavioural and psychological
symptoms of dementia 115
Medical problems that impact on dementia 122
Summary 122
CHAPTER 8 PSYCHOSOCIAL TREATMENTS 123
Some general rules of communication 123
Early dementia 124
Emotional support and lifestyle advice 124
Memory training 125
Making memories 126
Moderate–severe dementia 126
Validation therapy 127
Reminiscence therapy 129
Reality orientation 130
Music therapy 131
Physical exercise and activity programs 131
Aromatherapy and touch therapy 132
Audiotapes and videotapes 133
Behaviour therapy 134
Pet therapy 135
Light therapy 135
Multisensory stimulation: Snoezelen rooms 135
Physical restraints 136
Summary 137
CHAPTER 9 FAMILIES AND OTHER CARERS 138
The impact of early dementia 138
The impact of moderate dementia 143
The impact of severe dementia 146
Gender differences 148
Family education and support 149
Alzheimer’s Association 151
Positive aspects of caregiving 152
Summary 153
Dealing with Dementia 12/9/03 10:59 AM Page viii
viii DEALING WITH DEMENTIA
CHAPTER 10 COMMUNITY CARE SERVICES 154
History of community care in Australia 154
Aged Care Assessment Program 156
Home and Community Care (HACC)
Program 160
Carer services 161
Community Aged Care Packages (CACPs) 164
Aged Care Psychiatry (Psychogeriatric or
Mental Health for Older People) Services 166
Innovative community services 166
The future of community care in Australia 168
Summary 168
CHAPTER 11 RESIDENTIAL CARE 170
Why does placement into residential care
occur? 170
Preparation required for entering residential
care 171
Requirements of good residential care 174
Types of residential care for dementia 178
The residential care system in Australia 181
Resident fees and charges 182
Quality in aged care facilities 185
Future concerns 187
Summary 187
CHAPTER 12 ETHICAL AND LEGAL ISSUES 188
Ethical principles 188
Mental competency: Decision-making
capacity 189
How is decision-making capacity determined? 189
Substitute decision makers 191
Advance health care directives 192
Power of attorney and enduring power of
attorney 193
Enduring guardianship 193
Guardianship 194
Driving 195
Research on subjects with dementia 198
Electronic tagging 199
Dealing with Dementia 12/9/03 10:59 AM Page ix
CONTENTS ix
Placement into residential care 200
End-of-life decisions 201
Summary 203
CHAPTER 13 THE FUTURE 204
Detection of pre-symptomatic individuals
and early diagnosis 204
Prevention 210
Treatment 211
How will effective prevention and treatment
of dementia affect society? 214
Summary 219
Appendix 1 Australian telephone helplines 220
Appendix 2 Websites 222
Appendix 3 Books for carers 230
Glossary 232
Notes 238
Index 252