Dementia is a disease that significantly impairs the quality of life, and in fact is an impairment of mental capacity: thinking, remembering, logical reasoning. Knowing that you are suffering from this disease can be pretty disturbing at first, but the increasing number of ways to make the life of a person with dementia as good as possible is an extenuating circumstance. Taking care of these patients is tiring both physically and emotionally, over time also economically exhausting, so it can seriously affect the psychophysical health of the caregiver and the whole family. An insight into the growing number of available support measures facilitates the treatment and care of dementia sufferers and, to some extent, maintains the level of quality of overall functioning.

The most common questions that arise when it comes to this widely spread health problem are:

• What is Dementia?
• Are there any early, warning signs?
• How to accept the new state and prepare for the changes that inevitably will come in the further course of the disease?

What Is Dementia?

Dementia includes a group of different conditions that impair the normal cognitive functioning and behavior of people, which leads to disabilities in performing usual daily life activities. To a greater or lesser extent changes in memory, in operational functions (planning, assessment, decision making), coping in space, speech, mood, behavior are also present. The onset of the disease is usually gradual, the symptoms at the beginning may be so mild that they are hardly noticeable. Exacerbation is usually slow, but inevitably leads to behavioral disorders and personality changes, and to a complete loss of everyday skills to the point that the diseased person ceases to be independent, and in the advanced stage he is unable to dress, bathe, eat or walk independently. Dementia can affect anyone, and with aging, the likelihood of becoming ill increases.

Types of dementia

There are a number of physiological substrates that underlie the set of symptoms associated with dementia. Therefore, for the time being, there are several types of this disorder:

Alzheimer's disease

This is the most common type of dementia - about two-thirds of people with dementia have Alzheimer's disease. Although we do not yet know the definitive causes, it is known that there are typical changes in the brain - a decrease in brain volume and the accumulation of abnormal proteins between and within brain cells that impair brain function.

On average, the disease lasts about eight years and goes through three stages. In the early stages problems with remembering new events, orientation in space, even in a familiar environment are noticeable. There may also be problems with managing your finances (eg, paying bills). Difficulties in speaking can also be present, in terms of understanding more complex sentences, as well as finding right words. Independence is only slightly impaired and patients can function with less intervention from the outside and most often live in their own household. Depression, apathy and anxiety sometimes occur. In the second, so-called moderate or intermediate stage of the disease, the cognitive functions already mentioned worsen, which leads to a significant impairment of activities in daily life. At this stage, there is a risk of experiencing more pronounced behavioral disorders and psychological problems that exacerbate already severely impaired patient's self-esteem and may lead to experiencing a situation where they cannot move out of their own home and / or live without another person. In the third phase, the so-called late stage of the disease, which involves almost complete dependence on the other person, patients also have problems with basic simple activities such as eating, bathing and dressing. With the progression of the disease, patients seem to forget to walk and have increasing difficulties to move, to the stage where they become attached to bed. The slowness and stiffness that develops may be reminiscent of Parkinsonism. Epileptic seizures may also occur at this stage. All this leads to a high risk of developing pneumonia, urinary infections and other conditions that can be fatal.

Frontotemporal dementia

Frontotemporal dementia is a group of conditions that affect the frontal (frontal) and / or temporal (temporal) lobes of the brain. If the frontal lobes are more involved, there will be more difficulties with motivation, planning and organizing, controlling emotions and maintaining socially acceptable behavior. In cases where the temporal lobes are affected, there are more difficulties with speech and / or language comprehension. This dementia more commonly affects younger people, most commonly occurring between the ages of 45 and 60.

Dementia with Levi's bodies

In this type of dementia, there is a disruption of motor activity (reminiscent of Parkinsonism) with changes in attention and visual function as well as behavior, but it is important that disorders of mobility and dementia develop in parallel or sequentially over several years. Patients' awareness and attention levels vary from hour to hour or shorter, from episodes of severe confusion to near normal functioning. Hallucinations, most commonly visual (images that other people do not see) occur very early in the beginning of the illness. For example, patients describe in detail the pictures of animals, people or objects, scenes that others cannot see. Unlike hallucinations in psychiatric illnesses, fear and anxiety are rarely reported here, so they are often not mentioned before being targeted during the diagnostic interview. It is interesting to note that sleep disorders occur with “vivid dreams,” in which one most often chases them, persecutes them, and where, defensively, they can cause various injuries to themselves and to persons around them. This disease is associated with the existence of Levi's bodies (specific protein clusters) in brain cells and their extensions.

Vascular dementia

This type of dementia can occur very quickly after a stroke (3 months) or develop gradually when it comes to multiple changes in the small blood vessels of the brain. There are behavioral outbursts in this dementia, as well as problems with attention, memory and speech. Unlike Alzheimer's disease, here we can expect motor symptoms at the very beginning, such as (most commonly) "lower body Parkinsonism". Worsening through stages is common to this type of dementia.

Family occurance of dementia

The current knowledge indicates the importance of hereditary factors in dementia. About one-third of people with Alzheimer's disease have a family member (parent, brother or sister) who has or has had this disease. This is not to say that dementia is always hereditary and many patients in family history do not have registered cases of dementia. Alzheimer's disease is mainly sporadic disease, and familial forms with clearly autosomal dominant inheritance (occurrence in each generation) are represented by 2.5 to 5%; and these are some cases with early onset of the disease. There is a hereditary risk if at least three family members in two or more consecutive generations have or have had this disease, two of whom are first-degree relatives.

Are there any early, warning signs?

Early signs of dementia can be subtle and difficult to identify. They occur in different spheres of psychic life and functioning.

Memory loss for recent information and events that affect daily life

Occasionally, we all forget something, but if we remember it later, such a problem is not a concern. Anyone can snap a wallet or keys, while a person with dementia can end up putting things in the wrong places all the time. Reminding a person with dementia does not help, so s/he often repeats the same questions over and over.

Action on TV, in movies or books

Older people are able to follow the action of the movie. People with dementia become incapable of watching TV, movies or reading a book.

Knowledge and information

Although remembering knowledge from befeore may be slower, the older person can essentially recall more information, just needing more time. A person with dementia forgets what she knew, such as knowledge of historical sites or events.

Difficulties in performing regular tasks

Elderly people may not be as efficient in their day-to-day activities, or may be confused about finding streets where they go less often, are slower in handling new appliances, or need more time than before for finishing different tasks. People with dementia have difficulty driving because they do not recognize and understand the signs and rules in traffic. Problems also occur at home, they no longer know how to use apparatuses or are unable to learn how to operate new appliances.

Daily activities such as dressing or cooking

Unless there is some physical reason, the elderly can perform these activities. People with dementia are no longer able to dress on their own or cook for themselves or others.

Speech problems

Older people occasionally have trouble finding the right words in conversation, while a person with dementia may have difficulty following or starting a conversation or may tend to use wrong words. They may also have difficulty finding words, with no use of reminding.

Written and oral instructions

Older people are able to follow directions. Persons with dementia gradually lose the ability to follow instructions, because of difficulty in understanding, at the beginning of more complex and later simple constructions, as well as due to forgetting itself.

Disorientation in time and space

It is acceptable to forget what day it was or why you went to another room. A person with dementia is often unaware of the current year, month, season, has difficulty finding public transportation at a known destination, difficulty finding his or her home or friends, post office, bank or health center, despite of having used that path for years before.

Problems with complex tasks, joy, planning and decision making

There are often problems with organizing a home budget, but this is usually addressed through a careful approach. A person with dementia becomes unable to carry out administrative and financial transactions (to make decisions, to manage bank accounts, troubles with saving, investing and managing money).

Mood and behavior changes

Everyone is sad or whimsical at times. A person with dementia may have mood swings, disinterest or over-emotional reactions to situations and events. S/he may accuse the household of stealing from them or may have other misconceptions (eg that someone is doing something against him / her behind his / her back, that they are not loyal to him / her, etc.).

Relationships with other people

People change a bit with age, but the basics of personality and behavior remain the same. A person with dementia may become more open and less considerate or become more withdrawn and have less confidence.

Loss of initiative

It is normal to get tired of work, past interests or social commitments. A person with dementia loses interest or becomes unable to begin activities that s/he previously enjoyed.

How to accept the new state and prepare for the changes that inevitably come in the course of the disease?

If you think you have dementia, it is important that you visit your doctor to make the right diagnosis as soon as possible. First, a complete medical evaluation should be done to identify possible vitamin B12 deficiency, thyroid disease, cerebrovascular disease, chronic brain infection for which appropriate treatments are available. Early diagnosis enables the use of medicines available in our country that are thought to delay the worsening of the symptoms of the disease. You will also have the opportunity to learn more about the opportunities you have, to plan further steps and access to appropriate services and find support in a timely manner.

The assessment must include:

• talk about previous illnesses,
• talking to a family / person who knows the patient
• a general overview
• Neuropsychiatric examination
• laboratory tests, including blood and urine tests, basic laboratory blood counts and biochemical analyzes (blood sugar, liver enzymes, renal function parameters, electrolyte status)
• Thyroid hormone levels
• Vitamin B12 levels in the blood
• Cognitive tests that assess brain function - especially memory, speech, attention span and problem solving
• an assessment of the ability to function independently on a daily basis
• brain imaging, observing the structure of the brain to exclude other medical conditions or to diagnose a specific type of dementia (optimal brain imaging using computed tomography - CT brain scan)
• Ultrasound examination of extracranial and intracranial vessels
• a mental health assessment that can identify treatable conditions such as depression or alleviate some of the symptoms of dementia

When diagnosed, the patient and caregiver / companion should receive information on what dementia is, the course of the disease, the medications that patient should take, the benefits and side effects of treatment, and the relationship with the patient. The doctor should explain things to you so that you understand them, answer all your questions, give advise and support, and listen.

Treatment of dementia

In treatment of Alzheimer's desease medicines from two large groups are being used: of so-called cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and NMDA receptor antagonists (memantine) registered in our country. It is important for you to know that none of the medications used lead to a cure for dementia. These medicines are manufactured by different manufacturers and are all verified and approved by the Agency for Medicinal Products and Medical Devices of the Republic of Serbia. Alzheimer's drugs are on the positive list of the Republican Health Insurance Fund, which means that they are obtained with a prescription with some participation of the insured. During the course of the illness it is possible that medications for other various psychiatric symptoms may be needed such as are those for depression, apathy, hallucinations, aggression etc. There are products on the market that have been marketed in the treatment and prevention of Alzheimer's dementia, but it has been shown that there is no scientific justification for this, despite of them being widely used. This group includes the following preparations: various vitamin preparations - vitamins of complex B, vitamins E or C, as well as a group of drugs thought to repair cerebral circulation: ginkgo biloba, piracetam, nicergoline, vinpocetin, cerebrolizin, ergolid-mesylate, pentoxifylline, cinarizin.

Practical recommendations for patients

A diagnosis of dementia will probably mean that you will have to make changes in your daily life. You need to keep in mind that this is a progressing disease, which means that patients become more dependent on the other person and cannot live and function independently. This does not mean that major changes are needed immediately, but it is a good idea to plan your preparation for possible new situations in the further course of the disease. It would be a good idea to choose a trusted person to handle your finances. Likewise, you should express your desire for care in situations where someone else's assistance in daily life is needed, e.g. whether you are going to live in a domestic household with a caregiver or want to go to a home or household of children or relatives.

Whether we say or no, and to whom we say we are suffering from dementia

It can be difficult to tell your family / community and friends about the diagnosis of dementia. Confirming the diagnosis can help family / community and friends accept what is happening. As the disease progresses, the help of others will be needed, so it is best to share this information with loved ones as early as possible.

Family and friends are very important!

Family and friends certainly play a key role in supporting people with dementia, including a valuable connection to a patient's past. The most important thing a close person can do is continue to support the patient and encourage him or her to remain an active member of the family and the local community. The recommendation for family and caregivers is certainly a timely professional, legal and financial counseling in order to structure and clearly organize everything that the coming period brings.

Take care of your somatic health: Eat healthy and be active, rest when you are tired. See your chosen doctor regularly. Engage in mentally stimulating activities: read, resolve crossword puzzles, try a new hobby. Talk to your friends. Stay socially engaged. Actions you once did easily will become more difficult. Embracing the change and adopting skills in overcoming obstacles can lead to the establishment of a new system of balance and stress reduction.

Practical recommendations for people closest to the patient:

1. First of all, it is necessary to provide an environment without potential hazards to the patient, preferably without moving to a new, unfamiliar environment. Arrange space with as little furniture as possible so that it does not interfere with safe passage and movement. Provide potentially slippery surfaces with textile substrates, regulate showers with automatic thermometers, adjust lighting, keep medicines, chemicals, tobacco and alcohol indoors.
2. Get well informed about the disease
3. Avoid criticizing behaviors and conflicts with a person with dementia
4. Clearly structure everyday activities and establish a routine (at the same time getting up, having meals, therapy, maintaining hygiene)
5. To show respect to the patient, to involve him/her in decision-making, to be considerate, reasonable and gentle in communication
6. Provide the patient with bracelet containing basic information, especially in the late stages (name, surname, address, telephone number of the contact person)

Diagnosis of dementia does not represent the end of life. With appropriate support from the family and the community, adequate treatment and recommendations for organizing living conditions at home and in the hospital, we can provide these individuals with a better and more fulfilling life.

Our aspirations, as those responsible on behalf of the profession, are directed against loneliness and isolation, while preserving dignity and independence to the fullest extent of (growing) possibilities.

There is no sure way to stop yourself getting dementia, but there are things you can do that may make it less likely that you will.

• Ask your doctor to check your heart health, including blood pressure and cholesterol, and follow their advice if they are too high.
• If you have diabetes, keep to your doctor’s advice.
• Don’t smoke.
• Eat a balanced diet with plenty of fruit and vegetables.
• Keep your weight healthy.
• Stay active and try not to spend too long sitting down.
• Keep using your brain – through activities or social groups you enjoy.
• Drink no more than 14 units of alcohol per week.