Is It Really Dementia?
By: Angil Tarach-Ritchey RN, GCM
I continuously see a lack of understanding about dementia. People often use Alzheimer’s and dementia interchangeably as if the only cause of dementia is Alzheimer’s. I would like to clarify what dementia is and its causes.
Dementia is a loss of brain function that occurs with certain diseases. There are two main causes of non-reversible dementia, Alzheimer’s and vascular. Alzheimer’s is from plaques that form between nerve cells in the brain and tangles that are proteins twisted up that form inside dying cells. It is believed that these plaques and tangles interfere with nerve pathways resulting in dementia. Vascular dementia occurs when blood flow to the brain is interrupted, usually by a stroke. Strokes are from a blood clot or bleeding in the brain. Blood flow to brain tissue is interrupted, resulting in dying brain tissue. This is how vascular dementia forms. Simply, Alzheimer’s is nerve related, and vascular is blood-vessel related.
You may have heard of lewy body dementia (LBD). Patients with LBD have abnormal protein structures in the brain. It still isn’t clear whether LBD is a form of Alzheimer’s or a separate disease, but it is the leading cause of dementia in elderly adults.
There are also treatable causes of dementia. Those causes include brain tumors, infections, low vitamin B12 levels, normal pressure hydrocephalus (an increase of spinal fluid in the brain), thyroid conditions and metabolic disorders. Metabolic disorders can include endocrine disorders such as Addison’s disease, Cushing’s disease, or the complicities of diabetes, as well as electrolyte conditions, liver and kidney complications.
Alzheimer’s has no definitive diagnostic test, although it appears research is getting closer to a test. It is usually diagnosed after all other possible causes of dementia have been ruled out. That is why it is extremely important for patients to get a comprehensive exam by a geriatric specialist to determine the cause.
Memory loss can be a temporary condition related to a drug interaction or excessive physical stress on the body from illness. Narcotics can often cause the elderly to experience memory loss and even hallucinations, so it’s important to get a good health history on admission.
Too many patients are being given a diagnosis of dementia by primary physicians or hospital physicians without a thorough evaluation. Being labeled with dementia without a full work up and evaluation is very unfair to patients who will then have their ability to make decisions revoked, typically for life and are often ordered inappropriate medications, like Seroquel, an antipsychotic. Seroquel is contraindicated in people with dementia, yet I’ve seen that drug ordered without any evaluation, consultation or before trying a less drastic treatment.
As nurses, we should always question a diagnosis of dementia, since dementia is really not a diagnosis in itself. It is a symptom of a cause. A nurse would never accept a diagnosis without a thorough assessment and diagnostic testing, and we shouldn’t just assume that every senior with a diagnosis of dementia has been appropriately diagnosed either.
About the Author
Angil Tarach-Ritchey RN, GCM is a national expert in senior care. With more than 30 years experience in senior care and advocacy, Angil is very passionate about eldercare and is well respected in her field.
Since 2002, Angil has owned Visiting Angels, a private duty homecare agency in Ann Arbor, Michigan.
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