Is Dementia Cause for Home Health Care?

As of today, there are more than 55 million people diagnosed with dementia, with more than 10 million new cases added each year. That number is expected to continue rising, and there are millions more that are currently undiagnosed. From Alzheimer’s Disease to vascular dementia, dementia is one of the most common causes of disability and dependency among older people. These are our loved ones, friends, and family – and they may require in-home care. But is all dementia the same? What causes it? Knowing these answers will help determine if home health care is the appropriate next step.

What is dementia?

Dementia is not a specific disease, it’s an “umbrella” term that describes a wide range of symptoms associated with a decline in memory or thinking skills severe enough to reduce a person's ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type.

What causes dementia?

Dementia is caused by damage to brain cells that interferes with their ability to communicate with each other. When brain cells cannot communicate normally, thinking, behavior, and feelings can be affected. The brain has many distinct regions, each of which is responsible for different functions (like memory, judgment, and movement). When cells in a particular region are damaged, that region cannot carry out its functions normally.

What are other types of dementia?

Vascular Dementia is caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients. Inadequate blood flow can damage and eventually kill cells anywhere in the body but the brain has one of the body's richest networks of blood vessels and is especially vulnerable. In vascular dementia, changes in thinking skills sometimes occur suddenly following strokes that block major brain blood vessels. Thinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage. A growing number of experts prefer the term "Vascular Cognitive Impairment (VCI)" to "vascular dementia" because they feel it better expresses the concept that vascular thinking changes can range from mild to severe.

Dementia with Lewy Bodies (DLB) is a type of progressive dementia caused by abnormal microscopic deposits, called Lewy bodies, that damage brain cells over time that leads to a decline in thinking, reasoning, and independent function. Lewy bodies are also found in other brain disorders, including Alzheimer's Disease and Parkinson's Disease dementia. Many people with Parkinson’s eventually develop problems with thinking and reasoning, and many people with DLB experience movement symptoms, such as hunched posture, rigid muscles, a shuffling walk, and trouble initiating movement. Hallucinations, delusions, and misidentification of familiar people are significantly more frequent in early-stage DLB than in Alzheimer’s Disease. REM Sleep Disorder is more common in early DLB than in Alzheimer’s Disease. Disruption of the autonomic nervous system, which can cause a blood pressure drop upon standing, dizziness, falls, and urinary incontinence, is much more common in early DLB than in Alzheimer’s Disease.

Huntington's Disease is a progressive brain disorder caused by a single defective gene. This defect is "dominant," meaning that anyone who inherits it from a parent with Huntington’s will eventually develop the disease. Symptoms of Huntington’s Disease are behavior disturbances, hallucinations, depression, moodiness, restlessness or fidgeting, paranoia, and psychosis. Abnormal and unusual movements include grimacing; head turning to shift eye position; jerky movements in arms, legs, face, or other parts; slow, uncontrolled movements and unsteady gait; a severe decline in thinking and reasoning skills; irritability; depression; and other mood changes. 

Is dementia the only thing that can cause these symptoms?

There are many other conditions that can cause symptoms like those seen in dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies. A careful medical exam and laboratory tests are used to determine if something other than dementia may be causing these problems.

Is dementia always responsible for behavior changes?

For people who have dementia, sometimes a behavior change is caused by something other than dementia, especially if it is sudden. A rapid change in behavior can be related to infections, urinary tract infection, or pain. Urinary tract infections can cause changes in someone with dementia that you might never expect, and the impact can be profound. Communicating pain becomes difficult in the late stages of dementia. For this reason, it is important to look for physical signs of pain such as: pale skin tone; flushed skin tone; dry, pale gums; mouth sores; vomiting; fever may or may not be present; or swelling of any part of the body. Pay attention to non-verbal signs: gestures, spoken sounds, and facial expressions (wincing, for example) may signal pain or discomfort. Watch for changes in behavior such as anxiety, agitation, shouting, and sleeping problems. These can all be signs of pain, infection, or a urinary tract infection.