Dementia and Alzheimer's disease

There is no single answer. Depending on the diagnosis, the type of disease and other factors like age, general health, intercurrent diseases... The evolution of dementia will vary depending on the individual case.

The person with dementia is going to suffer a progressive decline in their abilities, which will affect their ability to make decisions and stop them from controlling or handling their economic, financial or legal affairs.

That is why the family, from the very time of the diagnosis, needs to reflect on this issue and try to solve it, while the person with dementia is still able to make decisions. In that sense, it is advisable to consult a lawyer or a notary, who will be able to give the correct advice to fit the situation or needs of the person with dementia.

They shouldn’t drive. It has been shown that the presence of cognitive deterioration increases the risk of having an accident, as safe driving requires the integrity of cognitive functions such as attention, planning, visual recognition and visuospatial ability.

It has also been shown that the progression of neurodegenerative diseases such as Alzheimer's diminishes the capacity to detect imminent collisions, due to the combined reduction in these people’s cognitive and visual capacities.

We recommend starting as soon as possible with daily use of a diary. If he gets into the routine of carrying his diary, noting down what he needs to do and checking it frequently every day, he will be more able to maintain his autonomy.

No. In fact, there are no evidence-based studies demonstrating the therapeutic efficacy of video games or consoles for people with Alzheimer's disease.

There is, however, an interactive multimedia system, Smartbrain®, specially designed to stimulate cognitive capacities, which has been demonstrated to have real therapeutic efficacy in that it strengthens the effects of pharmacological treatment.

Yes, they are useful tools for improving attention span, reasoning, calculation... They are an enjoyable ways of stimulating cognitive function.

Changing memory can be improved through cognitive reinforcement and stimulation during the phases of learning and information recovery.

Recent studies suggest a clear positive effect on neuropsychological functions of programmes of cognitive stimulation in the treatment of Alzheimer's disease, enabling the disease’s progression to be slowed.

Therefore, to achieve the maximum therapeutic benefit for patients in the mild to moderate stages of Alzheimer's, the combined use of cognitive stimulation programmes and pharmacological treatment is recommended.

Not all Alzheimer's disease patients become aggressive, although they do become more irritable and apathetic, which causes them to become less tolerant and more rigid. Some people begin suffering with depression when they become aware of their memory loss, which delays diagnosis in the majority of cases.

Managing aggression will depend on factors like:

– Previous personality: in people who are, for example, intolerant of frustration, controlling or manipulative as an adult, Alzheimer's disease will make these symptoms more acute and more difficult to redirect. Reproach or insinuations from the carer can provoke an aggressive reaction, typically verbal and occasionally physical.

– Poor understanding of the problem on the part of the family, who attempt to make the person with dementia participate in situations that they do not understand. The situation worsens further if there was a prior difficult relationship.

– Establishment of a psychotic process (delirium or hallucinations) linked with underlying Alzheimer's disease. This is when it becomes necessary to introduce specific treatment, given that the situation is distressing, both for the patient (who experiences it as though it were real) and for the family, who are not able to redirect it.

Alzheimer's disease has a very low level of family heredity: only 1% of all Alzheimer's cases are hereditary, and at least one progenitor and two or more family members must have it. They will all have the same mutation, and if the mutation is known, diagnosis can be made before symptoms even appear for carriers of a family mutation.

Furthermore, the disease appears between 30 and 40 years of age. Heredity should not be confused with genetics: hereditary genetic mutations are predetermined from the moment of conception. Genes are common and shared with family members.

Only specific risk genes determine whether or not Alzheimer's will appear throughout our lives. These genes are responsible for most sporadic cases.

However, Alzheimer's disease is genetic: there are risk genes in our DNA which, in a determined moment of our life, and in combination with other environmental factors, toxins, lifestyle, etc., can determine the appearance of the disease, especially after the age of 65.

Alzheimer’s always evolves. Survival can vary from a minimum of 2 to a maximum of 20 years after diagnosis, with the average time being 10 to 12 years. Once the first symptoms begin, the disease will pass through three phases until the death of the patient. This will not be the case if another illness or an accident causes death prior to that.

In the first phase (mild), symptoms appear as the functional loss of the more complex activities of daily living, the so-called complex instrumental activities, such as those where an idea or action needs to be processed, programmed and executed.

These are the tasks that allow us to carry out social or work-related activities, learn new things and develop our potential intellect through introspection, imagination and the emotions. They are expressed through abstract perception of the world and the use of formal logic. This is the formal operational stage, acquired from the age of 12, and is the first to be lost when the disease is beginning to appear.

The second phase (moderate) begins when the more simple instrumental capacities of daily living start to become destructured: shopping, using money, controlling medication, maintaining appropriate hygiene or an appropriate diet; situations which are necessary for survival and self-care. Interaction with the environment begins to be lost and there is a growing inability to focus on more than one aspect of a stimulus. Egocentrism appears or worsens, as does the inability to adapt to changes of routine.

This is the beginning of the loss of concrete operations, which were acquired between 7 and 12 years of age.

The third phase (severe) is characterised by the loss of the most basic capacities of daily living (nutrition, hygiene and control of the urinary and faecal sphincters).

People affected need help in their basic care because they are no longer able to do this on their own. The have lost the capacity to understand information from sensory perception and their interaction with the environment.

They are not capable of manipulating objects, and once an object disappears from sight, they cannot understand that it still exists. Sensorimotor skills, which are developed between birth and age 2, are destructured. The order in which there functional capacities are lost is the reverse of that in which they were acquired; in the end, all that remains is emotional memory, the only thing that links them with their surroundings and the only way in which they can communicate: a smile, a hug or a kiss, but without knowing the when, who or why.

It depends on the stage of the disease and their own perception of their memory loss. It is common in classical AD that memory loss does not allow them to remember recent information. At first, being told that they have Alzheimer’s can be traumatic for them.

However, later they forget what they have been told, and occasionally unconsciously deny the truth of it, because they don’t see that they have any problem, saying “I don’t know why they’ve brought me here if there’s nothing wrong with me and I can do everything perfectly well.”

Another situation is when the patient is aware of their state and has significant symptoms of depression because of it. In these cases it is better to postpone informing them of the diagnosis, with the family’s consent. The problem should be explained to the patient in the least traumatic way (“You have a memory problem that we are going to try to control”), without speaking the “magic” word that is terrorising them, redirecting this explanation along more positive lines.

As the illness continues to evolve, perception of the self is lost and the previous distress disappears. It is possible for altered behaviour to appear as a symptom, for example delirium or highly distressing hallucinations. These are not caused by the patient’s perception of the disease; they are actually symptoms of the disease itself, which they experience vividly.

When this is the case, we will be obliged to treat the symptoms in order to control the anxiety and fear that they cause.