Impact of Memory Loss in a Demented Patient on Family Relationships

Introduction

Chronic diseases such as stroke, hypertension, and diabetes affect the patient’s ability to function normally hence forcing the family members to participate in the provision of care. The caregivers provide the patients with the required financial, physical and emotional support without any recognition or training. The caregivers often assume their responsibilities under sudden and extreme circumstances, with minimal preparation or guidance which means they are likely to face many challenges while carrying out their duties.

In the UK and the United States, family caregivers are relied upon to provide care to patients suffering from dementia. Although care giving has become prevalent, it has well-documented negative effects on the health and the well-being of caregivers. Available literatures indicate that non-cognitive, behavioural and psychological symptoms are the most hurting to caregivers. In order to encourage the quality of services available to the patients while safeguarding the health and the well-being of the family care-givers, it is important to examine the association between patient’s non-cognitive symptoms and the family relationships within the dementia patient-caregiver dyad.  This study will examine the effects of the patient’s cognitive capacity on the family relationships.

Background

Dementia, a chronic illness that is characterized by a decline in memory and cognitive abilities, is a common ailment among the aged population. The disease negatively impacts on the patient’s ability to function normally hence requiring the assistance of a caregiver. Dementia has several subtypes and they conclude Alzheimer’s disease (AD), vascular dementia (VD), dementia with Lewy bodies (DLB), Parkinson’s disease and Front temporal Dementia. Of these subtypes, AD is the most common as it accounts for 70% of all dementia cases. The disease has no known cure and is classified by stages: mild to moderate to severe.

Literature review

Behavioural and psychological symptoms (BPSD)

Behavioural and psychological symptoms of dementia include agitation, anxiety, apathy, delusions, depression and hallucinations. Sink, Holden and Yawffe (2005) believe that early diagnosis is very important in order to reduce the costs of caring for a dementia patient.  There are many strategies that have been developed to deal with behavioural and psychological symptoms of dementia and they include: behavioural therapy, cognitive stimulation therapy, psycho-education, and pharmacological interventions. Pharmacological interventions involve drugs such as antidepressants, mood stabilizers, cognitive enhancers and antipsychotics. Antipsychotics include drugs such as Olanzapine and Risperdone. However, antipsychotics are associated with the following side effects: sedation, extra pyramidal symptoms and neurlepic malignant symptoms.

Antidepressants are also commonly used to deal with behavioural and psychological symptoms of dementia. Some of the common anti-depressants are Fluoxetine and Paroxeteine. Just like antipsychotics, antidepressants also have a range of side effects and they include: anxiety, headache, sedation, gastrointestinal symptoms and sensual dysfunction. Mood stabilizers and cognitive enhancers are also associated with adverse side effects which include sedation, gastrointestinal disturbances, confusion, agitation, gait and balance issues, liver dysfunction, hyperammonemia and thrombocytopenia.

According to Sink, Holden and Yaffe (2005) there are several risk factors for these adverse effects. The first risk factor is social support. If a caregiver does not receive support from the other family members, he or she is at increased risk of becoming depressed. The second risk factor is the severity of the illness. As dementia advances, the symptoms become more pervasive. At times, the patient may not be able to work and is forced to depend on the help of the caregiver to perform even the simplest task. These situations are debilitating to the caregiver. Other risk factors are ADL disability and the patient’s problem behaviour. These two elements determine the engagement levels of the caregivers. If the patient is disabled or if he portrays some problematic behaviour, the engagement of the caregiver increases. On the other hand, if the dementia patient can walk and does not display any socially inappropriate behaviour, the participation of the caregiver reduces. Ultimately, a caregiver who engages more in the provision of care to a dementia patient becomes more predisposed to adverse effects such as depression

Pharmacological treatment of dementia has been found to be risky. This is because most of the pharmacological interventions indicated above are associated with adverse side effects. It then follows that before any of these interventions is used it is imperative for the healthcare provider to weigh the potential risks of treatment-related risks against the risks of not treating the dementia symptoms. It is also important to note that pharmacological interventions should target specific syndromes that are either frequent or are considered pervasive to the patient. Lots of studies have been conducted to examine the efficacy of pharmacological interventions.

Sink, Holden and Yaffe (2005) conducted a systemic review of randomized controlled trials for patients with dementia and found out that pharmachotherapies are not effective for the management of behavioural and psychological symptoms of dementia. Sink, Holden and Yawffe (2005) further found out that atypical antipsychotics caused serious adverse cerebrovascular events, extrapyramidal side effects and other adverse outcomes. Another study that was conducted by Yaffe (2007) reported that atypical antipsychotics vary in efficiency. This study that was a meta-analysis of the randomized, placebo-controlled, double-blind and parallel-group trials compared the efficacies of the aripiprazole, olanzapine and risperidones (Yaffe, 2007).

When it comes to anti-depressants, Sink, Holden and Yaffe (2005) conducted a systematic review of five randomized controlled trials of anti-depressants in the treatment of dementia. The drugs that were evaluated are: setraline, fluoxetine, citalopram, and trazodone. The results of the review indicated that of these drugs, only citalopram has any benefits in the treatment of behavioural and psychological symptoms of dementia. In another systematic review that involved 19 randomized controlled trials, Sink, Holden and Yaffe (2005) found out that anti-depressants are well tolerated in elderly patients with dementia.

Sink, Holden and Yaffe (2005) conducted yet another systematic review to examine the efficacy of valproate, a mood stabilizer, in the treatment of behavioural and psychological symptoms of dementia.  The findings of the review indicated that valproate did not have any efficacy over placebo in the treatment of dementia symptoms. Other studies that have conducted on the efficacy of valproate indicate that low-doses of this drug are ineffective in the .............