The most feared changes in mental state as someone grows older are the organic brain syndromes, commonly known as senility. Doctors are often asked to confirm a diagnosis of senile dementia in an old person who is living with relatives, because he is becoming forgetful. The forgetfulness may take the form of leaving taps running or forgetting the names of grandchildren. Although memory loss alone may not indicate the full onset of dementia, the old person may also have become lethargic,and unconcerned about personal hygiene. A second stage of dementia, the confused phase, is easier to recognize. The person affected may be uncertain as to what day of the week it is. He or she may be puzzled by familiar household objects such as door keys, and may remember to take them when going out, but be confused as to what they are for on returning home.
Demented people may take to wandering about the house at night and cause disturbance to those with whom they are living. They also exhibit a good deal of anxiety themselves. In the final phase of dementia the elderly person’s mental faculties are in such disarray that they are no longer capable of looking after themselves. They may wander off and get hopelessly lost or walk into traffic.
This degree of mental decline is sometimes followed by accidental death but, given adequate care, old
Diagnosis and treatment of dementia
At present, little can be done to arrest the progress of either form of dementia. Often because of pressure on the relatives of patients so afflicted, long-term institutional care is needed. Once in care, therapy is frequently directed towards keeping the demented patient aware of his or her surroundings and of the time and place. This treatment, called ‘reality orientation’, is of debatable help to the old person, but it may be reassuring to relatives.
It is impossible to determine whether the children of an elderly dementia patient will themselves eventually be afflicted with the disease. There is, however, a great deal of sense in asking whether a correct diagnosis has been made. Severe, so common in the elderly, can mimic many of the symptoms of dementia. Also, other illnesses such as kidney failure can bring about states of confusion similar to that found in dementia. Further confusion can be brought about by the multiplicity of drugs given to old people to treat a variety of conditions. It is not unusual for the elderly to be given tranquillizers for sleep difficulties and other psychotropic drugs for anxiety and depression. Elderly patients may not understand the significance of the drugs they are given and may take them at the wrong times, or worse still in the wrong dosages. Sometimes eliminating all of the previously prescribed drugs has a remarkable effect in eliminating the confusion, al- though a decision to take this step should not be made without qualified advice. A recently developed technique, called computerized axial tomography (CAT scan) can give cross-sectional views of the brain. Photographs obtained by this method may help to identify various causes for dementia and thus confirm the diagnosis. Careful questioning of the patient to establish the extent of his or her awareness of the surroundings also helps to ensure a correct diagnosis. The profession is obliged to do everything possible to make sure the condition is really senile dementia and not something else that can be effectively treated and cured.