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Dementia - Dementia is a syndrome caused by disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation,comprehension, calculation, learning capacity,language and judgement. Consciousness is not clouded. Dementia mainly affects older people: only 2% of cases start before the age of 65 years. After this the prevalence doubles with every fi ve-year increment in age. Dementia is one of the major causes of disability in later life.

BPSD - behavioural and psychological symptoms of dementia

There are very many underlying causes of dementia. Alzheimer’s disease (AD), characterized by cortical amyloid plaques and neurofi brillary tangles is the most common, accounting for one half to three quarters of all cases. Vascular dementia (VaD) is diagnosed when the brain’s supply of oxygenated blood is repeatedly disrupted by strokes or other blood vessel pathology, leading to signifi cant accumulated damage to brain tissue and function. The distinction between AD and VaD has been called into question, given that mixed pathologies are very common. Perhaps vascular damage is no more than a cofactor accelerating the onset of clinically signifi cant symptoms in people with AD.

There are a few rare causes of dementia that may be treated effectively by timely medical or surgical intervention— these include hypercalcaemia, subdural haematoma, normal pressure hydrocephalus, and defi ciencies of thyroid hormone, vitamin B12 and folic acid. For the most part, altering the progressive course of the disorder is unfortunately not possible. Symptomatic treatments and support can, however, transform the outcome for people with dementia and their caregivers.

Alzheimer and other dementias have been reliably identifi ed in all countries, cultures and races in which systematic research has been carried out, though levels of awareness vary enormously. In India, for example, while the syndrome is widely recognized and named, it is not seen as a medical condition. Indeed, it is often regarded as part of normal ageing (1).

For the purpose of making a diagnosis, clinicians focus in their assessments upon impairment in memory and other cognitive functions, and loss of independent living skills. For carers and, arguably, for people with dementia, it is the behavioural and psychological symptoms of dementia (BPSD) that are most relevant. Nearly all studies indicate that BPSD are an important cause of caregiver strain. They are a common reason for institutionalization as the family’s coping reserves become exhausted. Problem behaviours may include agitation, aggression, calling out repeatedly, sleep disturbance (day–night reversal), wandering and apathy. Common psychological symptoms include anxiety, depression, delusions and hallucinations. BPSD occur most commonly in the middle stage of dementia (see also the section on Course and outcome, below). Despite their significance, there has been relatively little research into BPSD across cultures. One might anticipatethat cultural and environmental factors could have a strong infl uence upon both the expression of BPSD and their perception by caregivers as problematic (2). Behavioural and psychological symptoms appear to be just as common in dementia sufferers in developing countries (3). In some respects the developing country caregivers were more disadvantaged.

Given the generally low levels of awareness about dementia as an organic brain condition, family members could not understand their relative’s behaviour, and others tended to blame the carers for the distress and disturbance of the person they were looking after.

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