Unit 17: Caring for Individuals with Dementia
Case Study 2: Mrs. Anjeela Johal Kaur
Anjeela Johal is 68 years old and has Alzheimer’s disease. Anjeela is a practicing Sikh, and her religious
practices are important to her. Anjeela attends the Gurdwara, (temple) every week, accompanied by her two
sons, her daughters-in-law and their children. Recently Anjeela attended a special celebration at the
Gurdwara with her family. At the end of the ceremony, one of her grand- children looked to where Anjeela
had been sitting and found that she was no longer there. Anjeela was found several yards away, at the site of
her previous home, looking for her husband who had died last year.
There have also been other instances, where Anjeela has become lost in familiar places and is now developing
mood swings where she varies from happy to angry and is difficult to manage. The family have discussed
Anjeela with the family G.P. and decided that she would be better cared for in a residential setting. Anjeela
has agreed to this but is unhappy about leaving her family home.
Anjeela has now moved to the Ashfold Residence where the staff are fully trained to support her.
The manager of the residence has met with Anjeela and her family to discuss the care and support required to
ensure that Anjeela still achieves a high quality of life. The family have informed the manager of Anjeela’s
dietary preferences, her interests, likes and dislikes. The family have also shared some of Anjeela’s history
including her marriage, her work as a teacher and medical conditions, she has type 2 diabetes and an allergy to
penicillin.
It has been agreed, that one of her sons will collect her on Sunday mornings and drive her to the Gurdwara. It
has also been agreed, that if no one in the family is available, due to holidays or illness, then one of the staff
will accompany Anjeela to ensure that she is able to follow her religious practices.
Anjeela was present at all planning stages and her opinions respected. She did become distracted and forgetful
in the sessions, and information gaps were filled by the family. Anjeela was informed about decisions and
appeared to be in agreement. The family have brought pictures from home to place on the walls of Anjeela’s
room in the residence and a CD player, so that she can listen to traditional music.
The residence celebrates all of the major festivals from the major faiths and Anjeela was supported in making
and distributing food for tasting to the other residents during Diwali.
Anjeela has been provided with photographs of the family and her career as a teacher and loves to chat to the
other residents about the children she taught. She sometimes becomes confused and appears to forget where
she is. The staff remind Anjeela that she now lives in the residence, using her preferred title of Mrs Johal
Kaur.
Dementia is a syndrome associated with an ongoing decline of brain functioning. In this assignment I will be
focusing on three to include Alzheimer’s disease, vascular dementia and frontotemporal dementia. For those
working in Health and Social Care, it is important to understand the range of symptoms that those with
dementia may display, as well as knowing the different types of dementia.
There are a number of different types of dementia.
P1: Explain the causes of three different types of dementia.
Causes of Alzheimer’s Disease
Alzheimer’s disease is the most common type of dementia. It causes problems with memory, thinking and
behaviour and is a gradually progressive condition, meaning that it continues to develop and gradually
become more serious. Alzheimer’s disease is thought to be caused due to abnormal build-up of proteins in and
around brain cells. It is not completely clear what causes this process to begin, however scientists do know
that it begins years before symptoms appear. As brain cells become affected there is a decrease in chemical
messengers called neurotransmitters, which are involved in sending messages, or signals, between brain cells.
Additionally, levels of one neurotransmitter, acetylcholine, are particularly low in the brains of people in
Alzheimer’s disease. Different areas of the brain shrink over time, with the first area affected usually being
,the one responsible for memories, although in more unusual form of Alzheimer’s disease different areas of the
brain are affected.
Whilst the exact cause of Alzheimer’s disease is unknown, there are several factors that are known to increase
your risk of developing the condition. For example, age is the single most significant factor, with the
likelihood of developing Alzheimer’s disease doubling every 5 years after the age of 65. However, it is not
only older people who are at risk of developing Alzheimer’s disease, as around 1 in 20 people with the
condition are under 65. This condition is known as early or young-onset Alzheimer’s disease, and it can affect
people from around the age of 40. Another significant factor in the cause of Alzheimer’s disease is genetics
and family history. A person can inherit genes from their parents that can contribute to their risk of developing
Alzheimer’s disease, although the increase in risk is small. However, in a few cases, Alzheimer’s disease is
caused by the inheritance of a single gene which results in the risk of the condition being passed on being
much higher. A person having a family history of Alzheimer’s that goes back through generations can
increase their risk of also developing the condition. There is also a link between Down’s syndrome and the
development of Alzheimer’s disease, as those with Down syndrome are at higher risk of developing the
condition. This is due to the genetic changes that cause Down’s syndrome, as they can also cause amyloid
plagues to build up in the brain over time, which can cause Alzheimer’s in some individuals.
Lifestyle factors and conditions such as smoking, obesity, diabetes, high blood pressure and high cholesterol
can increase the risk of Alzheimer’s. Therefore, the risk can be reduced by stopping smoking, eating a health
and balanced diet, staying active, losing weight if it is needed, drinking less alcohol, and having regular health
checks as a person ages.
Causes of Vascular Dementia
There are a number of risk factors that can increase a person’s chances of developing vascular dementia.
Whilst it is possible to avoid some of these risk factors, others cannot be controlled. Vascular dementia is a
condition that is caused by the lack of blood that carries oxygen and nutrients to a part of the brain, meaning
the brain does not receive a sufficient amount of blood and oxygen supply. This results in a portion of the
brain being damaged, as brain cells are damaged and eventually killed, leading to vascular dementia. There
are a number of conditions that may lead to this, such as stroke, cardiovascular diseases, aneurysm in the
brain, diabetes, high blood pressure, and high cholesterol. Some individuals with vascular dementia also have
brain damage caused by Alzheimer’s disease, which is known as mixed dementia. There are also certain
lifestyle factors that can contribute towards the risk of developing vascular dementia, such as smoking, an
unhealthy diet, lack of exercise, and drinking too much alcohol. These issues increase the risk of damage to
the blood vessels in and around the brain and can cause blood clots to develop inside of them. A person’s risk
of developing vascular dementia can be minimised through making healthy lifestyle changes and treating any
health conditions they may already have. However, there are certain factors that a person cannot change that
can increase their risk of vascular dementia, such as age. The risk of vascular dementia increases as a person
ages, with people over 65 most at risk. Family history can also increase the risk, as issues such as strokes can
increase if a close family member has had one, meaning the risk for vascular dementia is higher. A person’s
ethnicity can also affect their likelihood of developing vascular dementia, as those who have a south Asian,
African or Caribbean background are at higher risk of vascular dementia, as related health problems such as
diabetes and high blood pressure are more common in these groups. In rare cases, genetic conditions may also
increase a person’s risk of vascular dementia, however there is a fairly low risk of inheriting vascular
dementia.
Causes of Frontotemporal Dementia
Frontotemporal dementia is less common type of dementia that is caused by clumps of abnormal protein
forming inside of brain cells. It is thought that these proteins damage the brain cells and cause them to stop
working properly. The connections between nerve cells in the lobes begin to break down, with the levels of
chemical messengers in the brain becoming lower over time. These messengers allow nerve cells to send
signals to each other and the rest of the body. As more nerve cells become damaged and die, the brain tissue
in the frontal and temporal lobes start to get smaller. The proteins mainly build up in the frontal and temporal
lobes of the brain at the front and sides, which are vital for controlling language and behaviour. Whilst it is
not fully understood why this occurs, there is often a genetic link with around 1 in 8 people with
frontotemporal dementia having relatives who were also affected by the condition. Frontotemporal dementia
affects the front and sides of the brain, also known as the frontal and temporal lobes. Whilst dementia
, typically affects those over the age of 65, frontotemporal dementia tends to start at a younger age, with most
cases being diagnosed with people aged 45-65. However, frontotemporal dementia can also affect younger or
older people. Similar to other types of dementia, it tends to develop slowly and gradually worsens over several
years. Frontotemporal degenerations are inherited in around one third of all cases, meaning those with a
family history of frontotemporal dementia are often more at risk of developing the condition. Overall, while
no specific cause for this type of dementia has been found, some protein structures are thought to affect how
the brain works, and risk factors include a family history of dementia.
P2: Explain the symptoms of three different types of dementia.
M1: Analyse how the different types of dementia might be identified by their symptoms.
People typically begin to become more forgetful as they age, and this is often a normal sign of aging.
However, for someone with dementia, these changes will be different, more severe, and can impact their life
more. Some individuals may only experience certain symptoms of a specific type of dementia, with some
people experiencing some of the later symptoms earlier than usual for the progression of that disease.
A person is advised to visit a GP if they are worried about their memory or are struggling with planning and
organising. Here, they will ask about their concerns and what they and their family have noticed. The GP can
carry out some simple tests to try to figure out what the cause is, and if necessary, they will be referred to a
specialist for assessment. The GP will also check other aspects of a person’s health, carry out a physical
examination and may organise some blood tests. They will ask about any other medicines a person is taking in
order to rule out any other possible causes of the symptoms and will typically ask them to carry out some
memory, thinking, and pen and paper tasks to assess how different areas of the brain are functioning.
If a person is referred to a specialist, they may visit a psychiatrist, an elderly care physician, or a neurologist.
This specialist may be based in a memory clinic that specialises in diagnosing, caring for and advising people
with dementia. At the setting they will assess a person’s memory and other areas of their mental ability, using
tests known as cognitive assessments. These tests aim to assess a number of different mental abilities,
including short- and long-term memory, concentration and attention span, language and communication skills,
awareness of time and place, and abilities related to vision. Whilst these tests can be a good indication of
dementia, the results may be influenced by a person’s level of education, meaning they should never be used
to diagnose dementia by themselves.
Symptoms of Alzheimer’s Disease
The symptoms of Alzheimer’s disease are typically mild to start with, however as the more brain cells are
damaged over time the symptoms become worse and begin to interfere with a person’s daily life. The rate at
which the symptoms progress is different for each individual. The first symptoms of Alzheimer’s disease tend
to be problems with vision or language rather than with memory. With Alzheimer’s, symptoms often depend
on the stage of the disease. Early symptoms can include memory loss, misplacing items, forgetting the names
of places and objects, a person repeating themselves regularly, and becoming more hesitant to try new things.
In this stage, there are often signs of mood changes, such as increasing anxiety, agitation and periods of
confusion.
As Alzheimer’s disease progresses, memory problems get worse. Middle-stage symptoms of Alzheimer’s
include increasing confusion and disorientation obsessive, repetitive or impulsive behaviour, delusions,
problems with speech or language, disturbed sleep, mood changes, difficulty performing spatial tasks, and
agnosia. Later symptoms include difficulty in changing position or moving around independently,
considerable weight loss, gradual loss of speech, and more serious problems with short and long-term
memory. Some people with the condition may find it increasingly difficult to remember the names of loved
ones and they may struggle with recognising their family and friends. By this stage, the individual with
Alzheimer’s disease typically needs support to assist them with everyday living, such as with personal care,
eating and using the toilet.
In the later stages of Alzheimer’s, complications such as pneumonia and other infections, falls and fractures,
bedsores, and malnutrition or dehydration can occur. In some cases, other conditions can be responsible for
symptoms worsening, such as infections, strokes, and delirium, and certain medications can also be
responsible. In this stage, the symptoms become increasingly severe and can be very distressing for the person
