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Unit 17 Health and Social Care Distinction
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A completed coursework unit at Distinction level.
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Dementia is a syndrome in which an individual experiences a decline in theircognitive abilities due to a physiological change in their body. Dementia acts as an
umbrella term for various different disorders that are caused by changes in the brain
resulting in subsequent memory loss: vascular dementia, lewy body dementia,
frontotemporal dementia, creuzdfeldt-jakob and Alzheimer's (Alzheimer’s Society,
2020).
Alzheimer’s Disease
In Alzheimer’s disease, the
connections between nerve cells
become damaged. Abnormal levels
of proteins build up in the brain
resulting in plaques which damage
the blood supply to the brain,
subsequently resulting in nerve
cells beginning to die. Between
neurons there are synapses across
which neurotransmitters are
passed in order to send chemical
messages throughout the nervous
system (National Institute of Aging,
2020). Another feature of Alzheimer's is that the connections between neurons
become damaged, meaning that neurotransmitters cannot pass across them,
subsequently resulting in slower reactions to stimuli due to signals being unable to
pass between neurons (Alzheimer’s Society, 2020).
Once an individual reaches the age of sixty five, their risk of Alzheimer's doubles
every five years (NHS, 2020) which is why Alzheimer's is significantly more prevalent
in the elderly. As the overall UK population is aging (NHS, 2020), more and more
individuals are developing Alzheimer's as it is something that becomes more
common with age due the human body beginning to work less effectively. With age,
the brain begins to shrink which can then result in unstable molecules being
produced in excess. These molecules can then cause proteins to begin to become
entrapped within the brain and subsequently damage neurons which therefore
results in Alzheimer's developing (Cherry, 2020).
Additionally, individuals with down’s syndrome have
an increased risk of developing the disease as the
genetic trigger for the syndrome can also result in
amyloid proteins developing in tangles which are the
main characteristic of Alzheimer's. Since some
strong evidence links heart health to brain health
(NHS, 2020) and many individuals with down’s
syndrome will experience heart conditions, this may
therefore increase their risk of Alzheimer's.
Recent research has linked cardiovascular heath to
an individual’s risk of developing Alzheimer's and
thus factors that negatively impact an individual’s cardiovascular health will have an
effect on their risk of developing Alzheimer's. Primarily, lifestyle factors and pre-
,existing disorders affect an
individual’s cardiovascular health
such as a lack of exercise, obesity,
hypertension, poorly controlled type
2 diabetes and high cholesterol
(Mayo Clinic, 2020). It is thought
that cardiovascular disorders can
cause Alzheimer's as they can
result in defects, preventing blood
and thus oxygen from effectively
leaving the heart. If the brain is
starved of sufficient oxygen it may become hypoxic (NHS, 2020) which can thus lead
to cell death, something associated with Alzheimer's which can then cause
symptoms associated with Alzheimer's.
Alzheimer’s has been found to be linked
to a faulty APOE gene which is found on
chromosome 19 and plays a role in
handling fats in the body (Alzheimer’s
Society, 2020). Inheriting a faulty variation
of this gene increases the risk of an
individual developing the disorder,
especially if the APOE4 gene is inherited
which has been most strongly linked to
the disorder. However, having the disorder does not conclusively determine that an
individual will develop the disorder as multiple factors affect its development within
the body. Despite the gene being linked to alzheimers and thus there being a genetic
link to the disorder, it is yet unknown how the gene increases the risk of the disorder
(NHS, 2020).
In an individual with Alzheimer's, the musculoskeletal system will be negatively
affected by the disease. As Alzheimer's results in neurotransmitters crossing the
synapse between neurons significantly slower, an individual will react to stimuli
slower than someone without Alzheimer's due to the electrical impulses in their brain
failing to travel at a sufficient speed (NHS, 2020). Therefore, movement will be
significantly impaired in an individual with Alzheimer's resulting in them taking shorter
steps, having poor balance, and shaking or stiffness due to muscles becoming rigid.
Combined with the physical symptoms, individuals will also experience psychological
changes due to Alzheimer's. As well as problems with consolidation of short term
memory to long term memory, individuals with Alzheimer's will typically experience
mental health disorders such as depression (Alzheimer’s Society, 2020).
Experiencing depression may then negatively influence an individuals condition as
the symptoms of depression may prevent them from accessing their treatment. Since
one of the symptoms of depression is difficulty leaving the house, if an individual did
not have home treatment then they may struggle to get the motivation to attend their
appointments and receive treatment vital to keep them stable. Similarly, experiencing
memory loss may result in individuals failing to remember that they have
appointments which may then negatively affect their health and wellbeing. If
appointments were not attended then an individuals health and wellbeing will not be
monitored which may result in a subsequent decline in their condition without
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,intervention.
As Alzheimer's progresses, an individual can become aggressive as they will be
confused and lose control over their emotions, which may cause them to be
perceived as a burden by their family as they will be challenging to keep safe so may
be sent into Residential or Nursing Care to ensure they are safe and their health is
monitored. If this occurs then the individual may struggle more with their mental
wellbeing due to feelings of abandonment as they won’t be able to speak with their
family whenever they please due to being further away. However, being surrounded
by many other individuals with similar health conditions in a Care Home may also
help to improve their wellbeing as their social needs will be met due to being
surrounded by others.
As one of the main symptoms of Alzheimer's is decline in memory, it is often easy to
notice when it is developing or has developed as memory is used frequently in
everyday life thus if it begins to decline, other individuals will typically identify the
issue quickly.
In the later stages of Alzheimer's individuals will typically experience more noticeable
signs of Alzheimer's as they will begin to struggle with everyday tasks such as
obtaining adequate nutrition, urinating and speaking (NHS, 2020). Often in this
stage, full time care is required as the individual cannot reliably perform activities
needed to sustain life, such as eating, thus warranting additional support to ensure
that the individual's health is maintained as far as possible.
In the earlier stages, symptoms
will be primarily psychological
as the disease is in the brain
and therefore interfering with its
ability to function as normal.
Affected individuals may begin
to experience symptoms
typically associated with mental
illness such as hallucinations
and changes in their mood.
These symptoms will primarily
be experienced by the affected
individual but could still affect those around them as hallucinations may cause the
individual to become violent or act strangely towards others.
Neuropsychiatric symptoms are now recognised as core features of Alzheimer's
disease (NHS, 2020). As many structural features of a brain with Alzheimer's are
associated with neuropsychiatric symptoms, they are commonly experienced by
those with the disease. Four symptoms associated with Alzheimer's (apathy,
depression, psychosis and agitation) were identified to share some pathogenic
processes linked with the APOE4 gene which can cause Alzheimer's (NHS, 2020.
Chemical changes will occur in the brain due to ineffective neurotransmission which
can therefore result in mental health disorders caused by reduced amounts of
neurotransmitters, such as serotonin, which can lead to depression. Experiencing
Alzheimer's and depression may then result in treatment resistance due to forgetting
appointments, or lacking the motivation to attend appointments. If check-up
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, appointments are not attended then an
individual will deteriorate as they will not
be monitored therefore their treatment
plan will not change to meet their new
needs.
Experiencing Alzheimer's can have
severe negative effects on an individual's
wellbeing due to feelings of lack of
control over their symptoms. As many
symptoms cannot be treated by
professionals and Alzheimer's cannot be
reversed, individuals may feel hopeless
with regard to their condition which may result in them abandoning treatment and
subsequently deteriorating.
Alzheimer’s disease is a progressive disease
as symptoms get worse as the disorder
develops and there will not be any large
variations in presentation day-to-day
(MayoClinic, 2019). As the disease progresses,
symptoms will gradually become more severe
and will have a greater impact on an
individual’s daily tasks.
Alzheimer’s symptoms are primarily cognitive
and therefore can be easily differentiated from
other types of dementia as there will be limited
presentations of other symptoms. In the early and middle stages of Alzheimer’s, an
individual will experience no physical deterioration (MayoClinic, 2020) other than that
expected at their age and therefore Alzheimer’s cannot be confused for Lewy body
dementia of Parkinson’s dementia as the key symptoms of decreased motor function
will not be present during the diagnostic procedure.
However, many symptoms of Alzheimer’s dementia can also be present in vascular
dementia and therefore it is important to distinguish between the two disorders in
order to ensure that treatment is valid. Memory loss, mood swings, depression and
difficulty with verbal communication are all symptoms of both types of dementia
(Heerema, 2019) and can develop similarly in each type.
By taking a medical history, it can more reliably be determined which type of
dementia is present as certain elements in an individual’s history will only be
consistent with one type. If an individual has a history of cardiovascular disorders, or
has recently had a cerebrovascular accident (Heerema, 2019), then it is likely that
they will have vascular dementia as opposed to Alzheimer’s as strokes lead to
vascular dementia in 20% of cases (Alzheimer’s Society, 2020), however the
percentage is significantly lower for Alzheimer’s.
Additionally, Alzheimer’s disease develops progressively, whereas vascular
dementia can develop in a step-like manner (Heerema, 2019) as symptoms can
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