Cognitive Impairment
Cognitive Impairment can have many contributing causes which may be temporary or chronic. For older people, some common syndromes are mild cognitive impairment, delirium, and dementia.
Mild Cognitive Impairment
People with mild cognitive impairment (MCI) experience noticeable declines in memory, language, or thinking skills compared to others their age, but they remain independent and capable of performing everyday tasks. This syndrome can have many causes; therefore, the time-course of the symptoms varies widely.
The treatment of MCI is tailored to the contributing factors identified in your appointment. This may include treating medical or mental health issues and lifestyle changes (sleep, nutrition, exercise).
For a small number of people, mild cognitive impairment progresses to dementia over time.
Some people may choose to get additional testing for Alzheimer's pathology (pre-clinical Alzheimer's disease) and can be referred to a research centres to research new therapies.
Read more about MCI here at Dementia Australia.
https://www.dementia.org.au/brain-health/mild-cognitive-impairment-mci
Delirium
Delirium is an acute, fluctuating change in attention and thinking often triggered by infection, injury, medication, or pain.
People with dementia are more prone to developing delirium. People with lower cognitive reserve can get delirium from minor changes such as urinary tract infections or a change in environment.
Delirium can affect conscious state (hyperactive or drowsiness) and has a variable duration of days to weeks.
Treating the underlying cause often improves delirium. It can be helpful to screen for:
- Infections
- Pain
- Hunger/thirst
- Constipation/diarrhoea
- Sleep-wake cycle disruption
- Medication side-effects
- Confusing stimuli
Delirium can last a variable amount of time depending on how big the triggering illness/stimulus was. In general, delirium may last hours, to days to short weeks, and the symptoms can fluctuate.
Dementia Australia is a valuable resource for information about delirium and can be called for additional support.
https://www.dementia.org.au/living-dementia/mood-and-behaviour-changes/delirium
Dementia
Dementia is an umbrella term for several conditions that cause progressive cognitive decline affecting daily activities. The most common types are Alzheimer’s, Vascular and Mixed Dementia. Others include Parkinson’s, Lewy Body and Frontotemporal Dementia.
Symptoms develop gradually over months to years and affects different aspects of daily functioning and thinking. Cognition problems present in different ways for different people.
Alzheimer’s Dementia typically affects:
1. Memory
2. Language and communication skills
3. Visuospatial skills
4. Executive function e.g. planning tasks
5. Social behaviour
While there is no cure for Alzheimer’s, there are effective strategies to make everyday activities easier and safer. With holistic management, people with dementia still enjoy their hobbies, and have meaningful relationships. Assistance for daily functioning could include reminders for medications, help from carers, allied health or nurses. Additional Care can come from MyAgedCare or privately funded.
Read more about different types of dementia:
https://www.dementia.org.au/about-dementia/causes-and-types-dementia
Medication's for Alzheimer's Dementia
1. Acetylcholinesterase Inhibitors
Acetylcholine is a neurotransmitter in the brain that allows nerve cells to talk to each other. People with Alzheimer’s dementia have less acetylcholine in the brain.
Acetylcholinesterase inhibitors increase this neurotransmitter in the brain called acetylcholine to boost memory for longer temporarily. Between 40-70% of people find some benefit. The medications are generally more effective in mild-moderate Alzheimer’s dementia and less effective when dementia is severe.
There are 3 acetylcholinesterase medications with similar efficacy:
Donepezil
Galantamine
Rivastigmine capsule or patch
Side effects affect around 1 in 10 people and can include nausea, vomiting or diarrhoea which often gets better after a short time. A rare but potentially serious side effect can be a slow heart rate.
Memantine
People with Alzheimer’s disease can have too much of a neurotransmitter called glutamate which can damage nerve cells. Memantine protects the nerve cells by blocking the glutamate NMDA receptor.
Memantine can be added to an acetylcholinesterase inhibitor in moderate Alzheimer’s disease to have a small improvement in cognition.
Aged Care Support
There are many options for aged care supports in Australia and your geriatrician can provide guidance for your situation. Some aged care support options include:
Education for carers improves the quality of life for people with dementia. A key principle in the compassionate dementia care is actively including the person and their loved ones in decisions that impact their daily lives.
Many people with dementia can live safely at home with good social supports. Some people with dementia may benefit from support in a residential aged care home. If you are interested in taking a free online course, check out Understanding Dementia or Preventing Dementia (https://mooc.utas.edu.au/). There are also organisations that directly support carers such as Dementia Australia, Dementia Support Australia and Carer Gateway.
There are several private care providers that you can hire for additional help. This may be beneficial for some people who choose to have additional support to their MyAgedCare services or those who are waiting for or not yet eligible for services. Hourly costs can vary for the services provided, and the time of day. Some providers have live-in carer options if this suits your situation.
The Commonwealth Home Support Program helps you access entry-level support services to life independently and safely at home.
You can apply by contacting MyAgedCare. If you’re approved you could get services such as gardening, shopping assistance, meal delivery, personal care, nursing care, allied health or respite.
Support At Home Classifications 1 to 8 (previously called Home Care Packages Level 1 to 4) provide you with home care services subsidised by the Australian Government.
Support At Home may include:
o Clinical supports e.g. nursing care, occupational therapy and podiatry
o Independence support e.g. help with showering, taking medications, transport and respite care
o Everyday living e.g. cleaning, gardening, shopping and meal preparation.
Based on your individual needs, you may be approved for assistive technology and home modifications.
Moving home into aged care can be helpful for older people and their families if there is a need for a more supported environment. Aged care homes provide accommodation, daily living services (meals, cleaning), nursing care and personal care. In addition, they provide opportunities for social and physical activities for residents.
Staying at an Aged Care Home can be temporary (e.g. respite or the transition care program) or long-term.
People may personalise their rooms with personal items and make it their home. Families and friends can visit and sometimes take residents out for outings.
Aged care can relieve stressors that older people and their carers face by providing a lot of services in one place.
Doctors such as GPs and Geriatricians can also provide medical care by visiting aged care homes. Dr Giselle Bennett provides aged care home visits.
How much it costs to live in Aged Care depends on the place, your income and assets assessment and any optional goods and services. You can get an estimate on the MyAgedCare.gov.au website.