Question

social factors with dementia

Answer 1

Dementia is a syndrome associated with deterioration of cognitive functions including memory, executive functions, language skills etc. Usually dementia is a disease of elderly with most common cause being Alzheimer's disease. Other Acquired causes like Hypothyroidism, vitamin B12 deficiency, Infections can also lead to dementia.

Majority of Neurodegenerative dementias are not curable. They progress and makes patients dependant on their relatives for activities of daily living. Thus social factors have a key role in dementia.

Certain dementias like Frontotemporal dementias are characterized by psychiatric symptoms like behavioural disinhibition. They misbehave with others, lack hygeine and etiquette, agrresive and violent behaviour as well as impulsive and careless activities. Thus they become a burden to the relatives or society and they are frequently institutionalized.

Alzheimer dementia patients in later stages develop insomnia and wander around in the neighbourhood disturbing other's sleep and this often leads to social problems. These patients have poor memory and they frequently argue with others, does mistakes in traffic, fails to identify familiar persons, defecate in open places and cause social nuisance. These patients often have urinary and fecal incontinence leading to poor hygeine and other caregiver problems.

Delusions are frequent in dementia patients. Delusional beliefs like Capgras syndrome where patient thinks that the care giver is replaced by imposter causes care giver stress and poor social life for dementia patients. Hallucinations which are abnormal perceptions in the absence of real stimulus contributes to abnormal social behaviour of dementia patients.

Changes in social environment has an adverse effect on dementia patients. These patients often find it difficult to cope up with changes in their routine or social environment due to the reduced cognitive reserve. Therefore adverse life events leading to changes in social support often destabilize dementia patients and leads to reduced survival. Also hospitalized and institutionalized patients have a poor prognosis compared to patients managed at home. The stress suffered by caregivers of demented patients is immense and hence they require adequate social support. Economical burden caused due to dementia has far reaching consequences on the society. Most of these patients have medical Comorbidities requiring regular medical supervision, which adds to the social and economic burden.

The prognosis of dementia patient is primarily dependant on the amount of social support. Social isolation is associated with reduced lifespan and adverse prognosis. Proper education of relatives and neighbours are essential part of dementia management. Society should understand the social problems associated with dementia , sort out solutions and provide adequate support to the demented patients and their family.