The brain is a complex puzzle, and when compared to other organs such as the heart, kidneys, and lungs - we still know hardly anything about the computer that sits above our shoulders. We have a pretty good grasp on neural connections, but we are just scratching the surface around how information is processed. Some would argue that we are still trying to understand the basics. That brings us to the blog topic of dementia. It is no surprise that dementia is on the rise worldwide as medical advances improve and life expectancy goes up. (COVID drops the numbers slightly, but overall, life expectancy is still trending upward) The startling fact is that, with very little resistance, dementia has snuck its way into the top 10 causes of death, not only in the U.S., but across the globe.
A few drugs have been approved to slow the disease progression, but to date, no cure exists. The burden on the patient and their extended family is heavy. From a personal perspective, we lost my grandmother this past June from advanced Lewy-body dementia. (The same thing that was afflicting Robin Williams) To watch her slowly slip away over a 3-year period was hard to witness. She lost her personality and for the better part of her last year -- she no longer recognized us.
As we age, it's normal to lose some neurons and neuronal connections in the brain. However, with dementia and related neurological illnesses, the losses are far greater. At first symptoms can be mild, but as more connections disappear, the brain continues to atrophy (shrink + die). Alzheimer's is NOT normal aging. -- See image below:
Not all dementia is the same -- many times you will hear Alzheimer's and dementia used interchangeably - but that is simply not accurate. Dementia is the umbrella term for the overall cognitive decline, the loss of memory severe enough to affect the patient's activities of daily living, and Alzheimer's is simply the most prevalent form. To make an accurate diagnosis even harder - many people have mixed dementia, which could include multiple types.
As a first responder, it’s critical to understand how to best approach situations involving someone living with dementia, as well as their likely exhausted loved ones. The call volume for dementia related illnesses is only going to increase. Unfortunately, most pre-hospital professionals received little to no formal training on how to deal with this special population. Per the Alzheimer's Association, to make the EMS workforce more dementia competent, many agencies across the country are taking a simple approach to communication, called "TALK"
T- take it slow
A- ask simple questions, and allow ample time for response
L- limit reality checks (they hate the pressure of being quizzed or getting new info)
K- keep eye contact
Some other items include - getting on their level, introducing yourself, and approaching them from the front -- they generally don't like surprises.
If the patient becomes agitated during the exam, feel free to divert the conversation to something more pleasant. Focus on their abilities and keep in mind that reason or logic may not work with this group. Additionally, do not get tunnel vision, please remember that most of these patients are elderly and THEY STILL HAVE COMORBIDITIES!! Look at the entire clinical picture for these highly vulnerable patients. The nature of our work is chaotic by its very nature. At any given time in the ambulance or in the patient's home, they have multiple providers completing different tasks simultaneously. This environment can only exacerbate the anxiety someone with dementia is experiencing. The last take home message is that we should all take a moment to reassess our approach and bedside manner with these individuals. We also need to have some patience and grace for their extended family members.
October 16, 2023
Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP
Pass with PASS, LLC.