Dear Readers,

Shawna-Gay writes Lifeline from Kingston 6, where she lives with her sisters, two cousins, her uncle, and her grandmother. She is very concerned about her 82-year-old grandmother, who used to run the entire show and be in everyone's business but now cannot recall her own address.

Grandma is not eating well, has slowed down a lot, and is not keeping herself as clean as she used to. She is calling people thieves and calling out to persons unseen. A few weeks prior to the writing of this letter, grandma wondered out of the house and was missing for several hours. She was only discovered when a family friend saw her walking alone and called Shawna-Gay to let her know that her grandmother was alone on the road. Grandma was very agitated when they collected her. The doctor they took grandma to told them that it looked like she had dementia, maybe Alzheimer's disease.

Shawna-Gay asks Lifeline if it's not madness when someone talks to people no one else can see and becomes aggressive as this behaviour is not normal for grandma .She asks if her grandmother might have had a nervous breakdown as well.

First, it is important for Shawna-Gay and her relatives to realise that individuals who suffer with dementia, inclusive of Alzheimer's disease (AD), can experience hallucinations. Hallucinations refer to experiencing something which is not there (unreal). Hallucinations usually occur in the later stages of the disease. The person with Alzheimer's may feel, hear, taste, or even smell something that isn't there. The false perceptions are caused by degenerative changes that occur in the brain.

With dementia, the use of anti-psychotic drugs is associated with an increased risk of both stroke and sudden death and so such treatment must be used with caution - if used at all. Many people experiencing hallucinations in dementia respond positively to treatment with anti-dementia drugs.

Lewy Body dementia (LBD) occurs in prevalence second only to Alzheimer's and also tends to resemble Parkinson's disease, which, initially, is a disorder associated with slow movement.

Sometimes people with Parkinson's disease later develop dementia and hallucinations, resulting in a person manifesting a wide spectrum of symptoms encompassing a shuffling gait, a stiff gait, tremors, hallucinations, a blank expression, repeated falling, and sleep disorders. In effect, Lewy Body dementia can resemble both Parkinson's disease as well as Alzheimer's. Eventually, they also exhibit problems with urination, swallowing, and constipation.

Treatment of dementia is mostly geared to relieving the presenting symptoms. There is no known cure for dementia at this time, unless it is a secondary dementia, which has as its root cause, for example, medication a person might be taking. In such an instance, stopping the drug would reverse the symptoms.

Living with a relative suffering with dementia is far from easy and requires a team approach involving close family, the caregivers, and a medical team, which can include the physician, physiotherapist, occupational therapist, speech therapist, dietitian, and other health personnel. Many lifestyle changes are often needed to accommodate the disease. Usually, embracing the following guidelines is helpful:

Learn as much about dementia as you can.

Reduce all sources of stress in the afflicted individual's life. Stress and anxiety are well known to worsen the symptoms of dementia.

Depression is common and should be treated.

Exercise relieves stress and is good for the body tone, health, and mood. Go for walks with the affected person.

Avoid isolation. Keep the affected individual involved in family activities when possible.

Create a predictable routine for the person based on meal and sleep times.

Customise the home to prevent falling. Install rails, ramps, special chairs, and grips where necessary.

Play card games and puzzles that exercise the mind and engage cognitive function, thus slowing the progression of the disease.

Remember that the person with dementia does not necessarily intend to be difficult, but the world that they perceive differs from the regular world their caregivers inhabit. They can look in a mirror at themselves and see a stranger! If they seem frustrated, find out why. they may be hungry, thirsty, or tired and need to rest. Have patience with them and use eye contact and touch to reassure them.

Problems experienced by dementia sufferers include:

Reduced ability to detect movement;

Reduced ability to detect colours,

Problems with recognition of faces, words, objects;

Problems with depth perception;

Problems directing or changing gaze;

This results in:

Bumping into things;

Getting lost;

Clumsiness when reaching for objects;

Problems locating people or objects;

Misjudging distances.

The relatives and caregivers will cope better once they truly begin to understand the different world in which their loved one co-exists with them. Even so, the experience is not only about making changes to accommodate the ill individual, but will include poignant moments of lucidity, sharing, and love. Watch out for those worthwhile moments!

Write to: Lifeline, PO Box1731,

KGN 8

AJM