Early Onset Dementia
Early Onset Dementias or dementias of the working age have attracted a lot of attention over the recent years. The traditional division of health and social care service around the age of 65 has considerably disadvantaged patients with Early Onset Dementia whose care will usually fall between various services.
Early Onset Dementias encompass a group of progressive brain conditions that are associated with a number of cognitive, behavioural and physical problems. While the '65 year old' cut off point would be easily challenged from the biological view point, it is equally acknowledged that this group of patients will have a distinct set of needs that would justify establishing specialist services. For instance, these patients are likely to be physically more able compared to their elderly counterparts which would make behavioural changes more difficult to manage. They also are likely to have young families who will find such a diagnosis quite hard to accept. Financial commitments and possible employment issues are usually quite considerable. Further, carers of this patients' group are likely to present with a distinct set of needs.
Consequences of Early Onset Dementias
Depending on the nature of the dementing illness, patients usually present with a specific set of progressive cognitive disabilities. Certain types of dementias will present with alteration in personality, behaviour and difficulties in experiencing and expressing emotions. As the disease progresses, patients are likely to present with physical deterioration that will lead to complete dependence on others and the emergence of a number of important end of life issues.
Emotional Implications of Early Onset Dementias
It is hardly surprising that patients with Alzheimer Disease for example may find it quite hard to cope with the diagnosis; with increased risk of depression. It is also expected that a lot of patients will be quite distressed and frustrated with their failing abilities. In disorders such as Fronto-temporal dementia, apathy and possible disinhibition are common features. Further, patients will struggle to display specific social emotions such as empathy, sympathy and embarrassment which would add to the care giving burden.
Cognitive impact of Early Onset Dementias
Cognitive impairment could manifest itself in relation to various mental faculties. These would include memory impairment, visuospatial impairment and inability to coordinate fine purposeful movements. It is not uncommon for patients' language abilities to be compromised. For instance, patients' abilities to express themselves or understand others could continue to deteriorate over time till patients are no longer able to communicate their views or their needs. Patients' ability to communicate their wishes in other modalities such as written language can also suffer. Executive dysfunctions would also lead to problems in certain areas such as planning, prioritizing and problem solving.
Specific types of dementias will present with specific cognitive and behavioural patterns and would call for specific treatment strategies. Associated neurological and other physical problems are likely to complicate the picture even further and add to the management challenges.
Treatment of patients with Early Onset Dementias
Treatment of Early Onset Dementia is essentially multidisciplinary. While certain medications can slow the progress of Alzheimer Disease, the treatment of many other illnesses would be primarily symptomatic. A holistic multidisciplinary care plan will have to take into account a number of complicated clinical, social, environmental, ethical and medicolegal issues. Maintaining patients' safety and quality of life will be at the top of the priority list. A number of pharmacological and non pharmacological approaches are available for patients with Early Onset Dementia. Access to psychological therapies should always be considered.
The importance of caring for the carers could not be over emphasized. Empowering patients and their families to plan their future and make difficult decisions early on in the illness is a favoured approach by many specialist teams.