Vergeetachtig of dement?
Omgaan met dementie
Beeld: Getty Images | Chantal van der Leest |
“Oma wordt een beetje dement.” Het woord ‘dement’ heeft in onze taal bijna dezelfde betekenis gekregen als ‘vergeetachtig’. Maar dementie houdt meer in dan alleen geheugenverlies. Hoe weet je of iemand dementeert en kun je er iets aan doen?
Het woord dementie geeft aan dat er een achteruitgang is in het functioneren van de hersenen. De verschillende taken die de hersenen hebben, de zogenaamde cognitieve functies, worden niet meer goed uitgevoerd.
Verschillende soorten dementie
Niet alleen het geheugen is aangetast, maar ook bijvoorbeeld het taalgebruik (afasie), motorische planning (apraxie) en de herkenning van mensen en voorwerpen (agnosie). Iemand met dementie heeft last van deze symptomen tijdens normale dagelijkse bezigheden.
De achteruitgang in cognitie kan het gevolg zijn van vele aandoeningen. De ziekte van Alzheimer is het meest bekend. Maar ook Parkinson, Creutzfeld-Jakob, Huntington en zelfs Aids kunnen dementie veroorzaken. Allen hebben tot gevolg dat de patiënt minder goed kan functioneren, maar op welke manier precies, ligt aan de locatie en aard van de dementie.
Verloop
Een beginnende dementie, met name Alzheimer, is zo sluipend dat het snel onopgemerkt blijft. Dementerende ouderen kunnen goed smoezen verzinnen en hun partners vangen veel problemen voor ze op. Ze helpen ze met spullen die kwijt zijn en nemen taken van ze over.
De problemen worden vaak ineens zichtbaar in onverwachte situaties. Bijvoorbeeld als de partner overlijdt of de patiënt een heup breekt. Aan deze nieuwe situatie kunnen dementerenden zich slecht aanpassen. De achteruitgang wordt dan ineens schrijnend duidelijk.
Er kunnen rare situaties ontstaan. De bril die al dagen kwijt is, wordt teruggevonden in de diepvries. De koelkast puilt uit met een voorraad melk die elke dag wordt aangevuld. De patiënt vraagt naar mensen die al jaren dood zijn, of weet ineens niet meer hoe hij moet koffiezetten.
De eens zo beschaafde man tapt de ene schunnige mop na de ander, in een situatie waarin dat helemaal niet past. Veel mensen raken ook gedesoriënteerd. Dat wil zeggen dat ze niet meer weten waar ze zijn en in welke tijd ze leven. Ze zien hun kind bijvoorbeeld aan voor hun moeder.
Doordat deze dementerende ouderen zelf ook merken dat er iets mis is, worden ze vaak achterdochtig. Ze denken dat anderen dingen verplaatsen of dat ze voor de gek worden gehouden. Of erger nog: dat andere mensen van hen denken dat ze gek worden.
Langzamerhand zullen er zoveel functies uitvallen, dat de patiënten steeds meer hulpbehoevend raken. Ze lopen het risico om contact te verliezen. De wereld om hen heen is niet meer herkenbaar. Ze zitten liever in hun hoofd, met hun eigen herinneringen.
Opvallend bij Alzheimer is dat de patiënt vooral last heeft van zijn beperkingen. Sociaal gezien blijven ze erg vaardig, ze behouden hun karakter en ervaren emoties.
Oorzaak
Voor de meeste soorten dementie spelen de genen een grote rol. Deze bepalen hoe de hersenen zich ontwikkelen. Bij Alzheimer uit zich dit in een afwijking in de eiwitproductie.
In de hersenen ontstaan eiwitophopingen, zogenaamde tangles en plaques, die de overdracht van informatie bemoeilijken. Andere mogelijke oorzaken, gebrek aan vitamines of blootstelling aan zware metalen, zijn nog steeds niet bewezen.
Diagnose
Om zeker te zijn van dementie is het verstandig een arts of een geheugenpoli te bezoeken. Zij kunnen met zekerheid vaststellen of het om dementie gaat en welk type.
Ook kunnen zij andere oorzaken van de problemen uitsluiten. Veel van de symptomen kunnen namelijk ook wijzen op een delirium, normaal geheugenverlies, een depressie of angststoornis.
Behandelwijzen
Er bestaat geen geneesmiddel voor dementie. Het is een neurodegeneratieve aandoening. Dit wil zeggen dat het verloop zich niet kan verbeteren, je kunt het hooguit vertragen.
Door gezond te leven, zowel geestelijk als lichamelijk, kan het lichaam de gebreken die dementie met zich meebrengt beter opvangen. Hierdoor zijn bijvoorbeeld de hersenen getraind in het zoeken van informatie en zorgt het hart voor een goede doorbloeding van al die zenuwcellen in het brein.
Het ondersteunen van de mitochondriële functies, het corrigeren van het vetzuurprofiel en het overschakelen naar een ontstekingsremmende voeding vertragen de evolutie van het ziektebeeld.
Ook kan de kwaliteit van leven zo lang mogelijk worden behouden. Geheugensteuntjes of hulpmiddelen in huis kunnen bijdragen aan de zelfredzaamheid. Omstanders kunnen leren hoe ze het beste de dementerende kunnen helpen en benaderen. Begrijpen wat dementie inhoudt, is een belangrijke eerste stap.
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