About the brain. For the relatives.
Dementia is a disease and not a natural and inevitable consequence of getting old. Several different diseases can cause dementia. Alzheimer’s disease is the most common cause of dementia and accounts for 62% of all dementia cases, followed by vascular dementia with 17%, Lewy Body dementia with 4%, Frontal Temporal Dementia with 2%. The last 15% consists of different diseases.
With this little description, we hope to make you wiser about which different areas the brain controls and how dementia can affect the brain. Dementia is a disease of the brain that affects various functions due to the changes it causes in the brain. Most importantly, the connection between the cells in the brain are destroyed and some of the brain cells die. The brain cells die for various reasons and to understand the significance of the brain cells dying, it is necessary to know a little about how the normal brain works and how the cells work together.
The brain controls the body; it initiates all movements and reactions. It perceives sensory impressions and controls our behavior and thoughts. If you burn your fingers, a message goes via the spinal cord to the brain; you remove your fingers and think or say “off”.
As a relative of a person with dementia, one needs to understand that cognitive deficits (such as memory problems and language disorders), behavioral changes (such as challenging behavior and anger), and motor symptoms (such as slow movements or paralysis) tell something about which parts of the brain is affected by the dementia disease that the person is suffering from.
People with dementia cannot help the way they behave and they cannot help if they forget everything: It is due to the disease and they cannot “just pull themselves together”. It is also important to emphasize that people with dementia do not try to annoy their relatives, but that they react as they do because the demands we have made, might be too demanding and they do not have the resources to do the things different than they do, even though they themselves wish they could. The problems you as a relative experience when your spouse, parents, grandparents or friends have dementia depend on where the disease has affected the brain.
The brain is like a building and it needs maintenance. The cells need to be used to keep going. Humans have over 22 billion brain cells, but it is not the large number that is important, but rather the cooperation between the cells. The brain continues to develop through life if it is stimulated and we form new brain cells throughout life. A single brain cell can have more than 10,000 connections to other cells. The visual cortex, for example, has up to 20,000 connections with other cells. When a brain cell is dead, it can no longer send or receive impulses and the puzzle that the brain constantly is putting together breaks down. This is what the relatives may experience when the person with dementia no longer can find their way or no longer remember birthdays, even though they always have been good at it.
In the brain center, cells are assembled into large nuclei that act as a kind of assembly point or relay station. The impulses meet here and enable cooperation and redirection of impulses to other places in the brain. We learn through childhood to sort out all the impressions the brain receives so that unnecessary information is rejected and this way the brain only has to deal with what is relevant. When these areas of the brain are affected by dementia, the person with dementia may have difficulty concentrating and seem easily distracted. That is, if a person concentrates on looking in a magazine and then there comes a loud sound, then he / she cannot again concentrate on the magazine, but will try to find out where the sound is coming from or the person may be putting on clothes and if someone says something, he or she will stop completely.
In other areas, the brain gathers different sensory impressions so that they make sense. If, for example you see something yellow on four wheels, which comes towards you and which says a certain sound, the brain connects the two sensory impressions and we perceive that it is a yellow car coming. If a person is affected by dementia in these areas, sensory impressions are misinterpreted. In the case of the sense of hearing, music can be perceived as noise or one cannot understand what is being said, even though one hears normally and can distinguish language sounds. This may mean that the world no longer makes sense. The person with dementia, for example, cannot recognize his toothbrush and therefore does not know how to use it and might try to comb his hair with it.
After the senses have been processed in the healthy brain, they usually reach the frontal part of the brain, where plans are made and where behavior is controlled. Here is a kind of quality control. “Is it okay for me to act this way or not?” This part of the brain is initiating, controlling and directing all conscious behaviors. If there is damage in these areas, one cannot direct and control actions or act in accordance with norms and values in one’s own culture.
For people with dementia, this may mean that they practically cannot figure out how to perform ordinary actions, such as how to get dressed, how to take a bath, etc. If the person is affected elsewhere frontally, they may have difficulty controlling her actions and controlling her temper.
Injuries in this part of the brain can make it harder to organize one’s life, to take initiative and to keep track of things. Some people experience mood swings and may become angry or cry for no reason. Others become more uninhibited and may say embarrassing and cross-border things. People with dementia in the frontal part are often a challenge for both relatives and caregivers. They can walk around without clothes on because they are not freezing. They can snatch the cake dish and empty it instead of sending it around and if a woman comes by, a man can slap her behind if he wants! It is not about him being uneducated, but about him being unable to inhibit his impulses or show empathy. What is important here, again, is that this is not a conscious behavior. The person with dementia act on an impulse, that he could not inhibit.
First you can help people with dementia to create a structure in their everyday life, so that they do not have to do it themselves, because that is exactly what they are unable to do. It is also a task for relatives and caregivers to help them so that they do not end up in situations that they cannot handle.
Overall, one can consider the brain as a company where different departments have different tasks. Alexander Lurija, who was a Russian neuropsychologist, divides the brain into blocks according to function. Block number one consists of the brain stem, the emotional brain and the cerebellum. These areas control alertness, reaction readiness such as fight or flight, temperature, blood pressure, respiration, hunger / thirst and sex drive / lust. It is the brain’s energy center. In relation to the image of a company, it here “gate keeper” watches. The concierge opens the business, makes sure the energy supply runs and decides who comes in and who does not.
Block number two consists of the midbrain: It is parietal lobe, the temporal lobes and the occipital lobe and here the impressions that come from block number one are processed. In picture of a company, it can be said that it is the experts who receive and process the materials that are sent into the company. Block three consists of the frontal lobes and the motor part of the brain. This block is responsible for planning, managing and adapting behavior. This is where new ideas are created and thought processes of cognition emerge. The motor part of block three assembles and performs movements. If we see the brain again as a company, then block three is where the management and the boss sit. Block three is closely related to both block two and one. The managers of the company make sure that the quality of the products is in order. When you talk about brain “products”, we mean movement and actions. The quality of a movement is about being smooth and well-coordinated. The quality of actions and behaviors depends on what is culturally appropriate in a situation.
If dementia strikes in block one, the affected person will have great difficulty staying awake and may fall asleep in the middle of an activity. This is sometimes seen in people with the Lewy Body dementia, as this type of dementia can affect the brainstem level. If dementia hits block two, you see problems with sensory processing and you have difficulty understanding the world around you. Citizens with Alzheimer’s dementia are frequently affected here and in addition to memory problems, they have language and sensory challenges. If dementia strikes block three, as occurs with frontotemporal dementia, it is seen that the person has difficulty controlling his or her behavior or loses the idea of how to perform actions.