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When we think of dementia, we often think of pathological or biomedical models or perspectives of dementia. These models address neurodegeneration, vascular, and neuroinflammatory causes of dementia and focus on treatments that can prevent, delay, slow down and perhaps one day cure dementia. The biopsychosocial model or perspective explores the integration and interactions of the various biological, psychological, and social factors that contribute to the disease. This more comprehensive perspective centers on exploring the biopsychosocial aspects of dementia as an integrated holistic or “whole person” approach. In particular, this model examines how people with dementia, their care partners, families, healthcare providers, society at large, and in particular, underrepresented communities, can function together to improve outcomes and quality of life to those affected by this disease.
From the biomedical point-of-view, a vascular model of dementia proposes that dementia is caused by damage to blood vessels in the brain, which leads to a lack of oxygen and nutrients reaching the brain. Risk factors include diabetes, high blood pressure, hyperlipidemia and smoking. Vascular dementia symptoms may include short-term memory loss, spatial-temporal impairment, language difficulties and facial numbness. The neuroinflammatory model, dementia is caused by inflammation in the brain, which leads to damage to nerve cells. Causes of inflammation can include brain or spinal injury, chronic or traumatic stress, viral infections, metabolic disorders and lifestyle. This model is more commonly associated with Lewy bodies and frontotemporal dementia and can impact thinking and reasoning, personality, behavior, sleep, and memory, causing hallucinations and Parkinson-like neuromuscular symptoms.
In the biopsychosocial model the biological, psychological, and social factors can influence health and well-being. For example:
A psychological aspect of dementia includes the emotional and behavioral changes that often accompany the disease. Often referred to as behavioral and psychological symptoms of dementia or BPSD, these behaviors can include psychosis, mood disturbances, personality changes, agitation, aggression, pacing, wandering, altered sexual behavior, changed sleep patterns and appetite disturbances. People with dementia may also experience depression, anxiety, apathy and other emotional symptoms. Treatment considerations involve the use of potential pharmacological options, institutionalization and interventions addressing behavior management. These symptoms can be distressing for both the person with dementia as well as their care partners.
A social aspect of dementia addresses the impact that the disease has on the person's relationships, social networks and the community. This includes a focus on prevention, lifestyle change and community interventions. People with dementia may become isolated and withdrawn as their cognitive abilities decline, and they can become dependent on their caregivers, which can put a strain on that relationship. The social aspect of dementia also includes the impact that the disease has on the healthcare system and the community at large. An important and often overlooked aspect of dementia includes the care partners of people with dementia. Caregiving can frequently be a demanding and isolating experience, and caregivers may experience a decline in their own physical and mental health as a result.
The importance of understanding the biopsychosocial model of dementia is particularly underscored because dementia is a complex disease and involves multiple factors that interact with each other that affect the individual's experiences and outcomes. Understanding these factors can help healthcare professionals and caregivers provide comprehensive and effective care for individuals with dementia.
There is certainly more to discuss on this topic. Healthcare access, for instance, has been identified as a key factor in the prevalence and burden of dementia. People with limited access to healthcare may have a higher risk of developing dementia and may face additional challenges in accessing care and support for the disease. Research also suggests that early detection and intervention can delay the onset and progression of dementia and improve the quality of life for people with dementia and their caregivers. Therefore, access to healthcare and education about the risk factors is crucial in preventing and managing dementia. I will talk more about this approach in the next set of posts.
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