【4種類と症状】認知症を知ろう！認知症を持つ家族にイライラしない工夫とは
家族で認知症がある事がわかっている人がいても、イライラしてしまうことはないですか。
認知症には種類や症状がそれぞれあります。それを理解することで要介護者へのイライラが少しは軽減する可能性があります。
本記事は現役看護師が執筆、徹底解説します。
目次
まずは認知症の種類について知ろう！【4種類】
認知症にはおおきく分けて下記の4種類があります。
① アルツハイマー型
② 脳血管性認知症
③ レビー小体型認知症
④ 前頭側頭型認知症
この他にも認知症になる原因はありますが、主に上記にわかれます。
①アルツハイマー型
認知症でも一番このタイプが多いです。脳内にたんぱく質が異常に蓄積することで神経の伝達が悪くなったり、脳の細胞に傷がつきます。それにより脳が小さくなってしまう状態＝脳の萎縮を起こしてしまうことで認知症の症状がでます。認知機能の変動はありません。進行もゆっくりです。
主な症状
・記憶障害（物忘れが多くなる）
・見当識障害（日時がわからなくなる）
・失行（服が着替えられない、箸の使い方がわからない）
・徘徊
②脳血管性認知症
脳出血や脳梗塞といった脳血管疾患が根柢の原因です。それにより脳内の血液の流れが不良になることや、脳の細胞に傷がつくことで発症します。比較的記憶力は維持されることが多いです。脳血管疾患の再発や進行度により症状も左右されます。
主な症状
・まだら認知症（障害を受けていない部位は維持）
・感情障害(急に泣き出したりする)
・神経症状がある（片麻痺や言語障害など）
③レビー小体型認知症
異質なたんぱく質が神経細胞の中でも大脳皮質や脳幹部に溜まり、神経細胞が少なくなり症状が起きます。しかしなぜそうなるかは解明されていません。認知症状の進行が比較的早いタイプです。
主な症状
・レム睡眠行動障害（寝ながら大声を出す、壁を蹴る等）
・パーキンソン症状（小刻みに歩く、震える）
・幻視・妄想（見えないはずのものが見えると言うなど）
・認知機能の変動
④前頭側頭型認知症
ほかの認知症とは異なり指定難病に認定されています。脳の中でも 前頭葉と側頭葉が委縮します。その原因は様々なたんぱく質が蓄積されることにより、起こると言われていますが詳細は解明されていません。脳の中でも前頭葉と側頭 葉の部位は、思考や判断、感情のコントロールをつかさどっているため障害されることによって社会的な問題、人格の問題につながります。40-60代と比較的に若いうちに発症することが多いです。
主な症状
・常同行動(同じ時間に、同じことをするなど強いこだわりを持つ)
・言語障害(物の名前が出ない、文字の読み間違い)
・感情鈍麻（感情が鈍くなる、感情移入できない）
・本能のまま行動する（行動に抑制が効かない、万引きなどをするなど）
症状や対応にイライラしない工夫とは
ここでは実際に認知症を持つ家族から受けた相談や、通院患者を元に4人の認知症を持つ方の例をまとめました。
要介護者、介護者お互いがイライラしないように、どのような点に工夫する必要があるのでしょうか。
Aさん：アルツハイマー型認知症70代男性
最近ご飯を食べたことを忘れることが多くなって繰り返し家族に聞いてくる。本人に食べたことを伝えてても「そんなはずはない」と言い出す。妻はAさんにしつこいと感じ、つい、いらいらしてしまう。
Aさん：対応
「忘れてしまったんですか？食べましたよね？」などと指摘や否定をしないようにします。プライドを傷つけられたとなると、怒りを感じる原因になってしまいますので注意しましょう。カレンダーに毎食後食べた旨を記録しておく、食事が終わった旨の札を確認する札を作るなど物理的な対策をし、穏やかな声で対応してください。
Bさん：レビー小体型認知症 80代女性
パーキンソン症状があり動きに障害がでている。トイレに間に合わないこともたびたびある。紙のおむつはしているものの、おむつ内で失禁してしまうため「私はもうだめだ」とBさんは言う。トイレを汚してしまうことも増え、家族はイライラしているようだ。
Bさん：対応
行動をよく観察します。例えばＢさんの場合であれば、トイレへいきたそうにそわそわしている様子があればトイレに行くことを促したり、定時でトイレに行くことを進めるのもよいでしょう。移動時の動線が短くなるよう確保しておくことも大切です。また本人と相談し、ポータブルトイレを用意するのも有効な手段です。「おむつにおしっこすればいいでしょ。」といった言葉がけは、高齢者の自己否定につながります。本人の自尊心を保ちながらサポートします。
Ｃさん:脳血管性認知症 70代女性
脳出血後治療、自宅に退院した。足に麻痺が残っている。退院後、急に怒りだしたりと感情の起伏が激しく、家族もＣさんにイライラし声をかけることが少なくなった。麻痺があるため家に引きこもりがち。
Ｃさん：対応
大切なのは認知症の人に生活習慣や環境をあわせることです。家に引きこもっているからと無理に外出させたりするのはよくありません。一見気分転換に繋がりそうに思いますが、本人のペースではないため拒否につながります。また家族と同居の場合は、時々話しかけるようにします。Ｃさんは症状の出現にムラがあるだけで、いつまでも怒っているわけではありません。孤独を感じさせることで認知症の悪化につながります。
Ｄさん： 前頭側頭型認知症 60代男性
この診断を受けた頃から、毎朝5時に庭先にて大音量でラジオ体操をすることにこだわるようになった。また妻はＤさんと買い物へでかけるが、気づくとお菓子をいつも万引きしようとしている。妻はイライラとショックでＤさんを連れ、でかけるのをあきらめはじめている。
Ｄさん： 対応
Ｄさんの好きな1日の生活プランを様子を見て立てるようにします。ですが、周囲の人の理解も必要です。Ｄさんであれば、症状について周囲に知らせておくことが必要です。また買い物も、馴染みのお店にいくようにしたり、馴染みのお店ではＤさんの症状について知らせておくことや、商品の支払い方法を相談するなどしましょう。
このように少しの理解や工夫で、介護者も要介護者もイライラ解消につなげる対応を取ることができます。
まとめ
認知症にもそれぞれの種類により症状や対応が異なってきます。事前に認知症になることで出現する症状や傾向を知ることで、介護者とその家族の抱える、“認知症のわからない、怖い”と言う思いからくるイライラ、また要介護者のイライラやショックに対応することができます。
理解が深まれば次は具体的にどう動くかです。
認知症の家族にどう対応したらよいか…と言ったお悩みは介護の専門家に相談することで、さらに解決につながることでしょう。
「今後の生活環境が変わる事への不安」や「介護を使って生活をどうデザインをしていったら良いか」など介護は協力体制で成り立っております。 ちょっとでも解決できる、ストレス軽減できる記事を目指し、一つの相談場所のメディアを目指しております。
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