Dealing with dementia

  • Nation
  • Sunday, 07 Apr 2019

Dementia primarily affects older people. Eventually they will have difficulty performing routine tasks and need help with all aspects of daily life.

DEMENTIA is a group of disorders characterised by progressive loss of brain function, which affects memory, language, thinking and behaviour.

Around the world, there will be one new case of dementia every six seconds.

Dementia primarily affects older people, with the incidence rising after age 65. Eventually, those affected are unable to care for themselves and need help with all aspects of daily life.

There are many different types of dementia – Alzheimer’s disease (the most common), vascular dementia, dementia with Lewy bodies, fronto-temporal dementia and rare genetic variants of dementia. Alzheimer’s disease and vascular dementia make up 85% of dementia cases.

A diagnosis of dementia can be made by taking a careful history of the patient, from a close relative or friend, along with a clinical examination.

Blood tests and imaging are required to rule out treatable causes of dementia such as brain tumours and vitamin deficiencies.

The most common early symptoms of dementia are memory loss (especially short-term memory); misplacing things; difficulty doing routine tasks; difficulty with language or word-finding; poor judgment; inability to keep track of things (such as bills and conversation); and disorientation (getting lost in familiar surroundings).

Other symptoms include loss of initiative (no interest in hobbies, housework) and, changes in personality (unusually suspicious), mood (rapid mood swings) or behaviour.

The exact cause of dementia is not well understood. Alzheimer’s disease, being the most common variety, is due to excessive protein (tau and amyloid) deposition in the brain.

It is estimated that this protein deposition takes place over a span of 20 years before symptoms become apparent.

The long gap between deposition and symptom development offers a window of opportunity for intervention and risk factor modification.

About one-third of dementia cases can be prevented with risk factor modification.

Risk factors for dementia include lack of education, hearing loss, diabetes, hypertension, obesity, physical inactivity, smoking, depression, social isolation and inadequate night-time sleep.

Hence, preventative steps for dementia include a healthy diet; physical exercises; monitoring diabetes, hypertension and obesity; practising cognitive training; and avoiding smoking, depression and social isolation.

Cognitive training involves mental activities such as learning a new sport, hobby, language or skill, or even travel – which all enrich the brain with new sights and sounds. Irrespective of educational background, the brain benefits from lifelong learning.

While there is no cure for Alzheimer’s disease, researchers are now in the process of developing drugs for early-stage intervention of the disease.

Though not curative, there is a number of drug treatments that slow the progression of the disease and help with symptoms. Practical and emotional support are also important for dementia patients and their carers.

Worldwide, there are currently 50 million people with dementia and this number is expected to increase to 130 million in 2050.

There is an urgent need to clinically recognise dementia in its earliest stage to provide the care and support required.

Behavioural modification and risk reduction strategies may also prevent or delay the onset of dementia.

Dr Gunasundari Pushparasah is a consultant physician and neurologist at ParkCity Medical Centre in Kuala Lumpur.

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