May 21, 2019
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    Dementia – burying memory

    April 18, 2019

    Many of us are forgetful. In our everyday lives, we sometimes forget where we leave our keys, an appointment made, or the name of the person that we met recently. Sometimes in moments of forgetfulness, we may wonder, “Good heavens! Am I getting dementia?”

    Does ‘forgetfulness’ equal to dementia?

    Is forgetfulness normal? Yes, indeed. If we are busy, distracted, if we do not concentrate, we forget. With increasing age too, we tend to become more forgetful. This kind of mild forgetfulness alone doesnot equal to dementia.

    Dementia is a global impairment of cognitive functions – that means not only memory, but many other higher functions of the brain – such as intellect, memory, judgement and personality become impaired. This is an acquired disorder, which is more common in old age. There is no impairment of consciousness. This illness may first be noticed as forgetfulness, but the symptoms gradually increase and affect other aspects such as intellect, judgement and personality so that the person’s overall functioning becomes impaired.

    The rate of dementia in the population increases gradually over 65 years, with the risk going up with increasing age. Dementia is no respecter of persons or places; it can happen to any of us. Examples of well-known individuals who experienced dementia in their old age include former United States President Ronald Reagan.

    Disease of the brain

    Dementia is associated with changes in the brain. There are different types of dementia, related to underlying pathological causes. Whatever the cause, dementia is ultimately associated with the loss of cerebral (or brain) neurons. That is, the number and functioning of cerebral neurons become diminished in dementia. If a CT scan of the brain in a person with advanced Alzheimer’s dementia is performed, for example, marked cerebral atrophy (greater than appropriate for that person’s age), is likely to be seen.

    There are several types of dementia. The most common type is known as Alzheimer’s dementia. Another common type is vascular dementia. In Alzheimer’s dementia, the symptoms tend to start with memory impairment and gradually progress over several years. In comparison, the symptoms of vascular dementia may have a somewhat more abrupt onset and a fluctuating course. In vascular dementia, the loss of cerebral neurons is due to cerebrovascular accidents or strokes. This may occur in the form of a series of mild insults to the brain or a major stroke.

    How is dementia diagnosed?

    The diagnosis of dementia is made based on information from the patient and his or her family members who know the patient well. In other words, it is a clinical diagnosis, based on the history and examination of the patient. There are also specific examinations or tests that can be done to assess the patient’s memory and other higher functions which help to further confirm the diagnosis and assess the severity of the illness.

    Do investigations have a role in the management of dementia?

    Indeed they do. The doctor will conduct investigations to look for possible causes of dementia. This may include certain blood tests as well as imaging such as a CT scan of the brain.

    Can dementia be cured?

    Unfortunately, in most patients, after the brain changes due to dementia, there is no treatment to completely reverse or cure the poor memory and impaired cognitive functions.

    For certain types of dementia such as Alzheimer’s dementia, there are medications that may slow down the progress of the illness or reduce behavioural problems associated with the illness. This may be useful for some patients, but not for all. In vascular dementia, it is very important to control metabolic risk factors – for example, it is important to control blood pressure and manage any diabetes or hyperlipidaemia.

    Often the most distressing part of the illness is the behavioural features associated with dementia. For example, an elderly woman with dementia may not be able to fall asleep and may wander around the house at night, disturbing other family members who are trying to sleep. In situations like this, there are many things that can be done to reduce these behavioural problems. First, it is important to look for any causes for the person’s disturbed or changed behaviour – do they have any pain or discomfort or is there any environmental change that bothers them? Additionally, medication can be prescribed to make the person calmer or to help them sleep. The medication will not reverse forgetfulness or cognitive impairment, but it will reduce the disturbed behaviour making the patient more comfortable and making it easier for the family to look after him or her.

    Making life easier

    If we receive a lot of information and stimuli at the same time, we may feel overwhelmed and find it difficult to cope. It is the same for a person with dementia, and in fact, they may feel more easily overwhelmed compared to someone without cognitive impairment.

    Thus, on an everyday basis, when caring for a person with dementia, it is best to try to provide a simple regular daily routine without too many frequent changes – well, as far as practically possible! Reminders and prompts will be useful for a person with early dementia – to remind them to attend to their usual daily activities. As far as possible, encourage the patient to be as independent as they can; this is better rather than doing everything for them on the assumption that they are ‘unwell’.

    Of course, the level of functioning will depend on the severity of the illness. Some people with mild dementia may be able to help with daily activities such as cooking that they are used to; this may change with the illness, later on. It is also important to be aware of risks and minimise these. For example, if an elderly person with dementia tries to walk to the local shop, but he cannot remember the way to back home, then there is a risk that he will get lost if he goes out alone.

    A common problem experienced by some patients and families is that the patient claims that his or her belongings are being ‘stolen’. Often what has happened is that the patient has misplaced his or her belongings, but because of poor memory, he or she cannot remember this, but thinks it has been stolen. This may lead to arguments with other family members who understand that there is no theft going on. In situations such as this, arguing with the patient and trying to explain things to them is often not useful. They may not understand or accept the alternate point of view. The better response is to avoid confrontation (if possible) or to try and distract the person so that they forget about the ‘theft’. In the early stages of the illness, it is also useful to use reminders or organise ways for the patient to help remember things.

    As dementia progresses, the patient may need more support in day to day activities. Caring for this person should ideally be a joint concern of all close family members. Supporting each other in caring for the patient, getting practical support such as, for example, nursing care when possible and taking breaks are all important to prevent the carer from becoming exhausted.

    Can it be prevented?

    A question many of us may wonder is, “How do I avoid getting dementia myself?” Though there is no 100 percent clear answer for this, there are steps that you can definitely follow to minimise your risk of getting dementia in old age. The main strategy is to ‘look after your brain!’

    How can we look after the brain?

    There are several strategies to consider. One aspect is to check for and control diseases such as diabetes, hyperlipidaemia and hypertension. These often occur in middle age and if poorly controlled, may contribute towards future strokes and ‘brain harm’, which can increase the risk of dementia in old age. A good diet, regular exercise and enough sleep at night are additional ‘brain protective’ things to follow, which we often neglect.

    Another aspect is to keep ‘exercising your brain’ - keeping your cerebral neurons busy learning new things and having a greater ‘cognitive reserve’ will reduce the risk of future dementia. Anything that will make your brain awake and active is useful (e.g., reading about something you are interested in, crossword puzzles, Sudoku, chess or learning a new language). Learning something new is a very good brain exercise. It is best to try and choose activities that you are interested in, so that you are more likely to persist and continue it.

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