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Alzheimer’s Dementia, Act Before Memory Fades

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Dementia is a general term to describe a decline in mental ability which is severe enough to interfere with daily life. The brain cells of people with dementia die at a faster than normal rate leading them to lose their ability to remember, think and reason.

Alzheimer’s dementia is the most common type of dementia and accounts for about 60% of all dementia cases. It is the progressive loss of brain cells related to the formation of insoluble proteins in and around the brain cells. The onset of this condition is gradual and early symptoms may be missed.

As the condition advances, people with dementia may demonstrate personality and behavioural changes which impede them from coping with daily life. While the likelihood of having dementia increases with age, it is not a condition related to normal ageing.

The Other Types of Dementia

Apart from Alzheimer’s Disease, there are also other forms of dementia. These include Vascular dementia, Lewy body dementia and Parkinson’s disease dementia.

Vascular dementia is the second most common type of dementia. It is a result of impaired blood flow to the brain, often after a stroke or series of strokes.

3 Stages of Alzheimer’s Dementia

It is not always easy to recognise the early symptoms of Alzheimer’s dementia as they can be confused with normal ageing. For instance, it is normal to forget where one has placed his or her keys, but if the poor memory is associated with dementia, it will persist and worsen over time.

Dr Seng Kok Han, a Consultant Psychiatrist from Nobel Psychological Wellness Clinic, a member of Healthway Medical Group advises that medical attention should be sought if one displays the following signs and symptoms:

Early Stage: Mild Alzheimer’s Disease

At the early stage of Alzheimer’s dementia, patients can still function independently and carry on with day-to-day activities. However, more complex activities such as handling finances and engaging in employment tend to be impaired.
 Poor memory of recent events
 Missing appointments
 Word-finding difficulties
 Misplacing everyday items from time to time
 Spending more time than usual to complete daily tasks
 Personality changes (e.g. declining motivation, social withdrawal, become more irritable)

Middle Stage: Moderate Alzheimer’s Disease

A greater level of care and attention has to be given to patients at this stage.
 Memory lapses are more common and obvious
 Losing track of time and events
 Wandering and getting lost
 Dependent on others in managing finances, shopping or transportation
 Neglecting themselves (e.g. need to be reminded to bathe and dress appropriately)
 Become irritable and agitated
 Disturbed behaviour (e.g. experience hallucinations and delusions)

Late Stage: Severe Alzheimer’s Disease

At the final stage of the disease, patients are totally dependent on others for basic activities such as dressing, bathing, toileting and eating.
 Difficulty recognising family members
 Language is restricted or loss of speech
 Loss of continence and mobility
 Constant supervisions are required

Assessment

Assessment for dementia involves detailed medical history-taking, physical examination, cognitive testing, blood investigations and brain imaging.

Benefits of Early Intervention

Although there is no cure for Alzheimer’s dementia, early diagnosis enables patients and caregivers to have a better understanding of their condition and receive anticipatory guidance for emerging symptoms. They can also plan for the future, such as making a Will and Lasting Power of Attorney (LPA) while they still have the mental capacity. Interventions can slow down the progression of cognitive decline, prolong patients’ ability to carry out their daily activities and delay the need to place the patient in institutional care.

Some Tips to Prevent Dementia

• Having adequate rest and sleep
• Having a balanced diet of more fruits, vegetables and fish
• Exercising regularly
• Avoid smoking
• Maintaining good control of blood pressure, diabetes and cholesterol
• Engaging in mentally stimulating activities such as keeping up with current affairs, lifelong learning, playing mahjong and crossword puzzles
• Building positive relationships by having frequent interactions with family members and friends

Comprehensive Care to Manage Dementia Patients

Doctors, family members, caregivers and the community can play a part in helping patients with dementia cope with the illness. Early diagnosis and intervention allows patients with dementia to slow down the progress of cognitive decline and prolong the joy of spending quality time with their loved ones.

Medication

Prescribed medications such as Donepezil, Rivastigmine, Galantamine or Memantine can slow down progression of the illness. Antidepressants can be used to treat depression while antipsychotics can help treat hallucinations and paranoia, which can be seen in dementia.

Psychological Support

Psychological approaches include helping to orientate patients (reality orientation) and focus on meaningful activities of the past (reminiscence therapy). Cognitive training can equip them with skills to decrease everyday problems and improve the quality of their lives. Behavioral modifications are applied to help patients change specific challenging behaviours.

Social Interventions

It is important to work with families as they play contributory roles in influencing treatment outcomes and management. Referring patients to appropriate agencies such as day care, befriender services and family service centres can help in the aftercare.


Article contributed by Dr Seng Kok Han, a Consultant Psychiatrist from Nobel Psychological Wellness Clinic, a member of Healthway Medical Group

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