What is Dementia?
Dementia is caused by abnormalities in the brain which leads to the deterioration of memory and cognitive skills. This affects the ability for the person to do their activities of daily living (ADL) as per normal. It also causes changes in their behaviour, feelings and the way they interact with others. It is progressive which means that the early symptoms will occur slowly and gets worse over time.
Some may mistakenly perceive dementia patients as going senile and dismissed as a normal part of aging. If you notice behavioural changes (refer to symptoms below) in your elderly, do not ignore those signs. Bring them to see a doctor so they can diagnose the cause of the changes. If dementia is detected early, it might be at the stage in which it is still treatable and managing the symptoms would not be as difficult as it would be in the later stages.
The main cause of the behavioural symptoms is due to the abnormalities in the brain. The brain has different areas which are responsible for certain functions. If an area of the brain is damaged, the person will not be able to perform that affected function as per normal. For example, functions like memory, judgement and movement all have a specific area in the brain. This explains the varying types and degrees of Dementia and the reason behind the different symptoms and conditions each patient may have.
For example, in patients with Alzheimer disease (a type of dementia), the ‘hippocampus’ which is found in the brain, controls learning and memory. This area is the first to be damaged and this explains why memory loss is an early symptom of Alzheimer disease.
There are other causes of Dementia besides Alzheimer disease, such as thyroid problems and vitamin deficiencies. In addition, microscopic bleeding and blocking of blood vessel in the brain can lead to Vascular Dementia (read more about VD below)
Symptoms of dementia
It is difficult to diagnose the exact condition because the symptoms and brain changes of different types of dementia can overlap. In the beginning, the symptoms are more prominent in terms of changes in their behaviour and personality. For example, they will begin to feel irritated, and feeling anxious. Over time, they are unable to control their feelings and start behaving in an aggressive manner. It is common for them to display sudden outbursts of anger, gets easily agitated and in general, they will become more sensitive with their emotions.
You can also observe if they behave differently, especially with usual daily routine. They might have difficulties keeping track of their personal belongings like waller, preparing meals, remembering appointments and wandering outside.
- Feeling restless & frequently pacing around
- Sleep problems
- Sundowning (state of confusion starting in the late afternoon and continues even at night)
- Memory loss & memory problems
Dementia in Singapore
Vascular Dementia (VD) is a common form of dementia in Singapore and takes up almost half of the dementia cases here. As mentioned above, when the blood vessels are damaged, it cuts down the supply of blood to the brain. The supply of oxygen and nutrients which are crucial to the functions of the brain will be reduced. This explains why patients with VD experience memory problems, impairment of their cognitive functions and personality changes. Memory problems will bring about forgetfulness and confusion. A decline in their cognitive ability means they will exercise poor judgement and trouble doing daily activities. While a change in personality will lead to communication problems and relationship issues.
Patients are at risk of getting VD if they have the following:
- High blood pressure
- High cholesterol
However, despite vascular dementia being the most common form of dementia in SG, it can be avoided and you can lower your risk of getting VD.
How to reduce the risks or prevent Vascular Dementia?
You can lower your risks of getting Vascular Dementia or any other dementia conditions by adopting healthier lifestyle choices. According to Health Hub (Singapore) and other dementia-related resources,
- Eating healthy means eating a balanced diet and avoiding food high in fat, sugar and sodium content. These unhealthy ingredients increase the chances of contracting cardio-pulmonary diseases.
- Regular exercise helps to improve blood circulation and promote new brain cells.
- Stay mentally active through activities such as reading, games and picking up new skills through courses.
- Engaging in social activities can promote interactions and help to maintain strong ties with your loved ones. This will make you feel happy and less depressed.
- If you are a smoker, give up smoking as it will contribute more damage to your brain.
Treatment for dementia and how to manage the symptoms?
For serious cases of dementia such as Alzheimer’s, there is no cure and it is difficult to slow down the disease. The disease is managed through drug treatments. It is important to note that dementia is a progressive condition and will worsen over time. It may even become permanent for certain symptoms. However, some symptoms can be treated (those that are not caused by damaged brain cells but due to other conditions). For example, symptoms such as memory problems can be aggravated due to:
- Side effects of medicines
- Excessive alcohol consumption
- Thyroid problems
- Vitamin deficiencies
Behavioural symptoms can be aggravated as a result of changes in a person’s surroundings such as being removed from a familiar environment, new caregiver or being admitted to a hospital. For patients with Alzheimer’s disease, it can increase fear and add more confusion. As such, it is important to identify the root cause of the behavioural symptoms and best to avoid it so the symptoms will not become worse.
Tips for caregiver:
Approach patients with dementia with an open mind and in a way that promotes physical and emotional comfort. Identify and address needs that they have difficulty in expressing. Use the following as a guideline:
- Acknowledge that the patient is not acting mean but is showing symptoms of the disease. Do not be offended by their behaviour.
- Identify the cause and how the symptoms may relate to the experience of the person with Alzheimer's/Dementia. Understand why they are behaving in a certain way
- Change the environment if necessary to provide an ease of mind for the patient
- Observe their level of personal comfort (pain, hunger, thirst, etc)
- Avoid being confrontational (For e.g. They may confuse an old memory with the present and if this situation arises, be smart when engaging with them)
- Listen to their requests and if possible, respond and cater to those requests. (For e.g, try to prepare a favourite meal that they are familiar with)
- Having a schedule e.g. fixed meal times can help to retain a sense of routine, normalcy and prevent confusion.
If you are living with the patient, you can physically modify the house with new fixtures to facilitate dementia patients, such as:
- Locks to prevent them from wandering outside
- Lights and signs so they know the right locations in the home
- Grab bars and anti-slip mats or stickers to prevent falls
If you are overwhelmed with work and need caregiver stress relief, Alzheimer’s Disease Association has support groups for dementia caregivers in which you can connect with other people with similar experience. You can read more here.