Although dementia mainly affects older people, it is not an unavoidable consequence of ageing
Jane is thrilled to be the grandmother of five adorable grandkids and the mother of two accomplished children. She has been living with her husband in their own home since she retired five years ago, with little help from the family.
Her children have noticed some behavioural changes over the past six months. She forgets things more quickly, especially with the time and place. She frequently loses track of the conversation and forgets her grandchildren’s names.
She lost money a couple of times and left the front door unlocked. She has just lost her ability to cook and clean the house. Her family worries excessively about her emotional fluctuations and propensity to walk around aimlessly at night.
Jane’s behaviour is a typical example reported by family members regarding an individual with dementia. With more than 55 million people living with dementia worldwide and 10 million new cases each year, it is unsurprising that what Jane and many other elderly populations experience have become a major public health concern.
Dementia is an umbrella term that refers to a syndrome of cognitive function deterioration that goes beyond what would be expected from the normal effects of physiological ageing. The more recent guidelines for mental disorder assessment, the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), have renamed dementia “neurocognitive disorder,” which is divided into different severity categories and aetiological factors.
It is caused by many conditions, mainly those that have primary and secondary effects on the brain. Alzheimer’s disease is the most common form of dementia, accounting for 60 to 70 per cent of cases.
Effects on caregivers, families and society
Another major contributor to dementia is vascular disease, such as stroke. Other diseases are fronto-temporal dementia, dementia of Lewy bodies, and various reversible causes such as subdural haemorrhages, Vitamin B12 deficiency, and endocrine causes.
Although dementia mainly affects older people, it is not an unavoidable consequence of ageing. According to the World Health Organisation (WHO), dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people globally.
Because dementia causes a wide range of disabilities in its victims, it has physical, psychological, social, and economic consequences not only for dementia patients but also for their caregivers, families, and society at large.
Normal ageing will affect various aspects of one’s life. This includes deterioration in cognitive ability, including short-term memory, long-term memory, problem-solving ability, psychomotor slowing, and verbal comprehension. However, in dementia, the memory decline is more severe, disabling, and progressive.
Many patients will also experience co-morbid psychiatric disturbances such as depressed mood, irritability, paranoid ideations or delusions, sleep problems, and aggressive behaviour. For example, 20 per cent of patients will experience significant depressive symptoms requiring treatment.
These accompanying symptoms are essential to explore as they may result in a poorer prognosis, be more disabling to daily functioning, and cause more stress to carers. The most important message to the general public is that dementia is preventable, and early recognition and prevention are vital.
Numerous studies have confirmed that changing one’s lifestyle at an early age can lower the risk of dementia. This includes behaviours that promote physical activity, such as abstaining from dangerous substances like alcohol and tobacco, managing one’s weight, eating a healthy diet, and preserving blood pressure, cholesterol, and blood sugar levels.
Depression, social isolation, inadequate education, and environmental contamination are other modifiable risk factors in addition to those mentioned above. It is, therefore crucial to raise awareness regarding prevention in these areas, as doing so could soon lessen the total health burden. – The Health
Principles in the management of the elderly with cognitive decline
• Multi-disciplinary assessment to explore diagnosis, functional assessment, and social support
• Explore and treat reversible causes
• Explore behavioural and psychological disturbances associated with presentation, such as insomnia, psychosis, and mood symptoms
• Cognitive enhancement with pharmacological agents such as acetylcholinesterase inhibitors
• Optimise treatment of underlying co-morbid medical problems such as hypertension and diabetes
• Educate carers
• Psychological support for the patient and family
• Maximise mobility; promote independence with self-care; address toilet and feeding issues; and communicate effectively.
• Social management: accommodation, end-of-life care, wills, and other legal matters. – The Health
Dr Rozanizam Zakaria is Assistant Professor in Psychiatry, Kulliyyah of Medicine, International Islamic University Malaysia (UIAM) and Fellow in Child and Adolescent Psychiatry, Ministry of Health.