An Overview of Dementia and Alzheimer’s Disease
Dementia is the umbrella term for a number of neurological conditions, of which the major symptom includes a global decline in brain function. In simpler terms, it is seen as a general term or syndrome (as opposed to a specific condition) that is used to describe a wide range of symptoms. Although dementia is widely associated with memory loss, other common symptoms include decreased focus and attention, a change in thinking skills, a change in communication and language skills, and even the inability to perform everyday activities.
On the other hand, Alzheimer’s is a specific type of dementia that happens to be the most common one as well. Despite being the most common, it doesn’t necessarily indicate that everyone with dementia has Alzheimer’s disease. Other types of dementia include:
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia
- Creutzfeldt-Jakob disease
- Huntington’s disease
- Mixed dementia
In its simplest form, dementia is the umbrella term where Alzheimer’s falls under—the two are not interchangeable.
What Causes Dementia & Alzheimer’s?
In general, dementia is caused by various risk factors including genetics, lifestyle choices and health conditions, with age being the biggest contributing factor.
Alzheimer’s, in particular, is caused by an unusual build-up of proteins that are within and around the brain cells. One of the proteins, called amyloids, play a central role in Alzheimer’s disease as these plaques first develop in the areas of the brain involved with memory and other cognitive functions. The other protein called tau, creates tangles within the brain cells that disrupt its ability to communicate with other cells.
The abnormal presence of these proteins may affect specific brain regions involved in memory, ultimately causing Alzheimer’s disease.
Other forms of dementia could be caused by traumatic brain injuries, pre-existing vascular disorders, lack of blood flow in the brain, and other brain disorders such as Parkinson’s.
Signs and Symptoms: Dementia vs Alzheimer’s
Based on the Well-being of the Singapore Elderly (WiSE) study conducted in 2015, it revealed that 1 in 10 people aged 60 years old and above in Singapore has dementia.
Since dementia is a progressive deterioration in one’s cognitive function, the signs and symptoms affect individuals in different ways and at different rates. Some people go through all the stages of dementia, while others do not necessarily fit in a specific stage—the progression varies depending on the person. Here are the three main stages in which dementia progresses:
Early Stage (Mild)
In the early stage, it may be difficult to spot mild symptoms at first due to the gradual onset. These symptoms include:
- Frequently losing or misplacing belongings
- Getting lost in familiar places
- Losing track of time
These actions usually display problems in relation to memory and the ability to concentrate, which are still considered as mild.
Middle Stage (Moderate)
Once one’s dementia progresses to this stage, the signs become clearer and more apparent. However, it also becomes more restricting for the individual at the same time. The symptoms in this stage include:
- Forgetting recent events and major occasions
- Forgetting people’s names and significant information such as their address and telephone number
- Needing help with personal care
- Experiencing behaviour and personal changes like repeated questioning, paranoia, wandering and delusions
- Having slight difficulty in communicating or taking longer than usual to communicate a thought
- Withdrawing from certain social situations when it requires too much thought
This is the stage that usually lasts the longest and could go on for as long as a few years. With this progression, the individual will certainly need more care and assistance as the damage in the brain makes it difficult to perform everyday activities with ease.
Late Stage (Advanced)
Unfortunately, the most severe stage of dementia is when one loses the ability to engage in conversations, control their muscles and perform basic daily activities. They may still be able to talk at this point but will have difficulty forming a thought and articulating it. Eventually, you may begin to see personality changes or the fading of their personality altogether. Symptoms include:
- Gradually losing physical abilities such as the ability to walk, sit and swallow
- Having an increased need for assisted self-care
- Having difficulty recognising family members and friends
- Loss of awareness of surroundings and time
- Experiencing difficulty in communicating
While the symptoms of both dementia and Alzheimer’s disease may overlap, there are still distinct differences that indicate whether someone has Alzheimer’s or a different form of dementia. While both conditions are known to cause memory and communication impairment, along with a decline in the ability to think, the symptoms of Alzheimer’s are far more specific and can also include:
- Behavioural changes
- Difficulty remembering recent events, conversations or interactions
- Difficulty speaking and swallowing (only in the advanced stages of the disease)
- Impaired judgment
If you have elderly loved ones at home that are beginning to display these symptoms, monitor their behaviours and actions, and take note of the subtle signs. If these behaviours progress, do consult a doctor immediately.
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As mentioned by the Alzheimer’s Association, there is no one way to diagnose dementia. Instead, various tests and examinations are conducted to assess a patient’s symptoms and the severity of their condition, and to determine the type of dementia. Examples of some tests conducted include physical examinations and diagnostic tests, neurological exam, mental status tests and brain imaging.
Brain scans are often used to diagnose dementia to look for any changes that have taken place in the brain. While it is impossible to spot dementia on a brain scan, this procedure allows doctors to identify and rule out other conditions that may cause symptoms similar to Alzheimer’s. It can be used to reveal tumours, damage from severe head trauma or buildup of brain fluid.
Mental Status Tests
A mental status test simply assesses one’s memory and ability to solve simple problems with their cognitive skills. The purpose of such tests is to give an overall sense of whether the person is aware of their symptoms, are able to follow basic instructions, and whether they can remember the current date and time.
During a neurological exam, doctors will test the patient’s coordination, eye movement, reflexes, strength, speech, and sensory function. This gives doctors a closer look at other problems that may signal brain disorders apart from Alzheimer’s disease.
Physical Exam & Diagnostic Tests
Physical examinations and diagnostic tests are commonly used in the diagnosis of many conditions apart from dementia. In this process, you can expect physicians to ask about your diet, nutrition and alcohol consumption (if any); check your blood pressure, pulse and temperature; review medications that the patient is currently taking; collect blood or urine samples for further testing; and perform other procedures to assess overall health.
Beyond all the necessary tests and examinations, one’s medical history will also be taken into consideration. During this process, your doctor will review your entire medical background including your psychiatric history, any current or past illnesses, any medication that you are taking, as well as any history of behavioural or cognitive changes.
The information collected from these tests along with one’s medical background can help identify health issues that can cause symptoms of dementia.
Treating Alzheimer’s and Dementia
Although there is no cure for Alzheimer’s currently, there are various treatment options available upon diagnosis to slow down the progression of this disease.
There are a number of medicines that can be prescribed for Alzheimer’s disease to temporarily improve one’s symptoms. These medications may be prescribed to tackle the following symptoms:
- Behavioural changes (antipsychotics)
- Memory loss (cholinesterase inhibitors donepezil, rivastigmine, and memantine)
- Sleep changes
- Boosting brain function or overall health (fish oil supplements)
Depending on your medical history and the severity of your condition, your doctor will prescribe you with the most suitable medication based on your needs.
While there are no current medicinal treatments to cure Alzheimer’s Disease entirely, there are certain forms of dementia that may be controlled or reversed with treatment. One such example is Normal Pressure Hydrocephalus (NPH). NPH is caused by an abnormal buildup of cerebrospinal fluid (CSF) in the brain’s cavities, which can damage nearby brain tissue and cause multiple physical dysfunctions such as difficulty walking, loss of bladder control, and even problems with thinking and reasoning. Drug treatments and surgical procedures are some of the treatments recommended to patients in order to reverse the effects of NPH.
Dementia Care Support
Non-drug therapies such as cognitive stimulation therapy (CST) and dementia care support can alleviate some symptoms of dementia. Instead of medication, this refers to more holistic approaches that manage behavioural symptoms and promote physical and emotional support. According to the extremity of one’s condition, level of independence and ability to communicate, dementia care support will be customised accordingly and designed to improve their quality of life and help them cope with their symptoms.
Dementia Care for the Elderly
With the advancement of technology, there are now numerous treatment alternatives and options for dementia patients, from inpatient care to home care services. At Homage, we specialise in an array of specialised elderly care services, including dementia care.
Our dementia care programme uses a combination of both drug treatments and non-drug therapies to effectively provide the care support that your elderly loved one needs. This is inclusive of medication reminders, companionship, moderate physical activities, nursing procedures, as well as check-in visits. It is no question that each patient has varying needs and requires different levels of support. With our extensive team of trained caregivers, professional nurses, experienced therapists and licensed doctors, your loved one can receive the necessary care across the different stages of dementia at every step of the way.
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