Affecting 1 in 10 Singaporeans aged above 60 and half of those above 85, dementia is a common condition among seniors. Yet, there still exists many long-standing misconceptions that people have about the condition.
What is Dementia?
As we age, we may find our memory deteriorating. This is known as age-associated memory impairment and is considered part of the normal ageing process.
Dementia, however, while more prevalent among older adults, is not a normal part of ageing.
Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing.
Unlike what most people think, dementia is not a disease, but a syndrome in which there is a deterioration in cognitive functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, judgement and the ability to perform everyday tasks.
Types of Dementia
Oftentimes, we hear people using the terms Alzheimer’s and dementia interchangeably. However, they are not the same. Dementia is an umbrella term used to describe a group of symptoms, and Alzheimer’s is one of the many subtypes of dementia. In fact, there are over 400 types of dementia!
Here are 10 of the more common types of dementia:
Alzheimer’s disease is characterised by brain cell death and is the most common form of dementia, making up 60 to 80% of all cases. Older adults are more susceptible to this form of dementia.
Early signs include depression, short-term memory loss, confusion, mood changes and trouble speaking and walking as the condition progresses.
Vascular dementia is the second most common form of dementia, comprising 20% of all dementia cases, and is caused by a lack of blood flow to the brain. It tends to be more prevalent among older adults and may be related to atherosclerotic disease or stroke. Symptoms may appear progressively or suddenly, depending on the cause.
In the early stages, confusion and disorientation are common signs, but in the later stages, people may face trouble concentrating and completing tasks. Problems with vision and hallucinations may occur as well.
Lewy Body Dementia
Lewy bodies are small round clumps of protein that build up inside the brain’s nerve cells, disrupting neural signals and communication.
This causes memory loss, disorientation and visual hallucination. Sometimes, people may also have trouble falling asleep at night or unexpectedly fall asleep in the day. Many of the symptoms experienced by people with Lewy body dementia are similar to those with Alzheimer or Parkinson diseases.
Parkinson’s disease, at advanced stages, may lead to dementia.
Early symptoms include problems with reasoning and judgement, and can develop into confusion, hallucinations, irritability, depression, paranoia and speech difficulties as the condition progresses.
Frontotemporal dementia, also known as Pick’s disease, is a term used to describe several types of dementia which affects the front and side of the brain – areas that control language and behaviour. It can affect people as young as 45 years old.
Naturally, most of the symptoms of those with frontotemporal dementia revolves around behaviour and language, including loss of inhibitions and motivation, compulsive behaviour and forgetting the meaning of common words.
Creutzfeldt-Jakob disease is one of the rarest forms of dementia, with only 1 in 1 million being diagnosed with this condition. It progresses rapidly, and people often die within a year of diagnosis.
Its symptoms are similar to other forms of dementia, including confusion, memory loss, agitation and depression. Those with Creutzfeldt-Jakob disease may also experience muscle twitching and stiffness.
Wernicke’s disease and Korsakoff syndrome are two separate but linked conditions, often grouped together and known as Wernicke-Korsakoff syndrome. Technically, Wernicke-Korsakoff syndrome is not a form of dementia, but has similar symptoms hence is often classified under it.
Wernicke disease, also known as Wernicke’s encephalopathy, occurs due to bleeding in the lower sections of the brain caused by a vitamin B-1 deficiency. This vitamin deficiency could arise from malnutrition or chronic infections, but the most common cause is alcoholism.
Left untreated, physical symptoms such as double vision and a loss of muscle coordination tend to reduce, as signs of Korsakoff syndrome surface. Symptoms of Korsakoff syndrome include difficulty in processing information, learning new skills and remembering things.
Normal Pressure Hydrocephalus
Normal pressure hydrocephalus (NPH) is a condition that causes fluid build-up in the brain’s ventricles, affecting its tissue and leading to dementia symptoms. Some potential causes of this condition includes injury, bleeding, infection, brain tumour and previous brain surgeries.
Those with the condition may experience poor balance, forgetfulness, mood swings, depression, frequent falls and loss of bowel or bladder control.
Thankfully, NPH may be reversed, controlled and cured with surgery, hence it is important to seek treatment as early as possible to reduce brain damage.
Huntington’s disease is a genetic condition and onset of dementia symptoms tend to occur in younger adults. Due to premature breakdown of the brain’s nerve cells, this condition can cause dementia and impaired movement.
There are two types of Huntington’s disease: juvenile and adult onset, which corresponds to when the symptoms first appear. Symptoms for those with the juvenile form tend to appear during childhood or adolescence, while those with the adult form tend to only experience symptoms in their 30s or 40s.
Besides the physical symptoms of jerking, difficulty walking and trouble swallowing, dementia-related symptoms include difficulty focusing on tasks, impulse control problems, trouble speaking clearly and difficulty learning new things.
Mixed dementia occurs when a person has more than one form of dementia and is relatively common. In fact, 45% of those with mixed dementia are unaware of it. The most common combination is vascular dementia and Alzheimer’s disease.
While the symptoms vary depending on the varying combination, most people will experience difficulty speaking and walking as the condition progresses.
How do we differentiate between dementia and everyday forgetfulness? People with dementia often forget things that only recently occurred and may ask questions repeatedly. Oftentimes, the kind of memory loss they experience can make it hard for them to function independently in daily life. For example, they may forget names of people they have known for years or whether they have had lunch that day.
Difficulty performing familiar tasks
We usually do not give much thought to everyday tasks such as brushing teeth and preparing a meal. However, those with dementia tend to struggle to perform these tasks and often forget the right order to do things. For example, they may end up ironing a shirt that has yet to be washed.
Disorientation to time and place
Oftentimes, it is normal for us to lose track of time or the day of the week. However, persons with dementia tend to confuse day and night, and even get lost in familiar places that they frequent daily. For example, they may want to get breakfast in the evening, or get ready for bed in the middle of the day.
Poor or decreased judgement
Many of us have made bad decisions at different points in our life, but dementia can affect a person’s ability to reason and make simple judgement. For example, they may buy excessive amounts of food that they cannot finish or wear winter clothing in the summer.
Changes in mood, personality or behaviour
While our moods may be affected by various events in our life, persons with dementia may become unusually emotional or emotionless, or experience rapid mood swings for no apparent reason. There may also be dramatic changes in their personalities. For example, you could be sharing a joke with them, but they may suddenly burst into tears or get angry for no rhyme or reason.
Problems with images and spatial awareness
Persons with dementia may experience problems with images and spatial awareness that are independent of common age-related problems such as cataracts. It can be difficult for them to judge distance and depth, and determine colour or contrast.
Occasional moments of carelessness can cause us to misplace our things. However, persons with dementia often leave their belongings in unusual places and are unable to retrace their steps. For example, they may have placed an iron in the fridge or a wristwatch in the sugar bowl.
Withdrawal from work or social activities
It is normal for us to take a break from social interactions to recharge from time to time. Those with dementia, however, may take it to extremes, such as sitting in front of the television for extended periods of time, sleeping for longer than usual, or losing interest in activities and hobbies they once enjoyed.
Problems with language and communication
We may struggle to find the right word in conversations from time to time, but persons with dementia tend to forget simple words or replace them with an unusual word or phrase. For example, a person with dementia may forget the word ‘wallet’ and describe it as ‘the thing you use to put money in’ instead.
Difficulty planning or solving problems
People with dementia often struggle to focus and take longer than usual to complete fairly basic activities. In particular, they may find it hard to develop and follow a plan, such as shopping lists, recipes and keeping track of monthly bills.
There are many ways to categorise the various stages of dementia, especially given the variety of subtypes. However, one of the common ways to categorize the dementia experience is the three-stage model.
In the early stages, persons with dementia may have trouble remembering words and names, misplace things more frequently, become easily confused or show poor judgement with planning and decision making. They may also experience changes in their mood and a loss of interest in activities they once enjoyed.
At this point, however, most are still able to function independently. Individuals may start to recognise their declining memory and compensate using strategies such as post-it notes and phone reminders.
Besides a greater extent of memory loss, confusion and poor judgement, those with moderate dementia may require assistance with activities of daily living, become increasingly agitated or suspicious, or experience a change in their sleeping patterns.
Oftentimes, symptoms tend to worsen during the late afternoon and night for no apparent reason. This is known as sundowning.
Toward the later stages, persons with dementia may experience extensive memory loss, limited mobility, difficulty performing functions such as swallowing and bowel and bladder control. At this stage, round-the-clock care is usually required.
It is important to note that these symptoms vary depending on the type of dementia and the individual themselves. As the symptoms tend to develop over time, it may not be easy to categorise dementia into three clear, distinct stages.
There is no sure way to prevent dementia and more research is needed to find out its cause. However, there are some steps we can take to improve our overall health, which may be beneficial in preventing the onset of dementia.
Aerobic exercises, in particular, are great for our heart and circulatory system, boosting brain health. Strength, balance and flexibility exercises can also help seniors stay agile and avoid falls, lowering the risk of brain injury and hence dementia.
Adopt a healthy diet
In general, consuming a diet low in sugar and saturated fat, and high in omega fats and vitamins may prevent dementia. Frequent and regular consumption of tea also helps, due to the bioactive compounds within which contain anti-inflammatory and antioxidant potential, protecting our brains.
Take time to unwind
Persistent stress and anxiety has been proven to increase the likelihood of the onset of dementia.
If you often feel under pressure, remember to find time to relax, meditate and do something you enjoy. Hanging out with friends and laughing can also help your body fight stress.
Get sufficient and quality sleep
Poor sleep promotes the buildup of proteins in the brain that can lead to impaired memory and Alzheimer’s.
For those with poor sleep habits, start by establishing a regular bedtime and commit to it. If you have insomnia or sleep problems such as sleep apnoea, consult your doctor and work out a solution that is best for you.
While some types of dementia such as NPH can be reversed and cured (about 20%), most types are irreversible. However, there are things within our control that can help to manage the symptoms of this condition and slow its progression.
While there is no cure, medication can help with symptom management for a period of time, and slow the progression of the condition. Doctors may also prescribe medication to treat problems that arise due to dementia such as depression and irritability. Besides medical and nursing care, engaging in-home rehabilitation therapy services may be beneficial in maintaining the individual’s quality of life as the condition and symptoms progress.
Just like our body, our mind needs regular exercise to stay in top condition. Encourage your loved ones to try out brain teasers, riddles, puzzles and games, as keeping the mind engaged has been proven to delay declines in our cognitive function. Get some ideas on the indoor and outdoor activities you can try with your loved one with dementia to keep them both physically and mentally active here.
Reminiscence therapy and cognitive stimulation therapy are but some of the many approaches that can help to jolt your loved one’s memory. Bringing up memories from the past, playing their favourite music and engaging in fun activities can be beneficial for loved ones with dementia, or at least brighten their day and improve their quality of life.
As previously mentioned, having quality sleep and proper nutrition, and staying active can be beneficial for our loved ones with dementia by alleviating their behavioural symptoms and slowing the progression of the condition.
Caring for Elderly with Dementia
Being a caregiver for a loved one with dementia can be challenging at times. Here are some tips for caregivers of persons with dementia.
Counselling and Support
A dementia diagnosis is a stressful and emotional experience for both you and your loved one. At this time, having the right support is crucial. It may be helpful for both you and your loved one to join a support group or visit a counselor to help with the adjustment.
As dementia progresses, the care needs of your loved one will grow as well. Being well-prepared for the journey ahead can help to reduce stress and manage expectations. Discuss with family members to work out a viable arrangement, and explore potential long-term care options.
Adjust Your Communication Style
Over time, your loved one may face trouble finding the right words, repeat themselves often, or have inappropriate outbursts. In such moments, avoid becoming frustrated and remember that your loved one cannot help their condition. Speaking slowly and simply, and responding with affection and affirmation can help ease their confusion and build their confidence and self-esteem.
Develop a Routine
Having a familiar routine can be comforting for persons with dementia and help ease tension and anxiety. Help your loved ones establish a healthy routine that can keep their body and mind active.
While we care for our loved one, it is also important not to tire yourself out and practise self-care, to avoid feeling overwhelmed and last the caregiving road ahead. Remember that you are not alone – help and support are never more than a phone call away.
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