What is dementia, the condition that Pak Lah suffers from?
HURIN EIN12 Sep 2022 05:34pm
Photo for illustration purposes only - 123RF Photo
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Although many would have been familiar with the term dementia of it being commonly linked to old age, it is not a single disease.
According to Alzheimer's Disease Foundation Malaysia (ADFM), dementia was explained as a syndrome leading to the deterioration of cognitive function which includes memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement.
Statistics from the World Health Organisation (WHO) stated that dementia was seventh in the leading cause of death among other diseases and played a key role in causing disability and dependency of older people globally.
However, awareness and knowledge of dementia had been lacking raising the stigmatization surrounding this disease and causing prevention for diagnosis and care.
SIGNS AND SYMPTOMS
The effects of dementia vary across patients. ADFM stated that differences in dementia effects can especially be observed in the early stages depending on how well the patient copes with the illness as well as how their environment responds to them.
Other factors such as the underlying causes, health conditions as well as the cognitive functioning of the patient before they became ill will also affect the extent of dementia in an individual.
Stages of dementia were generally categorized into three stages early, middle and late stages.
The early stages comprised the patient being forgetful, losing track of time and feeling lost in familiar places.
It was often during this stage that people tend to overlook as the symptoms of dementia progressed gradually.
In the middle stage, patients will start forgetting recent events and people’s names and they will also start to feel unfamiliar despite being in their own homes. Communications will also be difficult and they may be needing help with professional care.
Behaviour changes like wandering and repeating questions were also common observations in the middle stage.
As the ailment progressed to the late stage, dementia patients will be inactive and need total dependency on the care of others.
At this stage, they will have a serious case of memory disturbances and physical symptoms were more apparent like they will be unable to be conscious of the time and place, have difficulties in walking and recognizing those close to them and may also undergo behavioural changes causing aggression.
Dementia was considered a progressive illness in which symptoms worsen over time. However, the rate of progression differs from one person to another.
TYPES OF DEMENTIA
An organisation specialising in personal care solutions Homage Malaysia outlined over 10 types of dementia.
The most common form, Alzheimer’s disease contributed to 60 to 70 per cent of cases. ADFM explained that in Alzheimer's disease, brain cells were surrounded by an abnormal protein causing damage to the internal structure. Over time, the brain cells will lose chemical connections causing them to die.
Starting symptoms may be observed in day-to-day memories but other symptoms may follow like difficulties in speech, problem-solving, decision making or visuospatial skills like the difficulty judging distances.
In Alzheimer’s disease, it was also important to take into account the patient’s family history as it was found that those who have a first-degree relative with Alzheimer’s have a 10 to 30 per cent chance of developing the same ailment.
Vascular dementia was cases linked to strokes and other health issues pertaining to the brain’s blood flow. If there were a reduction of oxygen supply to the brain or a narrowing or blockage of blood vessels, the brain cells will be damaged or even die.
Risk factors may include diabetes, high blood pressure and cholesterol.
In this case, individuals who faced strokes or mini-strokes have a higher chance of a worsening case of dementia.
Another type of dementia causing stiffness and trembling is called Lewy body dementia. Tiny abnormal structures called Lewy bodies formed inside the brain cells causing disruption to the brain chemistry which ultimately kills the brain cells.
This type of dementia was closely related to Parkinson's disease and often has similar symptoms including disruption in a person's motor skills or movement.
Individuals may be facing changes in alertness and susceptible to daytime sleepiness, confusion and staring spells, a term for a brief absence seizure due to abnormal electrical brain activity. They may also experience insomnia or visual hallucinations.
Changes to personality and behaviour were due to Fronto-temporal dementia where patients may act out of the ordinary and behave inappropriately. Speech and comprehension skills may also be affected by this type where they will face difficulty talking and understanding others.
Mixed dementia was where an individual may suffer from multiple types of dementia. With more than one kind of dementia, the disease progression will be faster.
One of the rarest forms of dementia, Creutzfeldt-Jakob Disease with only one in one million being diagnosed with this condition. Progression is rapid and patients often die within a year of diagnosis.
Symptoms of Creutzfeldt-Jakob disease had been similar to other forms of dementia but patients may also suffer from muscle twitching and stiffness.
Wernicke-Korsakoff Syndrome was another type and initially, it was not considered dementia but was later classified under the dementia spectrum due to the similarities in symptoms.
Wernicke disease occurred when lower sections of the brain bled due to vitamin B-1 deficiency and caused by malnutrition and or chronic infections but more commonly caused by alcoholism. If left untreated, Korsakoff disease symptoms will begin to surface where one may suffer from difficulty in processing information, learning new skills and remembering things.
Normal pressure hydrocephalus (NPH) was a dementia condition caused by injury, bleeding, infection, brain tumour and previous brain surgeries. Symptoms may include poor balance, forgetfulness, mood swings, depression, frequent falls and loss of bowel or bladder control.
Fortunately, NPH cases were curable through surgery but early treatment was the highest recommendation in these cases to prevent more damage to the brain.
Although dementia was strongly linked to old age, cases of young onset dementia were also not impossible as can be seen in Huntington's Disease commonly affects younger adults. This condition was due to the premature breakdown of the brain’s nerve cells causing impaired movement.
Huntington's Disease was said to be a genetic illness and classified into two types juvenile and adult-onset depending on when symptoms first appeared. The juvenile form showed symptoms from childhood to adolescence while the adult form appeared when the individual was in his 30s to 40s.
Physical symptoms comprised jerking, difficulty walking and trouble swallowing while cognitive symptoms were difficulties in focus, impulse control problems, speech and learning new things.
CARETAKER'S CHALLENGES OF CARING FOR DEMENTIA PATIENTS
A huge and crucial part of the care of dementia patients lies in the role of the caretakers.
Since dementia patients were highly dependent on their caregivers, they are more expected to provide “high-intensity care” and this causes dementia caregivers to have higher reports of strain like mental and physical problems as well as caregiver burnout.
Taking the role of a dementia caregiver was not an easy feat because according to findings from the National Health and Morbidity Survey in 2019, caregivers will be subjected to caregiver anxiety and stress.
Since more supervision is especially required in elderly dementia cases, due to their cognitive inability, they will be unable to express gratitude for the help they received and this will likely cause the caregivers to fall into depression.
The survey also stated that informal caregivers were prone to heighten depression, psychological stress, and worsening self-care and health.
Adding to that, dementia behaviours like wandering, aggression and inappropriate actions may cause them to feel as if they’re caring for a stranger, amplifying the feelings of being distant and lonely.
In the long run, caregivers might even neglect their health over prioritizing a dementia patient, especially if it was a family member or someone close. Thus, caregivers with chronic conditions and comorbidities were at risk of worsening health if this continued for a long time.
The accumulated stress from the caregiving burden may also possible to bleed through other aspects of life like family relationships and work. Consequently, with more stress hormones circulating within the system, it may cause disturbance to other systems in the body like the immune, digestive, sleep and even the reproductive system.
DEMENTIA TREATMENT
In accordance with ADFM, ultimately the treatment of dementia will be depending on the underlying cause but neurodegenerative dementias like Alzheimer’s disease have no cure.
Adding to that, anti-dementia medication and therapy that have been developed mainly cater to Alzheimer’s disease and have limited efficacy but medication to help protect the brain and manage symptoms like anxiety and behavioural symptoms were available.
Even so, it was suggested that drugs and medication should not be the only point of reliance as behavioural and psychological symptoms of dementia can be improved through pain treatment and spending more quality time with the individual.
A very important factor for the recovery of a dementia patient was communication. A research study stated in ADFM found that 10 minutes of one-to-one time each day could reduce symptoms.
During the communication, it was especially vital to listen carefully and look out for non-verbal cues as well as instil empathy in order to comprehend the realities faced by dementia patients.
Other examples of non-drug approaches that may help include life story work, physical exercise, music, dance and even hand massages.
However, if non-drug approaches were found to be ineffective to manage behavioural and psychological symptoms, or if symptoms were severe, then relying on medication would be wise.
