Malaysia is getting ‘older’ — By 2030, 15% of Malaysian population will be at least 60 years old and above. While aging is a normal process of life, an ageing nation may face various challenges in areas such as healthcare, financial services, city planning and social services.
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Particularly, an ageing Malaysia means that there will be more and more people experiencing dementia, a condition that primarily affects the elderly population. A large community study of the elderly in Malaysia found that as many as 14.4% of elderly have organic mental disorder, which includes dementia. Among those living in the government residential homes, the prevalence of probable dementia is even higher, at 36.5%.
Worldwide, the prevalence of dementia is expected to double every 20 years. The forecasted rate of increase is estimated to be > 300% in India, China and their South Asian and western Pacific neighbours.
All in all, even though you currently don’t have a loved one who is struggling with dementia, it’s good to educate yourself on dementia because it is indeed a common condition.
Dementia
Generally, the symptoms of dementia can be divided into two sub-categories, and a patient with dementia may have variable degrees of these symptoms.
Cognitive symptoms 🧠
Cognitive symptoms are the symptoms that have to do with how the brain works. The prominent cognitive symptoms associated with dementia are memory impairment (which is often brushed off as forgetfulness due to old age), particularly of learning new material. Language and spatial tasks (e.g. navigating around the house or in an immediate neighbourhood) may be affected as well. Poorer judgement and insights, especially compared with previous level of functioning, are also common.
Non-cognitive symptoms 🗯️
Non-cognitive symptoms in dementia are related to the person’s behavior and emotional control, known as the behavioral psychological symptoms of dementia (BPSD). Individuals with dementia may show verbal or physical agitation or aggressive and non aggressive behavior which can be verbal or physical.
Psychological symptoms are also common; people with dementia may experience depression, sleep disturbances, psychotic symptoms (delusions, misidentification or seeing things that are not real), and anxiety (which they may show an out-of-proportion response to a relatively small matter).
Dementia patients may also experience some extent of movement problems, known as the motor disturbances. This can include gait difficulties, slurred speech, and a variety of abnormal movements. In certain cases, they may have seizures as well.
Subtypes of dementia
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Dementia, after all, refers to a diverse set of behavioral, cognitive and emotional issues. There are various subcategories of dementia, and their treatment may also be slightly different:
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Alzheimer’s disease - Alzheimer’s disease is the most common type of dementia. People with Alzheimer’s disease mostly show memory impairment; movement problems would usually arise at a late stage of the disease.
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Vascular dementia - It’s well-known that many heart diseases are caused by plaques blocking the blood vessels, leading to heart attack, chest pain or stroke. Well, that is also how vascular dementia comes about – stroke is an important factor that leads to vascular dementia.
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Lewy body disease
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Dementia with lewy bodies
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Parkinson’s disease - In contrast to Alzheimer’s disease, people with Parkinson’s disease have predominantly movement problems, such as tremors, muscle stiffness, slowness in initiating movement and taking small shuffling steps when walking.
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Frontotemporal dementia - It is a more common form of dementia among younger individuals (52.8 to 56 years old). While memory is not largely affected, people with this type of dementia tend to show social misconduct, excessive chewing or sucking (hyperorality) and movement issues.
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Mixed dementia - A mix of Alzheimer’s disease and vascular disease
These conditions sometimes can overlap with each other and can be difficult to diagnose. Unlike many other diseases whose diagnosis can be done specifically via blood test, there’s no specific blood test for dementia. Diagnosis is often done by recognizing the patterns of problems experienced by the patient.
Medications used to treat dementia
The types of medications used in treating dementia may vary based on the severity of the condition. Besides tablets or capsules, some medications for dementia are available in patches to be applied on skin.
Acetylcholinesterase inhibitors
E.g. : donepezil (Aricept), rivastigmine (Exelon patch), galantamine
These medications are the most commonly used medical treatment for dementia. They boost the amount of a chemical substance in a person’s brain known as acetylcholine. With the restoration of acetylcholine, the symptoms of dementia can be relieved or controlled. Some of the common side effects of these medications include nausea, vomiting and diarrhea.
It’s also common for doctors to prescribe any of these medications with another medication known as memantine to patients with more severe dementia.
Antipsychotics
E.g. : Risperidone, aripiprazole, quetiapine, olanzapine
Antipsychotics are only used for dementia patients when they show signs of psychosis, aggression and agitation, especially when they might pose danger to themselves or others. There has been evidence showing that elderly patients with dementia-related psychosis treated with these medications are at an increased risk of death; most deaths were attributed to cardiovascular events (eg, heart failure or sudden death) or infections (eg, pneumonia). Hence, doctors would usually reserve these medications in the most necessary scenario and keep the treatment duration as short as possible.
Antidepressants
E.g. sertraline, fluoxetine, escitalopram, venlafaxine
Antidepressants will only be prescribed to dementia patients who show symptoms of depression to improve their general functions.
These treatments are not an one-off event. They require review by the doctors from time to time to ensure that the patient receives the most appropriate treatment based on disease condition. So if you’re a caregiver of someone with dementia, it’s important to attend follow-up with the doctors on time!
Besides, these medications can come with many side effects, your doctor or pharmacist should be telling you about them and how to manage these side effects. Before you let the dementia patient start trying other herbal products, supplements or over-the-counter medications, be sure to consult a healthcare professional first.
Control blood pressure & diabetes
This is particularly important for patients with vascular dementia, as their blood pressure and diabetes progressions may affect the severity of dementia. If you’re caring for someone with vascular dementia, ensure that they:
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Take their blood pressure and diabetes medications on time as per instructions by the doctor
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Check blood pressure and blood sugar level as per the instructions of a healthcare professional
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Attend regular follow-up with doctor
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Consult a healthcare professional first before trying other herbal products, supplements or over-the-counter medications
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Assist the patient to live a healthy lifestyle through adequate nutrition, limited alcohol consumption and quit smoking
Read more about lifestyle changes for dementia here
Medications are just part of the treatment
Dementia is a complex medical condition to manage, and medications are just a tiny part of the entire treatment of dementia. As patients with dementia lose their ability to take care of themselves day by day, the real challenge lies within changing an entire lifestyle to suit the patient’s needs.
It’s no easy feat to care for elderly with dementia. If you require any support for caring for a dementia patient, read more here.
Photo by Steven HWG on Unsplash
A word from Doc2Us
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References
CPG Management of Dementia 2009
Cover image credit: Photo by Steven HWG on Unsplash
