Dementia

Prevention

As people grow older, many become interested in ways to lower their chances of developing dementia. Although the cause and preventive measures of dementia have yet to be scientifically proven, there are certain lifestyle changes that could potentially lower the risk of developing dementia:

1. Exercise – regular exercise will not only improve health and maintain physical fitness, but also reduce the risk of arteriosclerosis (the hardening of blood vessels walls). Arteriosclerosis can affect blood circulation in the brain, which is one of the causes of dementia. Studies have also shown that regular exercise can minimize the decline of brain function and the chance of developing dementia. Example of useful exercises include: brisk walking, jogging, biking, or swimming.
2. Habits that prevent the development of vascular disease – the risk factors of heart-related disease (vascular disease) may also cause arteriosclerosis, which leads to the narrowing of blood vessels. This can affect the blood supply to the heart, brain, and other organs. If the blood flow to the brain is slowed down or stopped, it may cause a stroke which can lead to dementia. The practices that reduce the risk of vascular disease includes: not smoking, lowering cholesterol levels, controlling diabetes, controlling high blood pressure and maintaining a healthy body weight. Through these practices (especially reducing high blood pressure) together with preventive measures for stroke, the chances of developing dementia will be greatly reduced.
3. Stimulating brain activities – studies have shown that engaging in activities that keep the brain active as we age can help improve memory and verbal ability. Therefore, participation in these brain-exercising activities and social activities could reduce the risk of developing dementia. Some examples of these types of activities include: solving puzzles, playing Mahjong, reading, keeping aware of current events, and other hobbies.
4. Social life – studies have shown that a small social circle where a person has too few friends will increase the chances of developing dementia by 60%. A larger social circle appears to be effective in preventing dementia. So, it can be helpful to your mental health to continue to make new friends while still trying to keep in touch with old friends.
5. Getting adequate sleep and reducing stress – poor quality of sleep and too much stress can affect memory. As people age, a proper amount of sleep (minimum of eight hours) may help prevent memory loss.

 Currently, many herbal formulas, vitamins, antioxidants and other drugs have claimed to prevent Alzheimer’s and other dementias. Unfortunately, there is still a lack of evidence to show that these substances are effective.

 Content provided by Dr. Raymond Ma, Family Physician

Living With Dementia

Diagnosis

Dementia can affect a person’s memory, thinking, or reasoning skills. These problems are generally referred to as “cognitive impairment” due to dementia. Other than affecting the cognitive ability of a person, dementia may also affect a person’s personality. Dementia patients may say or do certain things that are out of character. Patients will gradually lose the ability to care for themselves, eventually relying on others to carry out daily activities. In this case, dementia does not only greatly affect the patients but also their caregivers and family members.

Many people confuse the two terms dementia and Alzheimer as describing the same condition. A main characteristic of Alzheimer disease is the accumulation of Amyloid protein in the brain. The first symptoms are short term memory lost – forgetting recent incidents and conversations. As time progress, Alzheimer disease may impact the patients’ long-term memory (forgetting things that happened in the past), and affect their thinking abilities. Alzheimer’s disease is perhaps the most common form of dementia, but is not the only cause of dementia.

Dementia symptoms can progress rapidly but also in some cases the progression is slow. Generally speaking, it is normal for a healthy older person to complain about their poor memory; however, if the severity of the memory loss is enough to interfere with his/her basic daily activities, then a further evaluation should be conducted. Still, one of the challenges is the patient being unaware of his/her symptoms. A diagnosis often only occurs when family members and friends notice the change and persuade the person to seek medical advice.

The assessment of a dementia specialist is very useful for the diagnosis and determination of the cause of dementia. Although currently there is no cure for dementia, once diagnosed the appropriate treatment and support can be provided for the patients and their families. As a result, the patient is more likely to stay independent longer and live a higher quality of life.

During the evaluation of dementia, many different professionals will be involved, including: doctors, genetic counselors, nurses, occupational therapists, psychologists, or social workers. They will work together to provide detailed information and reports for patients and their family members. This process will ensure that the patients and family members will receive help as needed.

Clock Drawing Test

This is a common test used to screen for dementia and to track its progression.

In this test, the patient is first asked to draw a circle which will represent the face of a clock (in some cases, a printed circle is presented to him/her). Then the patient is asked to label the 12 numbers in their appropriate places and then draw the two hands of the clock to indicate the time of ten minutes past eleven.

Seemingly simple, the test examines a lot of the functions of the brain. The patient has to be able to:

• understand and remember the instruction
• plan and execute the instruction
• be able to visually remember the image of the clock
• be able to distribute the numbers around the clock evenly
• be able to put the numbers and hands in the correct place
• have enough concentration to finish the task.

It is easy to administer, takes only a few minutes and requires minimal equipment. Unlike the MMSE (Mini-Mental State Examination), it depends less on language skill and education.

However, there are many ways of administering this test and there are at least twenty different scoring systems! Some are simple but some are very complicated. Nevertheless, all these different methods have been proven to be able to detect dementia.

The following is an example of one of the simpler ways of administering and scoring the test:

The patient will get one point for each correct action:

• Able to draw a circle
• Able to put in all twelve numbers in the correct order
• Able to place the numbers in the correct place on the clock face
• Able to draw the two hands on the clock
• Able to point the two hands to the correct time

Four to five points indicate normal cognition. Further investigation into dementia will be required for those scoring less than 4 points.

Healthcare professionals also use this to track the progression of the dementia and have also used the different types of mistakes to distinguish between the different types of dementia.

Regrettably, with the common usage of the digital clock, this test may become less effective within the next couple of generations.

Written by Dr. Kenneth Chan

MMSE (Mini Mental State Exam)

This test has obvious weaknesses. It is language and education dependent. Luckily, the test has been translated into Chinese and the results have been scientifically proven. Still, the test requires the patient to have at least six years of education to be valid. Furthermore, the patient has to be able to write, read and hear properly. In addition, the test is unreliable in distinguishing between borderline normal and mild dementia and is unable to tell what kind of disease is causing the dementia.

Even though the test has its imperfections, ,it is easy to use and it does give a numerical score which makes tracking the progression of the disease easier.

Dementia remains a clinical diagnosis: the doctor needs to consider the entire picture – the patient’s behavior, physical/psychiatric findings, the history of his/her illness and laboratory/scanning results – in order to make a diagnosis.

The MMSE is considered to be another tool to help with the diagnosis of dementia.

Written by Dr. Kenneth Chan