Is dementia a part of normal ageing?
Dementia is a terminal medical condition characterized by deterioration in the structure and function of the brain. It is by and large a condition of older age, but not a part of the normal course of ageing. Approximately 9 per cent of Australians aged 65 and over have a diagnosis of dementia; in people aged 85 years and older, this figure rises to 30 per cent. As Australia’s population ages, the number of people with dementia is expected to increase.
Symptoms and progression
Dementia affects people across multiple domains.
- It may start with forgetfulness which may lead to making more mistakes whilst doing things, losing your wallet or car keys or misplacing them.
- finding hobbies more difficult than before
- having trouble keeping track of day to day events or time.
- Losing orientation to place making it difficult to navigate back home.
- You may forget names and faces of familiar people.
- finding the right words when speaking.
- One may also have problems in eating, dressing or walking.
- Changes in personality and behaviour sometimes known as BPSD(behavioral and psychological symptoms of dementia), memory impairments, and difficulties with executive functioning.
Diagnosis and assessment
Alzheimer’s disease is currently the most prevalent form of dementia. It is caused by tangles and plaques on the nerves connecting brain cells. More than 2/3rds of all diagnosis of dementia belong to Alzheimer’s type.
The other causes of dementia are:
- Vascular dementia (caused by strokes or blockages of blood vessels in the brain)
- Lewy body disease (caused by proteins in the brain that damage cells)
- Fronto-temporal dementia (Degeneration in the front and side lobes of the brain).
As one would expect, a person’s genes, their lifestyle and environment play a part in whether someone will develop these diseases. It is a bit hard to predict who will develop dementia.
A diagnosis of dementia is made only after a comprehensive assessment, which should include:
- history taking from the person
- history taking from a person who knows the person well
- cognitive and mental state examination
- physical examination
- a review of medication in order to identify and minimise use of medications.
Some blood tests may be useful such as routine haematology, biochemistry tests (including electrolytes, calcium, glucose, and renal and liver function tests, thyroid function tests, serum vitamin B12 and folate levels.
MRI brain may be used to screen for structural changes such as tumours mimicking dementia. Special imaging techniques such as PET and SPECT were used to detect changes in brain function. Single-photon emission computed tomography (SPECT) or positron emission tomography (PET) are used to identify areas of reduced glucose metabolism or perfusion, thus indicating neuronal loss. Unfortunately, none of these measures improved diagnostic accuracy to a significant extent, thus they are not routinely used in differentiating mild cognitive impairment from dementia orin subtyping dementia.
Medical interventions: Australian guidelines suggest that any one of the three acetylcholinesterase inhibitors (donepezil, galantamine or rivastigmine) are recommended as options for managing the symptoms of mild tomoderately severe Alzheimer’s disease. However, they caution that such treatment may have unwanted side effects such as vomiting, dizziness, urinary incontinence, falls, muscle cramps, weight loss, headache, insomnia and Heart block. Memantine is another recommended option for people with moderate-to-severe Alzheimer’s disease who are intolerant to acetylcholinesterase inhibitors.
All individuals on these medications need to be reviewed by a medical practitioner at regular intervals.This is because they often work effectively for only a short period of time.
Psycho-social interventions: As in all other terminal illnesses, there is no cure for dementia. Psycho-social interventions are often most appropriate both to provide quality of life and to ameliorate behavioral and psychological symptoms of dementia (as differentiated from symptoms due to pain or agitation at not being understood by care givers). Psychosocial interventions that are person-centred, individually tailored, and non-invasive. Cognitive behavioural therapy is helpful for the anxiety and depression that can happen with mild dementia. Cognitive stimulation therapy provides social engagement and activities. Listening to music, talking about the past and going through old photo albums may help a person to connect with others. For later stage dementia, pets, painting and hand massage can prevent restlessness and agitation.
Care for people with dementia
Carers and familyoften require education to identify and address environmental and psychosocial factors that may increase the likelihood of the person with dementia experiencing distressing behavioural and psychological symptoms. Some of these may be just unmet needs such as pain, hunger, lack of meaningful activities and poor communication and high stress levels in the family. For the terminal course of dementia, the maximization of comfort for a person with dementia is the highest priority. Good communication, shared decision making, advance planning, provision of physical comfort and treatment of associated physical and psychological symptoms is likely to achieve this goal.
What can a psychiatrists at Mindoc do for dementia?
Psycho-geriatricianat Mindoc can perform a comprehensive assessment which will result in a clear diagnosis and management plan. They may also give you advise on treatment of associated depression, anxiety or help with behavioural problems such as aggression. In addition, they may be able to help with linkages with other local services and referrals to other health providers. They might be able to facilitate hospitalisation if necessary.