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Dementia: You’re not alone!

29 Jan 2022

When dementia creeps in through the back door, Loving is needed, like never before. An expressionless face, an empty heart, A once dazzling life that had lost its spark. I saw your sad tears and felt every fear Of foggy days that for you never cleared – Beryl L. Edmonds [caption id="attachment_186583" align="alignright" width="388"] UoC Faculty of Medicine Department of Psychiatry Senior Lecturer Dr. Anuprabha Wickramasinghe (MBBS, MSc Neuroscience, MD Psych, FRCPsych)[/caption] Whether you have been diagnosed with dementia or have a loved one fighting this disease, you may have many unanswered questions surrounding the condition. In this light we spoke to University of Colombo (UoC) Department of Psychiatry Senior Lecturer Dr. Anuprabha Wickramasinghe to find answers to some of our concerns.  What is dementia? Dementia is a memory impairment that is beyond the usual memory difficulties that come with old age. The disease mainly interferes with making new memories, and patients find it difficult to remember things that happened recently. Memories from the distant past remain normal in the beginning, although this too can get worse later. However, dementia is not the only reason for memory loss. For example, when somebody is overworked and stressed, not getting enough sleep, or taking excessive amounts of alcohol, memory can get poor. At the same time, certain reversible mental health conditions like depression lead to a false dementia-like state, simply because they do not pay attention to the surroundings, and together with their poor attention and concentration, they do not register information to be recalled later. Memory impairment due to these conditions reverses to normal when the underlying reasons have been addressed. In dementia, however, memory gets progressively worse over time in an irreversible manner, stated Dr. Wickramasinghe.  How do symptoms present? Patients are often unable to recognise this change, but the family members start to notice the memory impairment. Patients may talk of the same things repeatedly as they have forgotten they talked about it just a little while before. They may misplace things, keep looking for the things they have misplaced, and sometimes even accuse others of stealing them. They may forget appointments. They might have word-finding difficulty and loss of fluency in a language, might not be able to recognise people, and may struggle to do somewhat complex tasks like tying shoelaces, or buttoning up a shirt. Sometimes their personalities change and they can develop emotional and behavioural disturbances. Patients’ ability to carry out their day-to-day work is reduced. It is the worried family members who notice these differences who will bring the patient to see a doctor. In the early part of the illness, some patients may show awareness of the memory loss and seek help themselves.  How common is it? Dementia is a disease of old age. It is quite rare in the younger age groups. Roughly one out of 20 persons above the age of 65 will have dementia, and it gets commoner in older age groups. If you take the people above 80 years, almost one out of five will have dementia. It affects both men and women, although seen slightly more frequently in women, stated Dr. Wickramasinghe.  What causes dementia? The reason for developing dementia is the damage to areas in the brain that control memory and related functions. Cells in these brain regions gradually start to shrink and stop functioning. There can be several causes for this irreversible degenerative process.  Most commonly, that is in about six out of 10 instances, this is due to Alzheimer’s Disease. Cells that are crucial for laying down new memories start getting damaged due to a degenerative process, resulting in the deposition of protein materials in the cells. The efficiency of the cells are lost, and this leads to the slow and gradual destruction of the brain cells.     The second most common cause for dementia is the reduced blood supply to memory regions of the brain, because of cerebrovascular diseases such as stroke or repeated mini-strokes, diabetes and high blood pressure causing blood vessel damage or reduced efficiency of oxygen delivery to the brain due to heart or lung disease.  Brain diseases like Parkinson’s can sometimes lead to dementia in their later stages. Heavy and prolonged use of alcohol, exposure to other toxins, infections, hormonal diseases, brain abnormalities, and deficiency in vitamin B compounds like B12, thiamine, and folate are some of the other conditions that can lead to progressive and irreversible dementias.  How can you diagnose dementia? The doctor will gather information about the memory-related difficulties the patient is facing, how these have started and progressed, and about the patient’s ability to look after their daily routine activities by interviewing the patient, and most importantly, a family member. Clinical features may slightly differ in each dementia subtype.  The doctor will look for other health conditions by doing various blood, urine, and brain scans as it is important to treat any medical conditions that may be causing reversible memory problems. Several pen and paper memory tests can be used to measure the level of memory impairment by the doctor or another suitable member of the team like a trained psychologist. By putting all this information together, the doctor will decide whether the memory impairment is caused by dementia and if so, the type of dementia.  Sometimes the typical changes are evident in brain scan reports, but other times it is diagnosed through information gathered and by excluding other reversible causes.  Following the diagnosis, patients and family members usually have a lot of questions to ask. The doctor will explain the condition, and how to plan the treatment and life in general. This step must be done taking time. Does it run in families?  This is a frequent concern by the family members. If dementia has started after 65 years, other family members may only be at minimal risk when compared to people without an affected family member. Chances are more that the rest of the family members will not get dementia. There are no screening tests that can predict who will develop dementia in such families.  In rare instances, dementia can happen at younger ages such as in the 50s and this may have a more direct genetic link. In this situation, the family can discuss with their doctor whether genetic and other screening tests can be helpful.       When should you seek help and how?   If you suspect that a member of your family is having memory impairment, or other features mentioned earlier, it may be best to consult your family doctor or a doctor from the local hospital for initial tests and advice. If the doctor feels that specialist assessment is needed, your family member will then be directed to a suitable specialist to complete the rest of the assessment. Nowadays, most hospitals have doctors experienced in assessing and treating dementia.  What are the treatment options available for patients with dementia?   There are various treatment options currently available to improve symptoms in patients with dementia. We have not got a cure for dementia at present. Scientists all over the world are currently looking for better medications to help patients and their families.  The most important medications that are currently used to treat dementia are called memory enhancers. These medications can either improve memory or slow the decline of memory for a few years in certain dementias like Alzheimer’s dementia, Lewy body dementia, and dementia of Parkinson’s Disease. Although vascular dementia does not improve with memory enhancers, when it is present with the above dementias, these medications can be helpful. In other instances, doctors might prescribe medications for other nonspecific symptoms like poor sleep, low mood, or agitation if present, stated Dr. Wickramasinghe.  What are the practical steps that can help? Medication is only one small aspect of treatment. It is very important to get appropriate information about the condition from the doctor who makes the diagnosis. If the diagnosis is made early, the patient may have many years to live with dementia. Therefore, it is important to continue what the patient can do safely. Some patients even continue their jobs, driving, and fairly important family roles, in the early period of the condition. The family however needs to monitor the situation and identify early signs of problems. Depending on the severity, a gradual reduction of commitments is needed.  For example, a housewife who always cooked for her family can continue to do so as long as she is capable of cooking without risks, preferably supervised by family. If the family notices any difficulties like forgetting to switch off the cooker or other evidence of compromised safety in using the cooker, increased supervision is going to be needed or ensuring the patient does not have access to the cooker.   Likewise, families have an increasing role to play in supervising and assisting the patient with advancing dementia.  Patients can be at risk of falls, accidents, poor nutrition and hydration, forgetting medication, vulnerability to financial exploitation, and abuse. In severe dementia, the patient may unknowingly wander out of the home, and may not be able to find the way back home. Reducing such risks is a very important part of the management of dementia.  Some care teams might be able to offer various group activities in day centres, which serve several purposes. Group memory strategies can help keep their minds active and help the memory at least in the short term. Patients get to meet people and socialise, which is often appreciated by them. Light physical exercises and movement in a group setting also have many health benefits to the patients including slowing down of the deterioration. Most importantly, this may give the caregivers a break to catch some rest or attend to important household work. If such services are not available in your locality, family members can try to keep the patient engaged, and active. The goal of treatment is to maintain the quality and meaning of life.  How does it affect the caregivers in the family? Looking after a patient with dementia can be physically and emotionally taxing to the family. Family members may be struggling to come to terms with the fading memories and other abilities of their loved ones. When the caregivers do not have the right support from the other family members, they can develop depression. If they have not been looking after their health, they can be at a higher risk of developing physical health problems and complications. Therefore all family members must support each other when taking care of a family member with dementia.  What are the methods of prevention? Right now, our best chance is to prevent the development of dementia while we can. Improving any conditions that may make you more vulnerable to developing dementia such as stopping smoking, reducing or stopping alcohol, preventing or controlling diabetes and high blood pressure, keeping active, challenging your brain by learning something new like a language that you always wanted to learn may help prevent dementia.  Any take home message? Although dementia has no definitive cure at present, there are a lot of things families can do to help improve the quality of life of a patient with dementia. It is important to get a diagnosis, and correct support from the treating teams, other voluntary organisations, and family and friends whenever possible, concluded Dr. Wickramasinghe.  

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Discover Kapruka, the leading online shopping platform in Sri Lanka, where you can conveniently send Gifts and Flowers to your loved ones for any event. Explore a wide range of popular Shopping Categories on Kapruka, including Toys, Groceries, Electronics, Birthday Cakes, Fruits, Chocolates, Automobile, Mother and Baby Products, Clothing, and Fashion. Additionally, Kapruka offers unique online services like Money Remittance, Astrology, Medicine Delivery, and access to over 700 Top Brands. Also If you’re interested in selling with Kapruka, Partner Central by Kapruka is the best solution to start with. Moreover, through Kapruka Global Shop, you can also enjoy the convenience of purchasing products from renowned platforms like Amazon and eBay and have them delivered to Sri Lanka.Send love straight to their heart this Valentine's with our thoughtful gifts!


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