JANUARY-FEBRUARY , 2023 | THE HEALTH

MINDTALK

BY DR ROZANIZAM ZAKARIA

Her children have noticed some behavioural changes over the past six months . She forgets things more quickly , especially with the time and place . She frequently loses track of the conversation and forgets her grandchildren ’ s names .

She lost money a couple of times and left the front door unlocked . She has just lost her ability to cook and clean the house . Her family worries excessively about her emotional fluctuations and propensity to walk around aimlessly at night .

Jane ’ s behaviour is a typical example reported by family members regarding an individual with dementia . With more than 55 million people living with dementia worldwide and 10 million new cases each year , it is unsurprising that what Jane and many other elderly populations experience have become a major public health concern .

Dementia is an umbrella term that refers to a syndrome of cognitive function deterioration that goes beyond what would be expected from the normal effects of physiological ageing . The more recent guidelines for mental disorder assessment , the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ), have renamed dementia “ neurocognitive disorder ,” which is divided into different severity categories and aetiological factors .

It is caused by many conditions , mainly those that have primary and secondary effects on the brain . Alzheimer ’ s disease is the most common form of dementia , accounting for 60 to 70 per cent of cases .

EFFECTS ON CAREGIVERS , FAMILIES AND SOCIETY

Another major contributor to dementia is vascular disease , such as stroke . Other diseases are fronto-temporal dementia , dementia of Lewy bodies , and various reversible causes such as subdural haemorrhages , Vitamin B12 deficiency , and endocrine causes .

Although dementia mainly affects older people , it is not an unavoidable consequence of ageing . According to the World Health Organisation ( WHO ), dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people globally .

Because dementia causes a wide range of disabilities in its victims , it has physical , psychological , social , and economic consequences not only for dementia patients but also for their caregivers , families , and society at large .

Normal ageing will affect various aspects of one ’ s life . This includes deterioration in cognitive ability , including short-term memory , long-term memory , problem-solving ability , psychomotor slowing , and verbal comprehension . However , in dementia , the memory decline is more severe , disabling , and progressive .

Many patients will also experience co-morbid psychiatric disturbances such as depressed mood , irritability , paranoid ideations or delusions , sleep problems , and aggressive behaviour . For example , 20 per cent of patients will experience significant depressive symptoms requiring treatment .

These accompanying symptoms are essential to explore as they may result in a poorer prognosis , be more disabling

to daily functioning , and cause more stress to carers . The most important message to the general public is that dementia is preventable , and early recognition and prevention are vital .

Numerous studies have confirmed that changing one ’ s lifestyle at an early age can lower the risk of dementia . This includes behaviours that promote physical activity , such as abstaining

Dr Rozanizam Zakaria is Assistant Professor in Psychiatry , Kulliyyah of Medicine , International Islamic University Malaysia ( UIAM ) and Fellow in Child and Adolescent Psychiatry , Ministry of Health . from dangerous substances like alcohol and tobacco , managing one ’ s weight , eating a healthy diet , and preserving blood pressure , cholesterol , and blood sugar levels .

Depression , social isolation , inadequate education , and environmental contamination are other modifiable risk factors in addition to those mentioned above . It is , therefore crucial to raise awareness regarding prevention in these areas , as doing so could soon lessen the total health burden . – The Health

Principles in the management of the elderly with cognitive decline

• Multi-disciplinary assessment to explore diagnosis , functional assessment , and social support

• Explore and treat reversible causes

• Explore behavioural and psychological disturbances associated with presentation , such as insomnia , psychosis , and mood symptoms

• Cognitive enhancement with pharmacological agents such as acetylcholinesterase inhibitors

• Optimise treatment of underlying co-morbid medical problems such as hypertension and diabetes

• Educate carers

• Psychological support for the patient and family

• Maximise mobility ; promote independence with self-care ; address toilet and feeding issues ; and communicate effectively .

• Social management : accommodation , end-of-life care , wills , and other legal matters