Wednesday, 20 February 2008

Managing dementia


Support and care are vital in the management of dementia.

DEMENTIA is the loss of mental abilities like memory, thinking, reasoning, speech, mood and behaviour. It is more common as one gets older.

There are different types of dementia, viz:

=> Alzheimer’s disease – also known as “the disease of the long goodbye” – is the most common. The cause of Alzheimer’s disease is not known apart from a very small percentage which is due to inheritance. The hallmark of the condition is the build-up of plaques in the brain.

=> Vascular dementias make up about 20% of all cases. This is caused by poor circulation to the brain due to narrowed or blocked arteries. The onset is sudden and it often occurs after a stroke. The risk factors are: high blood pressure, diabetes, smoking and poor diet.

=> Lewy body dementia in which there are abnormal clumps of proteins in the brain. These clumps are also found in some people with Alzheimer’s disease and Parkinson’s disease, suggesting that the three conditions are related.

=> Fronto-temporal dementia is marked by shrinkage of the frontal and temporal lobes of the brain, leading to problems with language and/or behaviour but without memory problems.

=> Dementias that can be reversed with proper treatment. They include blood clot in the skull but outside the brain, brain tumours and infections, increase in fluid in the skull leading to pressure on the brain, underactive thyroid, high blood calcium, folic acid and vitamin B12 deficiency, drug and alcohol abuse.

=> Some medicines have side effects that produce dementia-like symptoms, like impaired memory and concentration. They include sleeping pills, tranquillisers, anti-depressants and medicines that have an anti-cholinergic effect, e.g. some medicines prescribed for allergy, cough or diarrhoea.

There are various symptoms, depending on the type of dementia. Many of those affected do not appear ill, particularly in the early stages. However, family and friends may notice changes, which are gradual in most instances.

Those with dementia have one or more of the following symptoms which are categorised into three groups for easy reference, viz: cognitive, functional and emotional problems.

Cognitive problems include:
=> memory loss – It may include forgetting the names of those they know well or where they live. Recent memory is usually affected first. As the condition worsens, past memory is affected.
=> speech and language – Simple words may be forgotten and inappropriate words may be used or the conversation may be repetitive, simplified or irrelevant.

=> problems learning new information or skills
impairment of thinking, calculation and/or judgment

Functional problems include difficulty in performing complex tasks, initially, and as the condition worsens, difficulty with activities of daily living, like dressing and personal hygiene.

Emotional problems include:
=> changes in mood or behaviour. There may be wide mood changes, irritability or aggression. As the condition worsens, inhibitions may be lost with the sufferer saying or behaving inappropriately. This can include sexual matters.
=> loss of emotional control
=> withdrawal from past activities, interests and social interactions

There are different symptom patterns with the different types of dementia. The symptoms may vary daily or not at all.

Many conditions (e.g. depression) have similar symptoms as that of dementia. As such, it is important not to assume that a person has dementia if he/she has one or more of the above symptoms.

Any complaint about memory loss, language or activities of daily living should be taken seriously. A history would be taken about the nature of the symptoms, their onset and course, medication, depression and medical conditions that affect memory. Physical examination and laboratory tests would be necessary to rule out treatable medical conditions.

It is sometimes difficult to diagnose dementia. If the doctor thinks a person has the condition, tests will be carried out. A standardised score of cognitive ability using rating scales, like the mini-mental state examination (MMSE), rates memory, attention, calculation, language, visual skills and orientation. The test takes about 10 minutes but is limited in that it does not detect subtle memory loss.

More detailed memory assessments, carried out by specialists, will provide better information about subtle memory loss.

Information obtained from blood tests, X-rays and/or a brain scan (computerised axial tomography [CAT] and/or magnetic resonance imaging [MRI]) are important in ruling out the treatable causes.

Sometimes, positive emission tomography (PET) is used as it has a high diagnostic accuracy and sensitivity for the early detection of Alzheimer’s disease.

There is no cure for most types of dementia. However, there is cure for dementias that are related to:

=> brain tumours, head injury or hydrocephalus, which are managed with surgery;
=> infections, which are treated with anti-microbials;
=> vitamin or hormone deficiency, which are treated with supplements;
=> medicines, which are treated by altering the medication prescribed;
=> drug and alcohol abuse, which are treated by lifestyle changes.

While there is no cure for Alzheimer's disease, treatment with certain drugs may prevent the symptoms from worsening, for a period of time.

The herb, gingko biloba, has been reported to have a small but significant improvement in symptoms like forgetfulness and confusion in Alzheimer’s disease and vascular dementia.

Non-cognitive symptoms are treated with a variety of non-pharmacological therapies e.g. aromatherapy, music, dance, contact with pets, massage, and exercise.

Anti-psychotic medicines are prescribed for a period of time for those who have severe symptoms like psychosis and agitation. Cognitive behavioural therapy may be prescribed for depression and anxiety. Anti-depressant medicines may also be prescribed.

When early dementia is first diagnosed, the preferences for care and treatment will be discussed with the affected person, when he/she is still able to make decisions. With the progression of the condition, the ability to make specific decisions will be affected. As such, it is advisable to make written instructions (called advance decisions and advance statements) about care in the future, stating what treatments and other help are wanted or not wanted; the preferred place of care, and carer; and end-of-life issues. The instructions may also include the power of attorney.

Support and care are the hallmarks of the management of dementia. Many of those affected are cared in the community by relatives or friends who face many challenges. Support and advice are available from doctors, nurses, other health care professionals and support groups like the Alzheimer’s Disease Foundation of Malaysia (

Dementia is not a part of the ageing process. It is more common in the senior citizens and is associated with various conditions that affect the brain. Those affected may appear well in the early stages but relatives and friends may notice changes. Assessment is important to exclude treatable conditions. There is no cure for the majority of dementias but much can be done to maintain the affected person’s quality of life. Support and care are the hallmarks of its management.

Dr Milton Lum is chairperson of the Commonwealth Medical Trust. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Tuesday, 19 February 2008

When Memories Die....

Alzheimer's Disease is the most common form of dementia. It is NOT a part of normal aging, but a disease involving the progressive loss of brain nerve cells. Since these nerve cells are essential for normal thought, memory and other brain functions, people with Alzheimer's Disease suffer a decline of mental functions which eventually interferes with the patient's normal daily activities.

Over time, Alzheimer's Disease patients lose their ability to perform even the most basic activities of daily living like brushing one's teeth, putting on clothes, bathing, etc. In the end, the ability to walk and talk may be lost as well.

Known as the disease of "The Long Goodbye", the illness often stretches over 10 and even 20 years. Despite intensive research in recent years, the disease is still not yet fully understood, and there is still no known cure.

Those most at risk of developing Alzheimer's Disease are the elderly, and the risk increases with age. According to statistics worldwide, one in 20 of those aged 65 and above have Alzheimer's Disease. However, amongst those aged 80 and above, one in five have Alzheimer's Disease. There is also a smaller group of people who may develop what is called Early Onset Alzheimer's from as young as their 40s or even late 30s.

Other major risk factors include genetic predisposition such as having certain genes or chromosomes, and a family history of Parkinson's Disease and/or Down's Syndrome. Minor risk factors include belonging to the female gender, and head injury.

At present, 18 million people worldwide have the disease. By 2020, 34 million.

In Malaysia, it is estimated that there are currently about 50,000 people with the disease. However, most of them are not diagnosed. This is because relatives think that the symptoms displayed are a normal part of growing old and thus do not seek medical advice on it.

Alzheimer's Disease affects not only the patients themselves, but also profoundly changes the lives of family members and close friends. Someone they love and care for gradually disintegrates as a person. Caring for a loved one with Alzheimer's Disease is sometimes referred to as a "36-hour-a-day" task.

However, proper understanding of the disease and management of the patient can reduce the burden considerably and greatly improve the quality of life for patients, their caregivers and families.

Tuesday, 5 February 2008

Join As ADFM Support Group Member - Membership Form

Click on the Form, fill in your details and be a member of ADFM Support Group.

Proposed National AD Care Givers Conference Program 2008

4th April 08 (Friday) :
3.00 p.m : Check-in at First World Hotel and Registration of Participants
5.00 p.m : Tea
5.30 p.m : Caucus Meeting of Heads of Support Groups & ADFM
7.30 p.m : Dinner
8.30 p.m : Fun Time at First World & Genting Resorts (Free & Easy)

5th April 08 (Saturday) :
7.00 a.m : Breakfast
9.00 a.m : Welcome Addresses
9.30 a.m : Medical Talks for Caregivers
10.30 a.m : Coffee Break
11.00 a.m : Talks for Caregivers Contd
12.30 p.m : Lunch
2.00 p.m : Talks for Caregivers
3.00 p.m : Panel Discussion on Caregiving Issues
3.30 pm : Tea Break
3.45 p.m : (Optional Program) – Visit Bukit Tinggi Resort (To pay for transport)
7.30 p.m : Dinner – Fellowship Night – Karaoke Sing-a-long (Co-ordinated by RCSA)

6th April 08 (Sunday) :
7.00 a.m : Breakfast
9.00 a.m : Launching of “Reaching Out” - OEJ
9.30 a.m : Launching of “National/Regional Network Grouping of Caregivers” - OEJ
10.30 a.m : Sharing & Discussion of Participants
11.30 a.m : Addresses by Support Group Representatives
12.00 p.m : Till We Meet Again – Closing Ceremony - Lunch



Dear ADFM Support Group Members,

The Alzheimer’s Disease Foundation Malaysia (ADFM) will be organising the above event from Friday, 4th to Sunday, 6th April 2008.

The aim of the Conference is to bring all the Caregivers, Volunteers and their families nationwide together to get to know one another, learn and share experiences and knowledge, and to have some fun and recreation.

This event will be subsidized by Alzheimer's Disease Foundation Malaysia (ADFM) for ADFM Registered Support Group Members.

For Early Bird Sign Up & Registration (by End Feberuary) : RM60/- per pax

For Registration After Feb 2008 : RM100/- per pax

Availability : First Come First Serve Basis

For those interested in Signing Up, print the registration form and fax to us or send us an email with the details :

FAX to us at : 03-2273 8493

Sign Up Today!