A Hot Trend in Aging Society: Knowing about Alzheimers Disease and Dementia Can Slow Their Progress

Remarkably, a lot of older adults living at home have shown signs of aging changes derived from the stress of not being able to go outdoors due to COVID-19 or due to their own health problems.

For example, an elderly father may often repeat the same questions. He used to take care of the family dogs when his son or daughter had to travel out of town. He knew how to set up the dog feeders, keep the cages clean and so on. But one day the child comes home to find the house in a mess, and blames his father, who insists that he did not do anything wrong.

The child feels that something is different about his father. What's wrong with him? The mobile phone that the father had always used fluently, whether to watch YouTube or listen to music, is now left unused. Are these just usual changes in older people or is he sick? Many aspects of his life, however, are still normal. He is still able to drive out to do his  groceries, but has started storing a lot of the same groceries. Normally he would buy one large pack of instant noodles at a time, now two packs are in the storage room.

This occurs because there has been no one with him for almost two months. The long term employee hired to care for him asked to leave to take care of her mother who has contracted Covid. So the father has to be alone with his dogs and has to bear many burdens. The house is thus not as tidy as before. What do we do? Shall we wait and see or does he now need a doctor? In the meantime, let’s try to find out a little more whether he has Alzheimer's disease or not. 

Alzheimer's disease and dementia

Alzheimer's disease is caused by the degeneration of brain cells. The damage begins in a part of the brain (the Hippocampus) that is responsible for recording details of everyday life. Some memories are well recorded and can be remembered later. Alzheimer's patients gradually lose the ability to record and store new memories in the brain. Patients' retention of personal events become gradually more impaired. Some information is well recalled, such as that about money and objects they love, while some are completely lost, such as forgetting an appointment with a relative who they have had no contact with for a long time.

In addition to forgetting, there can also be some other changes, such as incorrectly calling the name of an object or getting lost in familiar areas. Some patients can become disorientated about where they are and why they are there. The brain's ability deteriorates more and more until it affects normal living. Such elderly people become unable to live independently or safely, both in their work and personal lives. That means they have dementia.
 

Dementia is a broad term referring to a group of people with lack of mental capacities or their cognitive ability declines to the level that affects their life as mentioned above. Dementia and Alzheimer's disease are not interchangeable terms. To help us understand this better, let's compare dementia to mangoes and Alzheimer's to a variety of mangoes. That is, Alzheimer's is a type of dementia.

In addition to Alzheimer's, dementia has many other causes, and one of the most important is vascular dementia, which has the same risk factors as stroke and heart disease. After a stroke, the risk of dementia will increase. Care is needed to avoid risk factors for cardiovascular disease, including high blood pressure, diabetes, hyperlipidemia, smoking and obesity. The control of these factors can help prevent dementia from vascular problems.

Each of the six following symptoms can be an early warning sign of dementia:

    1. Failure to do familiar things, such as normal routines that used to be easy to do, but suddenly become difficult, in spite of having them done  for 20 years. What used to take only 30 minutes now takes two hours and is still not complete, because of confusion, circular thinking, no problem solving and inability to manage.

    2. Language problems. The patients want to start off by naming things, but need to try to explain the details of those objects instead. For example, "Please help turn on the movie box." (unable to call it a TV) and asking for "a long handle that puts the dust together" when asking for a broom.

    3. Problems with learning new things and retaining information. As an example, they can normally understand how to use new appliances like a phone, washing machine or TV, within 4-5 times of explanation, but with dementia, they can't even after 30 times of explanation. New information from the past few years starts to fade. Their old memories are still with them in the meantime but the problem is their new memories (recent memory loss), such as forgetting the recent appointment with children for a holiday trip. When it's time, the older person has not packed yet, and does not know what to pack, all the time claiming that no appointment has been made or to not have known about it.

    4. Trouble using hands. Normally people write or type on their computer keyboard with their hands. Many use hands to make several kinds of dumplings such as sticky rice dumplings wrapped in banana leaves or bamboo leaves and pork or shrimp dumplings. But suddenly the older adult cannot seem to do that as well as before or seems to have lost the ability altogether. They lose motor skills, despite them still having normal strength.

    Another problem of aging people is getting lost. They one day make a wrong turn on the way back to the house where they have lived for 50 years. When asked where they are going, they reply that they are going home. They don't know that this is not the way home and continue walking around.

    5. Lack of concentration. Many seniors can't keep doing the same thing for a long time and have to stop or change because they lose their concentration. They can't remember what they have just been doing. 

    6. Inappropriate behavior. They suddenly do not know how to behave in public places, such as in an ordination ceremony, making merits, or temple fairs, which causes misbehavior.

Three stages of dementia

    Stage 1: Having trouble with memory and some aspects of living, but still being able to take good care of yourself.

    Stage 2: Loss of self-care skills, such as not taking a shower, not brushing teeth, not knowing how to brush or using a toothpaste-like cream to brush teeth.

    Stage 3: Forgetting people around you, such as your own child, and being confused that the child is someone else, such as your sister or mother. Later, you will know yourself less, can't even remember your own name and don't know who you are.

    Most common symptoms of Alzheimer's disease include loss of language, direction, use of hands, as well as short-term memory, visuospatial, and general knowledge etc.

    The World Health Organization (WHO) has launched guidelines on the risk reduction of cognitive decline and dementia as following:

    1. Physical activity.  All types of movements and exercises can strengthen functions of the brain, heart, bone, muscle and reduce the risk of chronic diseases, depression and dementia symptoms. 

    2. Tobacco cessation. Tobacco is a major risk factor of coronary artery disease, as well as respiratory illnesses. Heart problems can also affect the brain. 

    3. Nutritional awareness. A diet consisting mainly of fruits, vegetables and fish is recommended, especially local food that is easy to find. However, try to maintain a balanced diet consisting of the five food groups.

    4. Abstain from drinking alcohol.  This is because alcohol has detrimental effects on the brain. 

    5. Boosting brain power. Frequently do activities that strengthen brain functions.    

    6. Social activities. A systematic review and meta-analysis study indicates that loneliness and social isolation is associated with dementia.

    7. Proper weight control. Obesity leads to many serious diseases. Middle-aged obesity is a major contributor to non-communicable diseases (NCDs).

    8. Management of high blood pressure. High blood pressure has effects on both the coronary arteries (vessels that feed blood for heart muscle) and the cerebral vessels (vessels that feed blood to brain) . A problem with blood flow can cause dementia.

    9. Management of diabetes symptoms. Studies have shown that diabetes in the elderly creates a high risk of dementia, but there is no clear reason why people with diabetes have a higher incidence of dementia than those without diabetes.

    10. Dealing with blood lipid levels. Thickening of the blood vessels from fat deposits would cause the heart to work poorly or increase risks of stroke or cerebral ischemia which can lead to dementia.

    11. Management of depression. Depression itself may decrease the brain's ability. Despite that there is no clear link between depression and dementia, according to a study published in the World Alzheimer's Report 2014, people with depressive disorder were twice more likely to suffer from dementia than the general population.

    12. Hearing loss management. Hearing words incorrectly causes communication difficulties. Elderly people with hearing problems will begin to isolate from society and feel loneliness which affects mental health and leads to dementia.

    So, what can we do? What level of brain degeneration would be classified as "Alzheimer's"? How to live with Alzheimer's in the family and community? Please continue in the next issue.

 

By Assistant Professor Sirintorn Chansirikanjana, MD.
Faculty of Medicine Ramathibodi Hospital, Mahidol University