Dementia is a decline in a person's mental capability and is a term used to describe a range of symptoms, including the loss of memory, language and problem-solving abilities amongst others that affect one's daily life.

There are various types of dementia. The most common type (60-80%) is caused by Alzheimer's disease. Other more common types of dementia (around 5-10%) include Lewy Body dementia, Vascular dementia and Frontotemporal dementia. However, there are also some less common forms, like Parkinson's and Huntington's.

What is Alzheimer's Disease?

The most common type of dementia. Alzheimer's disease is a progressive brain disorder, which means that it worsens with age. It is caused by the death of brain cells and the shrinking of the brain in size, which eventually affects parts of the brain that have an important role to play in social, behavioral and thinking skills.

As the disease progresses and worsens, more of these cells die off, eventually resulting in the person being unable to live independently. Ultimately, the complications associated with the disease are fatal

Vascular Dementia? What's that?

This is a term used to describe problems with logic, planning, memory and other thought processes due to brain damage that was caused by a blockage of blood flow to the brain. There can be many reasons for vascular dementia, one of them being strokes. Strokes can block an artery to the brain - When this happens, the brain cannot receive enough oxygen and nutrients, and parts of the brain may start to die off.

The impacts of vascular dementia (for instance, whether reasoning, or memory is affected) is largely due to where the blocked artery is, and which part of the brain is receiving insufficient blood flow.

Besides strokes, plaque build-up can also result in a blockage of arteries, leading to the same result of vascular dementia. Cardiovascular disease, high blood pressure or high cholesterol can be factors which increase your risk of vascular dementia.

What are the Differences between Vascular Dementia and Alzheimer's Disease?

Lewy Body Dementia

This disease is related to deposits of a protein known as alpha-synuclein in the brain. These abnormal build-ups are known as Lewy bodies, and can affect chemicals in the brain, which then lead to a whole range of problems from thinking, behaviour to even mood.

It is a progressive disease, which means that it worsens over time. The time between diagnosis and death usually ranges from 5 to 8 years, but can last from 2 to 20 years for certain people.

Parkinson's Disease

At its core, Parkinson's disease is a movement disorder. Parkinson's disease occurs when there is decreased dopamine (a hormone) in the body. When there are reduced dopamine levels, the brain cannot coordinate muscle movements , which leads to stiffness and movement issues.

People with Parkinson's may also have tremors or cognitive problems like memory loss. Similar to LBD, it is also progressive. With more advanced technological treatment now, most people with Parkinson's can have near-normal or normal life expectancies.

Syphilis Dementia

Syphilis is a type of sexually transmitted infection. It can be spread through unprotected sex with someone who has the disease. In later stages of the disease, syphilis can lead to dementia, usually 10 to 15 years after the infection.

Frontotemporal Dementia

It affects the front and sides of the brain and causes problems with language and behaviour. Although dementia tends to affect people over the age of 65, frontotemporal dementia tends to strike earlier, around the age of 45-65. Similar to other types of dementia, it also is progressive.

What are the Signs and Symptoms of Dementia?

There are a range of symptoms of dementia, with some being more specific for a certain type of dementia and others being more general. Here are a list of common symptoms for all types of dementia:

• loss of memory
• not being able to concentrate
• not being able to do familiar daily tasks like counting change
• not being able to follow a conversation
• changes in mood (becoming more anxious, depressed, or other emotions)
• being confused about time or place

Symptoms specific to Alzheimer's disease

• memory problems, like forgetting recent events or names on onset
• repeatedly asking the same questions
• having problems with tasks that need organisation or planning
• becoming confused in unfamiliar situations
• difficulty with numbers
• becoming more anxious or isolated

Symptoms specific to vascular dementia

• stroke-like symptoms such as temporary paralysis on one side of the body
• difficulties walking or problems with movement
• difficulty with planning or reasoning
• not being able to pay attention for long
• changes in mood like depression or becoming more emotional

Symptoms specific to frontotemporal dementia

• changes in personality like becoming selfish or unsympathetic. acting impulsively, overeating, etc
• problems with language like speaking slowly or using words incorrectly or in the wrong order
• getting distracted easily
• struggling with planning and organizing
• memory problems that tend to occur later on

Symptoms later on in dementia

• not being able to remember key information like close family or the location of their house
• not being able to speak altogether
• being unable to walk
• increased aggression, agitation
• hallucinations
• not being able to hold one's urine or faeces
• weight loss due to loss of appetite
• trouble swallowing or eating

How is Dementia usually assessed?

• Personal history (changes in cognition or physical ability, familial history)
• Physical examination (agility test, gait analysis)
• Lab tests (blood or urine tests to investigate potential reasons for dementia - eg due to vitamin deficiency or interaction of drugs)
• Cognitive testing (tests include memory, language, problem solving, counting skills and more)
• Radiological test (standard X-rays to rule out lung cancer which may cause a secondary tumour in the brain)
• Brain imaging tests (CT, MRI and more) to identify abnormalities in the brain and can show certain changes which are strongly linked to Alzheimer's disease.

Cognitive tests

There are many types of tests that the doctor can carry out to learn more about the patient's mental status, such as the mini-mental status examination (MMSE), Alzheimer's disease assessment scale - Cognitive (ADAS- Cog), or neuropsychological testing

MMSE

Usually takes only around 5 minutes and can be done in a clinic. Involves skills related to reading, writing, short-term memory and more.

ADAS-Cog

A more thorough test than MMSE, and is used to test for language and memory skills. Consists of 11 parts and usually takes around 30 minutes.

Neuropsychological testing

Involves a more in-depth testing approach by a neuropsychologist and takes around 2 hours to complete. May test recall of a paragraph, ability to copy drawings or tests involving logic and comprehension.

What is the Impact of dementia on the society?

Emotional Impact

Firstly, dementia can have a severe psychological impact on the patients themselves. Besides the obvious physical and cognitive deficits that may come with the disease, they may feel stigmatised (looked down upon on/differently) by other people, which may affect their confidence and self-esteem. As the disease progresses, they may have to rely more on other people for once-simple daily activities, which again, can make them frustrated and take a toll on their confidence. Their quality of life may be affected if they are not able to live their lives independently and do the activities they wish to do.

Besides the immediate effect on the patient, someone having dementia can also negatively affect the caregiver. They will have to play a key role in sustaining the patient's quality of life, and as the disease progresses, will need to spend more time taking care of them. This can quickly become stressful and overwhelming, especially financially, and if the caregiver has many other commitments. Of course, the caregiver may feel a sense of loss when he/she feels that the patient's personality is beginning to slip away.

On a larger scale, dementia can have an impact on society as a whole. An ageing population like Singapore will inevitably face the issue of dementia amongst its population. On a social level, this can affect the younger generation, who will have a larger emotional and financial burden given Singapore's falling birth rate.

Financial impact

From a financial viewpoint, dementia can also affect the country's work productivity, due to a decrease in work hours or quality of work. It is hence very important that we watch out for those who have symptoms of dementia, and encourage them to seek help as soon as possible.

For more information or if you require a medical consultation, please contact My Healthcare Collective here.