What is cognitive decline? Cognitive relates to mental activity. Cognitive decline refers to the worsening of thinking abilities.

Forgetting things occasionally and having difficulties multitasking are normal as people grow older. However, when these symptoms start to affect your daily life or they worsen and become more frequent , this could be abnormal.

Mild cognitive impairment (MCI) means that the cognitive decline is faster than normal but not severe enough to be called dementia. Some symptoms include:

• frequent forgetfulness of important events (e.g. family members’ birthdays, anniversaries etc.)
• frequently losing your train of thought or difficulty understanding conversations
• frequently losing your way in familiar environments
• frequently having difficulty in making decisions or carrying out tasks with many steps

This can also affect the elderly’s temperament. Symptoms include:

• being easily irritated and aggressive
• being depressed or anxious
• being apathetic

In some cases, the symptoms of MCI may stabilise or get better, but in some cases it can also worsen and lead to dementia. However, MCI may also indicate an underlying health condition, hence it is better to get a check-up or consult a doctor.

Dementia is the general name for certain symptoms caused by diseases that affect the brain. The most common disease that causes dementia is Alzheimer’s disease. Some symptoms that may indicate dementia are:

• forgetting short-term events or familiar words (e.g. a word that you just read, what you just ate, a family members’ name)
• difficulty in simple communication/ repetitive questioning
• sudden changes in personality
• unable to do simple tasks/ acting abnormally (e.g. putting clothes for laundry into the refrigerator)
• confusion and disorientation (e.g. getting lost in a familiar place)
• excessive tripping/ loss of balance
• changes in hygiene or eating habits

In these cases, cognitive decline is abnormally fast and one should seek professional help.

What increases the risks of having cognitive decline?

Having the following health conditions:

• Diabetes
• Smoking
• High blood pressure
• Higher blood cholesterol
• Depression
• Parkinson’s disease
• History of stroke
• Having the APOE e4 gene

Having the following lifestyle can also increase risks:

• Obesity
• Not exercising regularly
• Not having mental or social stimulation
• Chronic stress

What causes cognitive decline?

There is no single cause of cognitive decline. However, some patterns in the brain of people who have abnormal cognitive decline include:

• Abnormal build-up of protein (amyloid plaques) in brain tissues that lead to brain cells dying (cause of Alzheimer’s disease that lead to dementia).
• Abnormal build-up of another type of protein (Lewy bodies) which causes the chemicals in the brain to change (cause of Parkinson’s disease and Lewy body dementia)
• Blockage (mini-stroke) or reduction of blood flow in some blood vessels in the brain
• Shrinking of some parts of the brain (hippocampus and frontal lobe) that is important for memory due to aging
• Enlargement of parts of the brain that contains fluid (ventricles), leading to damage of surrounding brain tissue
• Low blood sugar in the brain lead to brain cells not being able to work well (could be due to diabetes)

Why should I screen for cognitive decline?

Although there is currently no cure for cognitive decline, being diagnosed early can help you and your family to manage your symptoms and make preparations to adapt your lifestyle.

For example, cognitive decline may increase the risk of falls , so getting diagnosed early can allow you to take steps to make your house more elderly-friendly to prevent falls. The elderly may also get lost in familiar places when going out so getting diagnosed early can help you to take steps such as having identification on the elderly at all times to help him or her get home safely.

How can I screen for cognitive decline?

Screening is recommended once a family member or the elderly notices the frequent occurrence of symptoms such as being more forgetful or sudden changes in mood.

Screening usually consists of simple tests and questionnaires for the elderly or family members on their observations. Blood tests or brain scans are not required for screening but may be required for diagnosis. They can be classified into the following:

1. Mental status test: these tests test language abilities, communication skills, memory, ability to follow steps etc.

• e.g. Abbreviated Mental Test (AMT), Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Elderly Cognitive Assessment Questionnaire (ECAQ)

2. Informant-based assessments: these questionnaires ask about others’ (usually family members) observations of the elderly’s behaviour

• e.g. Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Informant Report of Memory Problem (IRMP), question on the elderly’s progressive forgetfulness

3. Combinations of multiple screening tests

What impact will cognitive decline have on me? Can I do anything about it?

The diagnosis may come as a shock to the patient and result in fear or anger. Consulting a therapist may help one to deal with these emotions. However, understanding that dementia is just an illness and that the patient is still the same person can help with coping.

Living with dementia differs from each person due to their past experiences and different attitudes. But these are some of the things that someone with dementia may experience:

• feeling that they have less control over their feelings and how they express it,
  • e.g. having sudden outbursts of anger or becoming tearful
• feeling frustrated at their inability to remember things or live independently
• losing confidence in themselves and their abilities
  • e.g. not trust their own judgement
• often feeling confused and disoriented by their environment

Dementia support groups are available, where professionals and patients can interact and learn tips on coping with dementia or participate in activities and exercises. These support groups can help the patient to form more bonds and maintain a positive outlook.

While there is no cure for cognitive decline yet, treatment can be adopted to help with symptoms or slow the cognitive decline.

• Medication can be taken to boost memory or treat other symptoms and conditions such as sleep disturbances
  • the most common type prescribed is cholinerase inhibitors, which prevent the breakdown of a chemical in the brain which helps with memory
• Occupational therapy
  • an occupational therapist works with the patient to develop ways to live normally with dementia , which can slow cognitive decline

What impact will cognitive decline have on the family?

When a loved one has dementia, family members need to be prepared to devote more time and attention to supporting and caring for the elderly. Patience and empathy is required for the journey. The family should learn more about the patient’s condition in order to better support and understand him or her. There are also many support systems in the community available for the caregiver such as support groups for tips.

Visiting an occupational therapist together with the patient can also be helpful as the family can learn how to live with this change and modify their lifestyle or home. If the family is unable to provide enough support for the patient, they can also hire a full-time nurse or enroll in care services for him or her. If the caregiver requires a break, he or she can also enroll in short-term care services for the patient.

In caregiving, it is important to celebrate small victories and focus on successes. Caregiving is a marathon, not a sprint. The caregiver should plan well and take breaks to prevent burnout. Even with dementia, the patient is a loved one and this love will help you through this journey.

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