Dementia and AD

Dr Tamphasana Wairokpam *

Dementia and AD :: Pix - TSE

What is dementia?

A decline in cognitive function (memory, thinking, language, reasoning, behaviour) to such an extent that it limits the day to day functioning of an individual. There are many causes of dementia. The most common being Alzheimer’s disease (AD)(65%), Vascular dementia (20), Lewy body dementia (10) and Fronto temporal dementia (5%)

AD is a degenerative brain disease. Dementia is not a specific disease but an overall term that describes decline in cognitive function.

Approximately 12-18% of people aged 60 or above will have Mild cognitive impairment (MCI). About 10% of people with MCI will develop dementia while others will not. Our memory often changes as we grow older but dementia is not a part of normal aging.

Early signs of AD or dementia:

There are some warning signs that your loved one may be having early dementia. However, there is a big overlap between these signs of early dementia and normal ageing. The following description aims to highlight these early signs of dementia and differentiate it from that of normal ageing. Nonetheless, if you notice any of these signs, do not ignore them. Schedule an appointment with your doctor.

1. Memory loss that disrupts daily life: The most common sign of AD is memory loss, especially recently learned information.

As disease progresses, memory for important dates or events are affected, making patients rely on family members for things they used to handle on their own. Forgetting names sometimes, but remembering them later is a typical age related change and not dementia.

2. Challenges in planning or solving problems: this includes problems such as not being able to follow a familiar recipe or keep track of monthly bills and finances. However, occasional errors while managing finances or bills is a typical age related change.

3. Difficulty completing familiar tasks: having trouble driving to a familiar location, organising a grocery list. Again, occasionally needing help to use and set up appliances is a part of normal ageing.

4. Confusion with time or place: losing track of day, dates, season and passage of time. However, getting confused with day of the week or date but figuring it out later is a normal age related change.

5. Trouble understanding visual images and spatial relationships: problems with perception of distance and position in space, for example, not being able to tell which floor of the building, problems with depth perception and navigating movements. Again, visual issues due to cataract is a typical age related change.

6. New problems with words in speaking or writing: troubles joining or following a conversation. They may stop in the middle of conversation or keep repeating themselves. Trouble naming familiar objects such as calling a watch a clock. However,occasionally forgetting the right word or name is a typical age-related change.

7. Misplacing things and losing the ability to retrace steps: repeatedly misplacing things in unusual places and not able to find them again. Misplacing things from time to time is a typical age related change.

8. Decreased or poor judgment: changes in judgement or decision making. Doing things out of character of the person such as poor judgment while dealing with money, paying less attention to grooming or keeping themselves clean. However, making a bad decision once in a while is a normal age-related change.

9. Withdrawing from social activities: withdrawing from hobbies, social activities and engagement and trouble keeping up with a favourite activity. Again, feeling uninterested in family or social obligations occasionally is normal.

10. Changes in mood and personality: people with dementia may experience mood and personality changes such as easily becoming depressed, upset, irritable, anxious or confused. Again, developing a way of doing things and becoming irritated when routine is disrupted is a normal age related change.

Why should one get checked for dementia/ AD?

Getting checked early can help determine what is causing the symptoms and treat accordingly. If AD is the cause, getting an early diagnosis allows access to treatment options. Current medications do not cure AD but recently FDA approved 3 drugs (aducanumab, donanemab and lecanemab) which have proven to remove beta amyloid, one of the hallmarks of AD, from the brain.

These drugs have shown to significantly slow cognitive and functional decline in people with early AD. An early diagnosis also provides a better chance of benefiting from treatment.

It also gives patients and their family to plan for the future (legal, financial, end of life decisions), maximise time together and provides access to resources and support programmes. It also helps in addressing potential safety issues, such as driving. Early diagnosis has also been found to save costs of medical and long term care.

How is AD diagnosed?

No single test can diagnose dementia. Physicians use a combination of medical and clinical history, mental status tests, physical and neurological exams, diagnostic tests such as beta amyloid and tau markers in serum and CSF, and brain imaging such as MRI, PET-CT.

Genetic testing is available for APOE-e4 , the gene with the strongest risk for AD disease, but genetic testing in AD is a controversial subject and should only be done after discussion with a physician or genetic counsellor.

The presence of APOE-e4 gene does not indicate whether the person will develop AD, it only indicates that the individual has a higher risk of developing AD as compared to the general population.

Ways to good brain health:

1. Challenge your mind: Keep learning something new. Challenging your mind has short and long term benefits for your brain.
2. Get moving: engage in regular exercise. Activities that increase blood flow to the brain and body are beneficial. Walking , dancing, gardening, whatever works for you.
3. Protect your head: Prevent head injury. Wear helmets and seat belts,protective gear for sports, do what you can to prevent falls in elderly.
4. Be smoke- free: it’s never too late to stop. Quitting smoking can lower the risk of cognitive decline back to similar levels of those who never smoked.
5. Control your blood pressure.
6. Manage diabetes.
7. Maintain a healthy weight.
8. Sleep well: good quality sleep is important for brain health.
9. Eat right: more vegetables, leaner meat, low fat diet. Eat less processed foods.