面對『失智症』
From Dr Yu-Min Lin, Geriatrician & Rehabilitation Physician, CMDHB
失智症
Dementia
失智症是一種包含各種腦功能退化跟障礙的的症候群。它的症狀不單純只有記憶力的減退，還會影響認知功能、語言、判斷、注意力等各方面的功能退化。同時可能出現問題行為、個性人格改變、妄想或幻覺等症狀，這些症狀的嚴重程度足以影響日常生活。但是因為症狀通常是一點一點慢慢地出現，很容易被誤認為一般老化而延誤就醫。
Dementia is a syndrome which causes a variety of brain dysfunction. It does not only affect memory, but a variety of brain function including ability to understand, language, judgement and concentration. It could also cause behavioural or personality changes and even lead to hallucinations. These symptoms can affect the ability to perform everyday activity. Because it develops slowly over time most people do not seek medical help early and it is often diagnosed late in the stage.
世界衛生組織2010年報告預計全球有三千五百六十萬失智症患者。隨著老年人口持續增加，2050年全球預計會有一億以上的患者。新西蘭現有大約四萬八千患者。
World Health Organisation (WHO) report estimates that there are 35.6 million people with dementia world wide in 2010. As the aging population grows, it is estimated that in 2050 there will be 115.4 million people with the illness. Currently, tt is estimated there are 48000 people with dementia in New Zealand.
失智症分類
Common Forms of Dementia
在失智症的分類上，最常見的則是阿茲海默症與血管性失智症。但患者有時會存在兩種或以上的病因（又稱為混合型）。其他造成失智症的病因還有路易氏體失智症，額顳葉型失智症，飲酒過量，中樞神經系統感染，跟帕金森病。
There are two major causes of dementia. The most common is Alzheimer’s dementia followed by vascular dementia. However people often have a mixed picture. Other causes include dementia with lewy body dementia, frontotemporal dementia, alcohol excess, infection, Parkinson’s Disease.
失智症早期症狀
Symptoms
- 記憶減退影響到日常生活和工作
Memory decline affecting day to day life and work - 無法勝任原本熟悉的事務
Difficulty with familiar tasks - 言語表達困難
Communication difficulties - 喪失對時間、地點的概念
Orientation difficulties - 判斷力變差、警覺性降低
Judgement difficulties - 物品擺放錯亂跟遺失
Frequently misplacing or losing objects - 個性與情緒出現改變
Personality and emotional changes - 活動及開創力喪失
Withdrawing from day to day activities
失智症的病程
Disease Progression
失智症的病程，可分為、輕度（初期）、中度（中期）、重度（晚期）。
Dementia is a progressive disease and can be graded into mild, moderate and severe disease.
輕度知能障礙（Mild Cognitive Impairment）為正常老化到失智症開始出現徵兆之間，存在著一個過渡區域。輕度知能障礙患者在面臨較為複雜的工作任務或社會環境下會有問題，但簡易之日常生活並無影響。 臨床上這些患者每年約有10％-15％會發展為失智症。
There is a preceding period termed mild cognitive impairment where there is symptoms to suggest cognitive decline exceeding what would be expected as part of normal aging but people maintain there normal day to day function. Mild cognitive impairment has a risk of progression to dementia at a rate of 10-15% per year.
如何預防失智症
Preventing dementia
多動腦!! Exercise your brain!!
研究顯示，從事可刺激大腦功能的心智活動或創造性活動，都可降低失智症之風險。高教育人士相對風險下降。
Studies suggest people with higher education and engage in brain stimulating exercises have lower risk of developing dementia.
多運動 Physical exercise
有氧運動、太極拳對失智症都有預防及保護作用
Aerobic exercise and Tai Chi has been shown to reduce the risk of dementia
地中海飲食 Mediterranean Diet
地中海飲食被證實可降低心血管疾病，同時失智症發病的相對風險下降
Mediterranean Diet can reduce the risk of vascular disease and reduce the risk of dementia
多參與社會活動 Participate in social activities
社交孤立的人，失智症的風險增加2倍以上
Social isolation can increase the risk of dementia by up to 2 folds
戒煙 Stop smoking
抽菸相對風險上升近2倍
Smoking can increase risk of dementia by almost 2 fold
控制高血壓、高膽固醇、糖尿病、及肥胖
Control hypertension, hypercholesterolaemia, diabetes, and obesity
中年高血壓，肥胖增加失智症的風險。高膽固醇、糖尿病也是會增加失智症的風險
Hypertension and obesity in middle age is associated with increased risk of dementia. Diabetes and hypercholesterolaemia are also associated with increased risk.
藥物治療
Medications
臨床上，目前有藥物可用於治療失智症，但是不能治愈的。藥物的功效只有減緩疾病的進展。唯一在新西蘭政府有資助的藥物是 Donepezil（愛憶欣）。
There are of medications available for treatment of dementia. However there are not curative and only slows the progression of the disease. The only subsidized medication in New Zealand in donepezil (Aricept).
駕駛和生活安全
Driving and Safety
在新西蘭的法律規定，如果你有失智症，駕駛能力須要進行評估。病情嚴重者人可能無法安全駕駛，他們的醫生將建議停止行車。
There is legal requirement in New Zealand for driving ability to be assessed if you have dementia. It is likely as the disease progress people will no longer be safe to drive and their doctor will recommend them to stop driving.
其他對失智症病患主要的安全問題有火災（忘記關火）和街上漫遊及流浪（迷路）。同時也可能失去安全的對財務管理能力，並成為金融虐待的受害者。
Other major safety concerns are risk of fire (forget to turn stove off) and wandering (becoming lost). People can also lose the ability to safely manage their finances and become victims of financial abuse.
長期授權書
Enduring Power Of Attorney (EPOA)
人們可向受託人授予長期授權書，以便自己在其喪失能力後，無法處理個人福利跟財務時，受託人可代其行事，處理他們的財務，也可以代其作出有關他們的健康和福利的決定。 長期授權書與授權委託書是不同的。長期授權書在授權時並不會馬上生效。法律規定，只有當醫生判斷您已失去做決定能力才可以要求使持久授權書生效，這通常是需要醫生寫信給您的律師。
Enduring Power of Attorney (EPOA) is an authority given by you to another person to look after and control your affairs when you are unable to do so. This is usually divided to personal welfare and finances. EPOA is different from power of attorney. EPOA is not active upon appointment. By law, you will need to be assessed by a health practitioner and it is only when the health practitioner believes you no longer have the ability that the EPOA can be activated (by writing a letter to your lawyer).
家庭和支持團體
Family and Support Groups
家庭和支持團體是管理失智症的一個非常重要的因素。家裡有失智者病患的家庭通常會面臨巨大的影響跟變化。長期照顧失智症會導致身體，情緒和資金的壓力。失智症照顧者患抑鬱症的風險很高。有一些支持，可以使照顧者生活更輕鬆。人們可以連絡他們的家醫或阿茲海默症協會，看看有什麼協助。
Family and support groups are a very important aspect of managing dementia. Living with a person with dementia will have immense impact on people’s lives. It causes significant physical, emotional and financial strain on care givers. The care givers are at high risk of developing depression. There are some supports available which can help to make life easier. People can contact their GP or Alzheimer’s society to see what supports are available.
新西蘭阿茲海默症協會（英文網站）
台灣失智症協會（中文網站）
