From Dr Yu-Min Lin, Geriatrician & Rehabilitation Physician, CMDHB
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.
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.
Common Forms of Dementia
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.
Memory decline affecting day to day life and work
Difficulty with familiar tasks
Frequently misplacing or losing objects
Personality and emotional changes
Withdrawing from day to day activities
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.
多動腦!! Exercise your brain!!
Studies suggest people with higher education and engage in brain stimulating exercises have lower risk of developing dementia.
多運動 Physical exercise
Aerobic exercise and Tai Chi has been shown to reduce the risk of dementia
地中海飲食 Mediterranean Diet
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
Social isolation can increase the risk of dementia by up to 2 folds
戒煙 Stop smoking
Smoking can increase risk of dementia by almost 2 fold
Control hypertension, hypercholesterolaemia, diabetes, and obesity
Hypertension and obesity in middle age is associated with increased risk of dementia. Diabetes and hypercholesterolaemia are also associated with increased risk.
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).
Driving and Safety
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.
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.
Enduring Power Of Attorney (EPOA)
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).
Family and Support Groups
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.