Symptoms of dementia and four ways to prevent it

Cognitive impairment is not a normal part of aging but a result of deteriorating brain cells that lead to a rapid decline in brain function. As people age, the likelihood of developing this condition increases. According to Hong Kong’s Hospital Authority, one in ten individuals over age 65 is affected, and this rises to one in three for those over 80.

What is Cognitive Impairment?

Patients with cognitive impairment may forget things, become disoriented, or fail to recognize familiar faces. It is not a single disease but a term encompassing a variety of brain disorders.

Common Types of Cognitive Impairment:

• Alzheimer’s disease: The most common form of cognitive impairment, accounting for 60 to 70 percent of cases, characterized by brain cell degeneration due to amyloid plaques and tau tangles.
• Vascular Dementia: Caused by brain damage from strokes or vascular diseases.
• Dementia With Lewy Bodies: Patients may experience hallucinations or symptoms similar to Parkinson’s disease.
• Frontotemporal Dementia: Affects patient’s personality and behavior, often appearing before memory loss.

Symptoms of Cognitive Impairment

Symptoms are categorized into three stages: early stage, mid-term, and later stage.

Early stage

• Decline in short-term memory, frequently forgetting recent events.
• Hard to acquire new information or learn new skills.
• Repeatedly asking the same questions.
• Misplacing items.
• Difficulty with abstract language, feels challenging to communicate with others.
• Still able to manage daily activities but struggles with complex tasks like financial management and needs to be reminded.

Mid-term

• Emotions easily fluctuate and noticeable personality changes.
• Significant memory decline and disorientation regarding time and place, getting lost in familiar areas.
• Confusing past memories with current reality.
• Ability to express and understand declined, requiring assistance with daily activities.

Later stage

• Loss of memory, forgetting familiar people and important events.
• Loss of self-care abilities, unclear verbal expression, and potential incontinence.
• May require long-term personal care.
• Sleep patterns may become reversed.

Reducing the risk of cognitive impairment

While the causes are complex, the risk can be lowered through:

• Healthy lifestyle: Balanced diet, regular exercise, avoid smoking and excessive drinking.
• Social engagement: Interact with others and develop personal interests.
• Mental stimulation: Learn new skills to be mentally active.
• Regular check-ups: Early detection and treatment.

Is forgetfulness normal with aging?

Many people experience memory decline with age, but this can be an early sign of cognitive impairment. Understanding the difference between normal aging and cognitive impairment is crucial to not missing the golden period for treatment.

Warning Signs to Watch For:

• Forgetting recent events or repeating the same actions or words.
• Misplacing items, such as putting fruit in a closet, or suspecting theft due to forgetfulness.
• Difficulty with abstract language, using simpler phrases, and sometimes being incoherent.
• Confused about dates and times, getting lost in familiar places, not knowing where they are, or forgetting the way home.
• Becoming passive and losing interest in previously enjoyed activities.
• Emotional instability, decreased ability to control emotions, increased anxiety, and irritability.
• Reduced sense of security, being suspicious, or indifferent to people or events.
• Weakened judgment, failing to understand situations or make timely decisions, such as wearing inappropriate clothing, struggling with transportation issues, or not knowing how to react in emergencies.

Diagnosis and Treatment

Diagnosing cognitive impairment requires comprehensive evaluation. Doctors typically conduct clinical assessments, inquire about medical history and symptom impact on daily life, and perform cognitive tests (such as MMSE or MoCA), blood tests, and scans to rule out other conditions, before making a diagnosis.

While cognitive impairment cannot be cured, appropriate treatment can slow down the progress, alleviate symptoms, and improve a patient's quality of life.

1. Medication: Common drugs in Hong Kong include Donepezil and Rivastigmine, which slow down the brain degeneration and ease behavioral and emotional issues.
2. Non-Medication Therapies:
   • Reality orientation: Helps patients maintain awareness of time, people, places, and surroundings through structured routines to ease anxiety.
   • Reminiscence therapy: Encourages recalling past experiences to enhance long-term memory, stimulate cognitive function, and improve mood.
   • Multisensory stimulation: Involves daily exposure to various stimuli to maintain connection with the environment, such as music, touching plants, and feeling sunlight.
   • Cognitive stimulation activities: Engage patients in suitable activities like sorting clothes, pairing socks, or calculating shopping costs to train memory, focus, spatial awareness, and arithmetic abilities, helping delay cognitive decline.

Treatment depends on the type and severity of impairment, aiming to manage the condition and slow degeneration. Behavioral and emotional impacts may arise from the disease, environment, and other factors, making family, friends, and community support essential.

Cognitive impairment is not just a race for the patient but also their families. Caring for patients with cognitive impairment is a "marathon of endurance." Caregivers should balance their own physical and mental health while providing love and patience. Maintaining social connections, seeking support from family and friends, and utilizing community services like caregiver networks are recommended.

Cognitive impairment affects not only patients but also families and communities. Let’s work together to build a dementia-friendly community, offering understanding and compassion to ensure patients and their families feel supported and welcomed, embracing each day together.