Retired due to "dementia"! What is this disease that "steals" memory?

Recently, a shocking news came from the film industry: 76-year-old Taiwanese director Hou Hsiao-hsien will no longer continue to shoot movies due to dementia. This master who is good at capturing and preserving the memory of the times with his lens will gradually be devoured by the disease.

In fact, it is not only director Hou Hsiao-hsien. Many people we know have suffered from dementia : Gabriel García Márquez, the literary giant who created One Hundred Years of Solitude, could no longer complete the writing of his memoirs due to his illness; the beautiful and sexy Hollywood movie star Rita Hayworth , who was over 60 years old but still had charm, lost her memory first because of her illness; Chinese physicist Charles Kao , known as the "Father of Fiber Optics", had been deeply involved in the application of optical fibers in the field of communications for a long time, but after he became ill, he could no longer remember what "fiber optics" was...

Dementia, a disease that quietly "steals" human memory, is also known as dementia. It refers to an acquired syndrome in which cognitive ability is significantly reduced, leading to interference with occupational, family or social functions. Currently, there are more than 550,000 people with dementia in the world , of which more than 60% live in low-income and middle-income countries. There are nearly 100,000 new cases each year, and the prevalence of dementia in people over 65 years old is as high as 7%. Dementia is currently the seventh leading cause of death among the elderly worldwide and one of the main causes of disability and dependence.

01

What factors may cause dementia?

1. Age. The risk of dementia increases with age, however, dementia can also occur in younger people.

2. Family history. People with a family history of dementia are at greater risk. However, this does not mean that all family members of a person with dementia will develop the disease.

3. Diet and exercise. In people at higher risk, following a healthy lifestyle can reduce the risk of disease. This includes eating a healthy diet, exercising, receiving cognitive training, and participating in social activities.

4. Drinking. Several large studies have found that alcohol use disorder is associated with an increased risk of dementia, especially early-onset dementia.

5. Factors that endanger cardiovascular and cerebrovascular health. These include obesity, poor control of the three highs (high blood pressure, high blood lipids, and diabetes), smoking, and atherosclerosis; diabetes and smoking are also cardiovascular risk factors.

6. Depression. People with depression are more likely to develop dementia later in life.

7. Air pollution. Exposure to air pollution, especially from traffic exhaust and wood burning, has been linked to a higher risk of disease.

8. Head trauma. People who have had severe head trauma are at increased risk of developing Alzheimer's disease.

9. Sleep problems. People with sleep apnea and other sleep disorders may be at higher risk for dementia.

10. Low levels of certain nutrients. Reduced levels of vitamin D, vitamin B-6, vitamin B-12, and folate in the body can increase the risk of dementia.

02

What are the symptoms of dementia?

In most people's impressions, dementia affects patients' memory, thinking and social skills. They may not be able to recognize family members or friends, do not know the way, have only fragmentary memories, and cannot handle simple problems on their own. However, in the early stages of the disease, before memory problems occur, patients may experience some changes in mood and behavior.

Early signs and symptoms include:

• Forgetting things or recent events

• Lost or misplaced items

• Getting lost while walking or driving

• Feeling confused even in familiar places

• Lose track of time

• Difficulty solving problems or making decisions

• Having trouble finding words after a conversation

• Difficulty performing familiar tasks

• Visually misjudge the distance to objects.

Common changes in mood and behavior include:

• Feeling anxious, sad, or angry about memory loss

• Personality changes

• Inappropriate behavior

• Withdrawal from work or social activities

• Not very interested in other people’s emotions.

03

Can dementia be prevented?

There is no clear way to prevent dementia, but taking the following steps may help:

Keep your mind active. Mentally stimulating activities may delay the onset of dementia and reduce its effects.

★Actively exercise, at least 150 minutes per week.

★Quit smoking.

★Manage cardiovascular risk factors. Patients with high blood pressure, high cholesterol and diabetes need to take medication in a standardized manner to effectively control the disease.

★Maintain mental health.

★Maintain a healthy diet.

★ Develop good sleep hygiene habits. If snoring is accompanied by respiratory arrest, please consult a healthcare professional in time.

04

How should we care for people with dementia?

Although memory loss is the earliest and most prominent symptom in most dementia patients, it is usually the destructive behavioral symptoms that make us feel more helpless. Sometimes "dementia" patients are like disobedient "children", refusing to eat, losing temper for no reason, staying up late at night, unable to communicate... Recognizing and understanding these "abnormal" behaviors of patients and understanding scientific nursing methods can make patients more comfortable while reducing the burden on family members and caregivers who take care of patients.

😔Depression:

Depression affects up to 20% of people with dementia. People may feel anxious or sad about their fuzzy memories and unclear thinking, and may also show a lack of interest in the actions and emotions of others. Depression may cause agitation, apathy, insomnia, repetitive vocalizations, and refusal of food.

💤Sleep disorders:

The main manifestations include interrupted sleep, changes in circadian rhythm, frequent naps during the day, and long naps. These bad sleeping habits will hinder the rest of family members and increase the burden on caregivers.

Therefore, it is very important to help patients reestablish normal sleep patterns. To prevent this, we need to limit the possibility of patients taking naps during the day (such as leaving them alone in front of the TV), and let them participate in simple handicrafts, housework, and regular physical exercise. However, once bad sleep habits are formed, they can usually only be reversed with the help of medication, but they cannot be relied on for a long time.

😠Being emotional or aggressive:

About half of patients with dementia will experience agitation-related behaviors at some point in time, including aggression, bellicosity, hyperactivity, etc. Such behaviors usually have corresponding triggering factors, such as overstimulation, environmental changes, noise, pain, etc.

Because patients are often unable to express their concerns verbally, caregivers or family members should carefully evaluate any new behavioral symptoms to see if they are in pain or have systemic illness (eg, infection, dehydration, constipation) that could be the cause of the patient's agitation.

We can arrange a fixed schedule for the patient's day and execute it on time every day. Calendars, clocks, family photos, etc. should be placed in a prominent place. The room should also be well lit during the day to avoid patients' misunderstanding of circadian rhythms. When patients show mild agitation (such as pacing), try not to restrain their limbs, otherwise it may escalate the agitation.

Current research shows that after the condition stabilizes, medications related to agitation do not need to be used long-term. However, professional medical staff should regularly reassess whether medication is needed.

😵Delusions and hallucinations:

Delusional symptoms are common in people with dementia. People often become suspicious of their family members and may accuse them of stealing, of someone trying to break into their house, or of their long-dead family members being alive.

This may cause the patient to not understand or even fear the care provided by their family members. If family members insist on providing care, the patient may panic or even engage in aggressive behavior.

In this case, a hardline approach is clearly unwise, and we can temporarily leave the patient and return when the patient forgets the interaction. If more than one person is present, another family member can distract the patient while providing care. Non-threatening delusions and hallucinations generally do not need to be treated with medication.

References:

Gale SA, Acar D, Daffner KR. Dementia. Am J Med. 2018 Oct;131(10):1161-1169. doi: 10.1016/j.amjmed.2018.01.022. Epub 2018 Feb 6. PMID: 29425707.

Rossor MN, Fox NC, Mummery CJ, Schott JM, Warren JD. The diagnosis of young-onset dementia. Lancet Neurol. 2010 Aug;9(8):793-806. doi: 10.1016/S1474-4422(10)70159-9. PMID: 20650401; PMCID: PMC2947856.

Volicer L, McKee A, Hewitt S. Dementia. Neurol Clin. 2001 Nov;19(4):867-85. doi: 10.1016/s0733-8619(05)70051-7. PMID: 11854104.

Volicer L. Goals of care in advanced dementia: quality of life, dignity and comfort. J Nutr Health Aging. 2007 Nov-Dec;11(6):481. PMID: 17985063.

Author: Wen Jia, Ph.D. in Anesthesiology, Capital Medical University

Editor: Guru