Dr Lee Kim En
An elderly man could not find his way home after his daily routine of morning walk and breakfast at the nearby market. A lady in her mid 60s wore the same blouse over and over again, insisting it was the most comfortable piece in her wardrobe. A recently retired professional realised he had difficulty paying his bills, taking a much longer time to tally his monthly credit card statements.
Are these just cases of a lapse in memory?
Ronald Reagan, former President, United States of America, suffered a progressive decline in his brain functions, and was later diagnosed with Alzheimer's disease in 1994. 8 years before that, his son claimed that his father could not remember the names of the familiar California canyons he was flying over. He passed away at the age of 93 in 2004.
The number of patients suffering from dementia is alarming. Locally, the projected number of those aged 65 years and above in 2020 will hit 53,000, and this will further increase to 187,000 by 2020.
With a dwindling ratio of working adults to older dependents, the care burden on society is expected to be massive. Are we prepared for the silver tsunami?
Memory loss is a common, significant symptom in patients with dementia. Other symptoms include language difficulty, impaired thinking and judgment, inability to plan and complete complex tasks, changes in personality, inappropriate behaviour, agitation and paranoia. Observations from immediate family members are very helpful in establishing an early and rapid diagnosis.
Careful, thorough examination may alert the physician to other common conditions such as anxiety, depression, sleep disorders, stroke and Parkinson's disease. Nutritional deficiencies, hormonal imbalances and reactions to medication may also result in an impairment in cognitive function. Blood tests are therefore useful in the evaluation of these conditions.
Brain scans are often performed to ensure that there is no damage in the brain. For instance, the presence of a bleeding between the surface of the brain and the covering over the brain may cause symptoms similar to dementia. Enlarged ventricles in the brain may also cause memory loss, in addition to walking difficulty and poor urinary control.
Needless to say, it is important to establish the correct diagnosis, as the course of treatment and predicted outcomes are vastly different for each condition.
Mr S is a patient who benefitted from promptly seeking the right diagnosis. In his late 60s, Mr S continues to live an active life as a professional who works hard and enjoys social activities such as jogging, fishing and travelling. In recent weeks, he felt his response slowing down rapidly and his memory becoming much poorer. He could not remember where he left his reading glasses and mobile phone. He lost his house keys twice. His voice became softer and he had trouble using his right hand, particularly to write and sign documents.
Fearing that he was losing his brain functions and, at the same time, unsure if his symptoms were part of normal ageing, Mr S came to my clinic for an assessment. A large blood clot showed up in his brain scans. He underwent neurosurgery to remove the clot. Regaining his consciousness after general anaesthesia, he immediately felt that a fog had been lifted in his brain. Within a week, he was back at work, happy to have a second lease of life, and even happier that he did not suffer from dementia.
Many others, however, were unlike him.
Mdm H constantly misplaced things in her own home and became increasingly confused with time and place. She frequently forgot the boiling kettle on the stove and the running tap, and had difficulty with cooking – a routine familiar to her for many decades. She was subsequently diagnosed with Alzheimer's Disease.
Mr N had possessed a sharp mind until he suffered a series of small strokes. While he recovered well enough to remain physically independent, his family reported that he exhibited changes in his personality and behaviour, becoming easily agitated and withdrawing from social activities. Like the former British Prime Minister Margaret Thatcher, Mr N was found to suffer from vascular dementia as a result of strokes in the brain.
Cholinesterase inhibitors and memantine are medications that may help slow or reduce the development of symptoms. Physical exercises improve strength and cardiovascular fitness while slowing down the progression of cognitive decline. Participation in games and engagement in thinking activities may be helpful. Establishing a daily routine of social and physical activities is therefore very important in the care of dementia patients.
Communication becomes increasingly difficult and challenging as dementia worsens over time. It is common for the caregivers to feel very frustrated and worn out. Having a plan early in the course of the disease will help address uncertainties in managing financial and legal issues, as well as in identifying long-term care options.
Researchers are racing against time in an attempt to better understand dementia and hopefully discover the elusive cure for such a dreadful degeneration of the brain. Meanwhile, we must continue to rally around these patients and their families, providing them with unwavering love, care and social support. A person may lose control of their brain functions, yet they can still retain the dignity of living and the beauty of life.