Dementia describes a group of symptoms such as memory loss, impaired judgment, confusion and behavioural changes, which are severe enough to cause loss of function.

Dementia is not part of normal aging, though the elderly are more prone. Dementia occurs when the brain function gradually fails, affecting day-to-day activities.

Alzheimer’s disease is the most common type of dementia, followed by vascular dementia. It affects mainly elderly people. In Singapore, the prevalence rate of dementia in people above 65 years is 6.2%. It is an illness that causes significant distress to both the patient and his caregivers.

All types of dementia involve decline in mental abilities involving thinking and memory, but the specific symptoms vary depending on the type of dementia. Patients may have difficulties with:

• Memory loss affecting work
• Difficulty doing daily tasks
• Problems with language
• Confusion about time/place
• Poor/decreased judgement and problems with abstract thinking
• Losing/forgetting things
• Changes in personality
• Loss of initiative
• Changes in mood behaviour

While there is no way to prevent dementia, it is possible to lower the risk of dementia by:

• Staying mentally active
• Being socially engaged
• Eating healthily
• Being physically active

Risk factors of dementia include:

• Diabetes
• High blood pressure (Hypertension)
• High cholesterol (Hypercholesterolemia)
• Age
• Family history
• Stroke
• Parkinson disease

Some causes of dementia include:

• Alzheimer’s Disease (AD)
  AD is the most common form of dementia. Changes in the brain occur gradually. Signs include short term memory, changes in judgment, reasoning and inability to perform daily tasks.


• Vascular Dementia (VaD)
  VaD is linked to strokes and may be preventable. The lack of blood circulation in the brain results in localised damage to brain areas involved in attention, planning and behaviour.


• Frontotemporal Dementia (FTD)
  In the early stages, FTD mainly affects personality, behaviour and speech. Persons with FTD may behave rashly while their memory and sense of direction remain relatively intact.


• Lewy Body Dementia (LBD)
  LBD is a form of progressive dementia with noticeable changes in attention and ability to function from day to day. Persons may appear to have a lively imagination or hallucination. Signs may resemble those of Parkinson Disease.


• Young Onset Dementia (YOD)
  There is an increasing number of patients with YOD. This refers to dementia patients who are below 65 years old.
  
  The increased number could be due to rising awareness, resulting in more being diagnosed. It could also be due to the higher prevalence of vascular risk factors such as hypertension and diabetes.

• Interview
  You and your caregiver will be interviewed by a neurologist and a specialist nurse to understand the problems faced.
• Assessments
  A cognitive and language ability test will be conducted to help the neurologist make a diagnosis.

Other tests include:

• Blood
  Samples will be tested for vitamin deficiencies, thyroid disorders, and markers of infection/inflammation. Fasting is not required.
• Brain Imaging
  A Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan looks for a treatable cause of dementia or the presence of atrophy (shrinkage) in the brain (Figure 1). A Positron Emission Tomography (PET) scan can also confirm the presence of amyloid and tau pathology.
  
  
  Figure 1: Left - Normal Right - Dementia
  Shrinkage of the brain in Dementia patients


• Cerebrospinal fluid (CSF) testing
  CSF is drawn from the spine to test for markers of dementia. An appointment is needed for this outpatient procedure. You should come with your caregiver who can provide you support as the procedure will last a few hours.

Some causes of dementia may be reversible but at present, there is no cure for the common causes such as Alzheimer's Disease and Vascular Dementia.

Medications can help stabilize the levels of chemicals in the brain, which may improve some of the symptoms of dementia. Psychotherapy can help with feelings of loss, depression or anxiety. Education and support of caregivers is also a crucial aspect of holistic dementia care.

Appropriate care facilities, behavioural therapies, counselling, and education are available to improve care for patients and their families.

For available programmes, speak to your attending doctor.