Epidemiology
Dementia is one of the most common neurodegenerative disorders among the elderly, though there are also a small number of middle-aged patients. According to information from the Department of Health, one in 10 people aged 70 or above in Hong Kong suffers from dementia, with the rate increasing to one in three among those aged 85 or above. It is estimated that by 2036, there will be about 280,000 patients with dementia in Hong Kong.
What is Dementia?
Also known as major neurocognitive disorder, dementia occurs when brain cells are damaged or lost at a faster rate than normal as a person ages. This can severely affect brain function across many areas such as memory, thinking, behavior, and the ability to care for oneself, and can negatively impact the quality of life of patients and family members.
Symptoms
During the early stages, patients may have poor memory and find themselves forgetting things often, such as whom they have planned to meet or whether they have eaten or not. Their ability to perform daily tasks will also be affected – they may forget how to take their own medications, misplace items, lose their calculation abilities, or exhibit poor judgment.
Causes & Risk Factors
There are three main types of dementia: Alzheimer’s disease, vascular dementia, and other dementia. In severe cases, patients lose the ability to take care of themselves and end up confined to their beds, which may lead to various complications such as pressure sores, aspiration pneumonia, and profound weight loss.
| Proportion | Cause | |
|
Alzheimer’s Disease |
Approximately 70% of all cases |
The disease develops in the patient’s brain cells and plaques between brain cells, disrupting communication among brain cells and affecting the brain’s ability to receive external information. Patients gradually lose certain cognitive and mobility. |
|
Vascular Dementia |
Approximately 20% of all cases |
Caused by stroke or small vessel disease, which damages the brain and leads to brain degeneration. |
|
Other Dementia |
Remaining cases |
Caused by various conditions such as Parkinson’s disease, brain trauma, brain tumors, depression, malnutrition, thyroid disorders, or drug poisoning, which can lead to brain degeneration. |
Risk Factors
- Aged 65 or above
- Family history
- Hypertension
- Heart disease
- Diabetes
- Stroke
- Depression
- Anxiety disorders
- Previous brain injury
How is Dementia Diagnosed?
Dementia is diagnosed by cognitive assessment, which consists of four parts: (1) a review of medical history; (2) a targeted physical examination; (3) mental and psychiatric assessments; and (4) laboratory tests or scans. The assessment aims to determine the cause of dementia, degree of brain degeneration, behavioral and mental state (such as whether the patient has experienced delusions or depression), as well as the condition of the patient’s caregiver.
- Targeted physical examination: includes neurological and cardiovascular examinations to determine whether the patient has suffered, or is suffering from stroke, high blood pressure, or undiagnosed atrial fibrillation
- Mental and psychiatric assessments: cognitive and psychiatric assessments are conducted to evaluate the patient’s thinking ability and mental health condition
- Laboratory tests and scans: blood tests, MRI, or PET scans are used to diagnose and determine the severity of the disease
Treatment & Managing Symptoms
Although dementia could not be cured, early intervention and treatment can help manage or improve symptoms. Depending on the patient’s condition, doctors may recommend treatment through medications and/or non-pharmacological approaches.
| Medications |
Two commonly used medications include cholinesterase inhibitors and memantine. The former is used to improve patients’ memory and cognition, and is usually effective in those with early or mid-stage dementia. The latter is prescribed to patients at the middle to late stages of dementia and can help protect brain cells from the effects of glutamate and slow the progression of the disease. Depending on the patient’s psychological and behavioral conditions, doctors may also prescribe other medications to alleviate symptoms such as insomnia, agitation, depression, hallucinations, and delusion. |
|
Non-Pharmacological Therapy |
If a patient is diagnosed with mild cognitive impairment (MCI), a condition in which the patient has minor cognitive problems considered between normal cognition and early-stage dementia, doctors may prescribe cognitive training and brain exercises to help maintain cognitive function, relieve symptoms, and delay or prevent deterioration of brain function. |
Managing Symptoms
To slow down the rate of brain degeneration, dementia patients should keep their brain active as much as possible and also ensure adequate intake of vitamins B12, C, and E.
Vitamin B12 deficiency may lead to dementia, while vitamins C and E boast antioxidant properties that protect nerve cells and benefit blood vessels. Many overseas studies have also shown that adopting a Mediterranean diet high in fish, vegetables and olive oil, and low in meat is helpful in reducing the risk of dementia.
