Earlier intervention offers better options to boost quality of life for patients who have degenerative brain disorders.
It used to be a rare event: At a sporting event or shopping mall, an urgent voice is heard on the public address loudspeakers pleading for help in locating an elderly person who has wandered off and gone missing. It’s no longer so rare, as greying populations confront the growing
prevalence of Alzheimer’s disease and other forms of dementia.
Dementia = Alzheimer’s??
The terms dementia and Alzheimer’s disease tend to be used interchangeably to mean the same thing. Indeed the two are closely related, but dementia and Alzheimer’s are not identical. Dementia is the medical term that groups together several different disorders based on similar symptoms; Alzheimer’s is the most prevalent type of dementia.
“Dementia is caused by damage to brain cells,” says Dr. Itthipol Tawankanjanachot, a board certified neurologist at Bumrungrad who specializes in treating Alzheimer’s disease. “When cells from a particular region of the brain are damaged, normal body functioning becomes impaired. The damage accumulates gradually, affecting a larger and larger portion of the brain; as the damage continues to spread, other functions start to become impaired. By the time symptoms first appear, the degenerative process has been in progress and worsening for many years.”
Alzheimer’s disease is a form of dementia characterized by cell damage that originates in the hippocampus – the region of the brain that serves as the command center for learning and storing new memories. “This explains why short-term memory loss is an important initial indicator in diagnosing Alzheimer’s,” notes Dr. Itthipol. “Memory loss by itself doesn’t signify Alzheimer’s disease; we have to consider whether the memory problems are having a significant impact on a patient’s daily life.”
Lapses in memory that happen from time to time – mis-placing a cell phone or forgetting where you put your keys – aren’t something to worry about as long as they don’t affect one’s ability to carry on with everyday tasks and activities. But more severe memory loss – the kind that impairs one’s normal daily activities – is a troubling sign requiring pro-fessional medical attention. “As Alzheimer’s progresses further,” Dr. Itthipol notes, “patients will exhibit more signs of cognitive impairment – reduced language proficiency, poor judgment and reasoning, and changes in behavior and personality – resulting from the increasing damage to brain cells.”
Age and genetic abnormalities are the chief risk factors for dementia. An estimated five to eight percent of adults over 65 have dementia, and the risk rises together with age. For those in the 90-and-older bracket, the prevalence is much higher – about 50 percent.
“Dementia is caused by damage to brain cells. The damage accumulates gradually, affecting a larger and larger portion of the brain.” Dr. Itthipol Tawankanjanachot
Dementia’s reversible forms
There are two categories of dementia disorders: reversible and irreversible. “With reversible forms of dementia,” notes Dr. Itthipol, “the decline in cognitive performance can be traced back to a metabolic-related problem that’s more prevalent among seniors, including diabetes, high blood pressure, high cholesterol, and certain types of heart problems. If the root causes are correctly identified and properly treated, the patient’s dementia-like symptoms usually improve and may be resolved completely.”
The irreversible forms of dementia usually stem from neurological disorders. “The exact cause of brain damage is still not fully understood,” says Dr. Itthipol. “But a widely supported theory attributes it to the build-up of amyloid proteins in brain tissues. It’s normal to see some accumulation of amyloid proteins in an aging brain, but factors we still can’t identify are responsible for much higher levels of protein accumulating in the brains of Alzheimer’s patients.”
Diagnosing dementia
A number of factors are examined in the process of diagnosing Alzheimer’s disease and other types of dementia. A review of the patient’s medical history is conducted with input from the patient and family members. The doctor will perform a physical examination along with laboratory tests and an assessment of behavioral and emotional changes in order to confirm the type of dementia present and its possible causes.
“It’s not easy to gather sufficient information on the patient’s unusual changes based only on the observations of family members,” Dr. Itthipol explains. “Although Alzheimer’s and dementia produce a number of common symptoms, early symptoms tend to be dismissed as normal changes due to getting older rather than early indicators pointing to a serious disease. To improve accuracy, doctors have a number of tests to help diagnose dementia and to rule out other conditions. Tests enable doctors to evaluate the patient’s thinking abilities, termed cognitive function, and determine whether the impairment might be reversible.
In addition, a physical examination of the patient helps doctors identify the likely cause of the brain impairment, the severity of impairment, and the optimal treatment strategy. When treatment begins earlier, patient outcomes are better regardless of the actual cause.
“Mild- to moderate-stage Alzheimer’s patients may benefit from medications – called cholinesterase inhibitors – that help prevent the breakdown of cetylcholine, a brain neurotransmitter that plays an important role in memory function.” Dr. Sasitorn Siritho
Treatment challenges
Dr. Sasitorn Siritho, a neurologist at Bumrungrad, has many years of experience treating patients with Alzheimer’s or other forms of dementia. According to Dr. Sasitorn, once an Alzheimer’s diagnosis is confirmed, developing an optimal treatment plan depends largely on the nature of the symptoms.
“Though so far no treatment can stop the progression of Alzheimer’s,” says Dr. Sasitorn, “in the disease’s early and middle stages, certain medications can help keep a patient’s symptoms from worsening at least for a period of time.”
When the cause of the dementia is reversible, the doctor will treat the cause specifically. For example, if the patient has a brain tumor, tumor removal is the treatment option; if the patient is hypothyroid, medication for treating hypo-thyroidism is an option.
When the cause of dementia is irreversible, doctors must assess the extent of brain damage in order to determine the optimal treatment. “In addition,” continues Dr. Sasitorn, “there are medications that may help patient symptoms such as difficulty sleeping, wandering tendencies, agitation, anxiety, and depression. Treating these behavioral symp-toms is comforting to patients and eases the burden of caring for them.
Doctors should also consider a combination of lifestyle changes, especially nutrition and exercise, together with medication to target underlying conditions – to manage blood sugar levels for diabetes, to lower cholesterol and alleviate hypertension, and supplements in the event of vitamin deficiencies.
“The medications being prescribed for mild- to moderate- stage Alzheimer’s patients – known as cholinesterase inhibitors – help prevent the breakdown of acetylcholine, a brain neurotransmitter that plays an important role in
memory function,” Dr. Sasitorn explains. “The medication can help delay the onset of symptoms, or prevent them from worsening for some time.”
Non-medication treatments usually involve two elements: brain exercises to boost cognitive functions, and specific methods of patient care designed to enhance patient quality of life. “Activities or games – puzzles, for example - help reduce stress and promote brain function,” Dr. Sasitorn explains.
“Despite their dependence on others, Alzheimer’s patients can enjoy an improved quality of life with proper care. The role of caregivers is critically important.
Dr. Sasitorn continues: “In addition to providing guidance for caregivers and family members on what to expect and how to cope, doctors can recommend improvements to make the patient’s living environment safer, and give guidance to caregivers to ensure they protect their own health and their emotional wellbeing.”
The critical role of caregivers
Dementia and Alzheimer’s are progressive irreversible disorders that bring tremendous challenges to everyone involved – patients, caregivers and family
members – as patients become highly dependent on others.
Dr. Solaphat Hemrungrojn, a board certified cognitive behavioral psychiatrist at Bumrungrad, offers some helpful advice for those who serve as caregivers for patients with Alzheimer’s and types of dementia:
- Caring with empathy and understanding It’s important for caregivers to understand and be mindful that Alzheimer’s and other forms of dementia are medical conditions that affect most aspects of a patient’s life and behavior. It’s easy to lose patience dealing with a patient who has memory problems, has trouble learning new things, and can’t make rational decisions without help. In addition, the condition results in behavior and personality changes that make the caretaker’s burden even heavier. In those frustrating and irritating moments, remember it’s the disease, not the patient, that’s causing the changes.
- The care of a loving family For most patients, caregivers are also family members; oftentimes it’s adult children who go to great lengths to care for an aging parent who they love dearly. The care of a loved one is an important contributor to a patient’s emotional wellbeing; patients do better when someone who loves them is around to help with daily activities and watch over them so they won’t lose their way.
- Be sure to take care of you While helping others in need, it’s easy to overlook one’s own health and wellbeing. It’s important to know your limitations so you don’t fall into the trap of trying to do too much. Build breaks into your normal schedule, and take some extra time away if you start to feel overwhelmed. You can only give a patient your best care when you are feeling your best; especially considering the powerful effect that interaction between patient and caregiver can have on the wellbeing of patients with dementia or Alzheimer’s.
- Be sure to take care of you While helping others in need, it’s easy to overlook one’s own health and wellbeing. It’s important to know your limitations so you don’t fall into the trap of trying to do too much. Build breaks into your normal schedule, and take some extra time away if you start to feel overwhelmed. You can only give a patient your best care when you are feeling your best; especially considering the powerful effect that interaction between patient and caregiver can have on the wellbeing of patients with dementia or Alzheimer’s.
Dr. Solaphat Hemrungrojn
“There are still many reported cases of aging patients who, after spending their lives as responsible, valued members of society, become ill and are left on their own without proper care,” says Dr. Solaphat. “At a time of great need, patients deserve respect and care from the people they love. It is always better to be cared for by someone who is known to the patient and has been part of their life. The love of a caregiver is a powerful force for making a patient’s life much better.”
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