According to the latest data announced by the Taiwan Dementia Association in 2022, the dementia population in Taiwan over the age of 65 has already exceeded 300,000. By 2040, it is estimated that the dementia population will double to 660,000, and the prevalence rate is increasing yearly.
The prevalence of dementia is increasing. In the increasingly childless society of Taiwan, the future care of the elderly dementia population is facing a severe test.
In the past, dementia was generally considered to be incurable. However, in recent years, there have been many advances in the treatment of dementia, and it is still possible for patients to improve their symptoms or delay their deterioration through treatment, thus improving the quality of life of patients and their families in the future.
Aging does cause forgetfulness, but dementia is an entirely different condition. Dementia is not only a condition of memory loss but also a deterioration of cognitive functions such as language skills, spatial judgment, calculation skills, attention span, and abstract thinking skills, as well as changes in temperament and even hallucinations and delusions.
Symptoms of dementia can vary at different stages.
- I can’t remember what just happened
- Easily get lost in unfamiliar places
- Forgetting trivial things in life (such as where to put things, locking doors, turning off faucets, etc.)
- Unable to handle complicated things (e.g., shopping, planning trips, preparing meals)
- Difficulty concentrating
- Moodiness or irritability
- Still able to maintain life on your own
- Memory impairment in travel and distance (e.g., cannot remember your phone number, address, or previous school)
- Disorientation disorder, loss of orientation to people, time, and place (e.g., not knowing what day of the week it is)
- Urinary incontinence
- Irregularities in life patterns (e.g., day and night confusion)
- Hallucinations and delusions
- Social withdrawal
- Asking the same questions over and over again
- Needing help with daily living
Late stage symptoms
- Loss of ability to distinguish time, place, and people
- Loss of communication skills
- Urinary and fecal incontinence
- Reduced mobility
- Becoming childish
- Inappropriate behaviors (e.g., eating foreign objects, playing with dirty things, etc.)
- Loss of mobility, bedridden for long periods
- Complete dependence on others for care
Dementia risk factors
Congenital factors and acquired environment cause most dementia. Therefore, even if we cannot change the genetic factors, we can still reduce the risk of dementia by improving the acquired environmental factors (such as diet and living habits).
The degenerative form of dementia accounts for more than half of all dementia cases, making age the most critical risk factor for dementia.
The Three Highs
High blood pressure, diabetes, and cardiovascular disease all increase the risk of Alzheimer’s disease. According to research, diabetes can cause memory and cognitive decline. Patients with untreated hypertension >160 mmHg have five times the risk of Alzheimer’s disease. Controlling blood pressure through treatment can reduce the risk of Alzheimer’s disease.
According to research, smokers have a faster rate of cognitive deterioration. They are twice as likely to develop Alzheimer’s disease as the general population, and quitting smoking can reduce the risk.
People with a family history of dementia also have a higher incidence of dementia. In addition, early-onset dementia that occurs before age 60 is also more often associated with a genetic predisposition.
People with a history of depression are two times more likely to develop Alzheimer’s disease than the general population.
The risk of Alzheimer’s disease is three times higher in middle-aged obese people (BMI > 30). If the BMI is between 25 and 30, the bet will be increased by two times.
Types of Dementia and Treatment
There are three main types of dementia: degenerative dementia, vascular dementia, and dementia caused by other factors.
Alzheimer’s disease, commonly known as dementia, is the most common type of dementia, accounting for about 60-75% of all cases. It is a neurodegenerative disease with a slow onset but worsens over time. The actual cause is still being researched, but it is generally believed that genetics accounts for 70% of the risk factors. The average life expectancy after diagnosis is about 3 to 9 years, but some patients have lived for more than 20 years. The severity of the disease is associated with fibrous amyloid plaques and Tau proteins in the brain.
Regarding behavioral abnormalities, it is up to the physician to determine whether to administer psychotropic medication to control abnormal behavior. Studies have shown that about 70% of patients can improve their abnormal behavior. Some drugs have been shown to be 60% to 70% effective in overseas studies for cognitive impairment. Treatment can improve the quality of life for many patients and family members.
Dementia with Lewy Bodies
It is the second most common form of degenerative dementia, accounting for about 15-30% of all dementia. It occurs most often in the elderly, with an average age of 75 years, and is more common in men than women. In addition to cognitive impairment and hallucinations, the disease is characterized by tremors, limb stiffness, slow movements, and unsteady walking, somewhat like a combination of Alzheimer’s disease and Parkinson’s disease. The average remaining life expectancy after diagnosis is about 7.7 years.
Frontotemporal lobe degeneration
The most significant difference between frontotemporal lobe dementia and Alzheimer’s disease is that the initial onset of the disease is not characterized by memory loss but by changes in personality, behavior, or deterioration in language function. Inappropriate behaviors such as yelling, repetition of the exact words, agitation, and other abnormal behaviors often occur, so they are initially considered mental illnesses and referred to psychiatry. The age of onset is usually below 65 years old, and most cases are early onset dementia.
Vascular dementia is dementia caused by cerebrovascular disease. The leading causes are cerebral embolism and cerebral hemorrhage, also known as stroke. The cumulative number of strokes and the location of the stroke will affect the condition of vascular dementia. In the initial stage, the person may become sluggish, passive, and slow in behavior and spend a lot of time on daily activities such as eating and bathing.
Dementia is caused by other diseases, such as malnutrition (vitamin B12 deficiency, folic acid), metabolic abnormalities (hypothyroidism, electrolyte imbalance, etc.), brain diseases (brain tumor or trauma, hydranencephaly, etc.), and drugs or alcohol effects.
|Dementia with Lewy Bodies
|Frontotemporal Lobe Degeneration
The Key to Preventing Dementia
Although most dementias cannot be cured, we can prolong the duration of mild dementia and slow down the rate of deterioration. As a result, some patients have maintained mild dementia for ten years and can manage their daily lives without causing a burden to their families.
What are the best ways to prevent dementia or slow down its deterioration?
Active participation in social activities, such as community activities, charity clubs, friends or classmates gatherings, volunteering, playing chess and cards, etc., all help to promote brain functioning.
Participating in classes, regular reading, painting, gardening, playing mahjong, etc., are all excellent choices, and travel activities can be arranged to continue to receive new knowledge. In addition, listening to music can also soothe the patient’s emotions or provide positive stimulation for the patient’s brain through the operation or playing of musical instruments, which can delay the disease.
The exercise habit can be maintained more than two to three times a week to prevent dementia, such as walking, climbing, dancing, swimming, tai chi, etc. These relatively gentle and less intense exercises are also more suitable for the elderly.
Control the three highs
High blood pressure, high blood lipids, and high blood glucose all increase the risk of vascular dementia. Therefore, patients with chronic diseases suffering from three highs should actively receive treatment to control blood pressure, blood lipids steadily, and blood glucose, which can reduce the risk of dementia and delay the degeneration if there is dementia.
Studies have shown that the Mediterranean diet can reduce the risk of cardiovascular disease and Alzheimer’s disease. This diet is based on fruits and vegetables, grains and cereals, more beans, nuts, and fish (rich in omega-3 fatty acids), moderate milk and dairy products to supplement protein and calcium, and more unsaturated fats such as olive oil when cooking food.
Avoiding head injuries
People who have suffered severe head injuries are at significantly higher risk of developing dementia than the general population and should wear a helmet when riding a bicycle or motorcycle to reduce the chance of injury.
Many people with dementia may experience physical impairment and unstable walking when they have the disease, and caregivers should pay special attention to this because injuries from falls are often one of the reasons why dementia worsens.
It is also a learning curve to determine the level of care for the patient. Over-protection or under-care can have negative effects. In milder cases, patients can still take care of their daily activities, such as eating, dressing, bathing, etc., which are less dangerous.
The patient can be encouraged to participate in activities they enjoy, be accompanied more often to increase the opportunities for interpersonal interaction, and grasp several essential principles: control the three highs, eat a balanced diet, work and rest normally, exercise regularly, and avoid injuries to slow down the degeneration of dementia.
Dementia Family Support Resources
Caregivers of people with dementia often experience increased psychological stress and emotional distress due to communication difficulties, abnormal behavior, inappropriate language, and even violent behavior. On the other hand, if the person being cared for is their parent, it is a great loss for the caregiver to see their parent gradually deteriorate and eventually not even recognize their child.
The caregiver is often under pressure from many sources. In addition to physical challenges, there may be conflicts between family members and friends due to the uneven distribution of caregiving responsibilities, the lack of time to care for family and marital ties, or the financial pressure of quitting a job.
Caring for a person with dementia is a long-term physical and psychological test and requires a timely support system for oneself. The Taiwan Dementia Association provides a wealth of resources for the family members of patients. By participating in a dementia family support group, you can share your experiences with family members who have similar experiences and cheer each other on so that you can relieve your stress and learn caregiving skills.