MEMORY LOSS

Memory loss in old age is often taken for granted. While Dementia is the most common cause of memory loss as an individual approaches the later years of his or her life, it is not the only cause for memory impairment. Some of these causes that may lead to concerns with memory are mentioned below in brief.

MILD COGNITIVE IMPAIRMENT: This is a state where-in a person experiences a decline in mental faculties such as memory, attention, orientation, language, thinking and judgement. The impairment is more than just everyday forgetfulness, but is not severe enough to warrant a diagnosis of dementia. Although it is often seen as a precursor to dementia, every person with Mild Cognitive Impairment may not develop dementia.

DEPRESSION: Depression in older adults often manifests as memory problems along with other symptoms. That is, an older adult suffering from depression could show symptoms of dementia. This condition is known as ‘pseudodementia’. Some of the common symptoms are excessive concern about their memory, feelings of guilt, hopelessness, lack of interest, anxiety as well as appetite changes.

REVERSIBLE DEMENTIA: Reversible dementias are conditions which present with the symptoms of dementia, but may be causes by various treatable factors. As such, unlike dementia, they can be treated. These conditions are mentioned below under ‘treatable dementias’.

Apart from the abovementioned conditions, memory issues are predominantly seen when an older adult develops one or the other form of Dementia.

DEMENTIA

What is Dementia?

Dementia refers to a decline in several of the mental faculties of a person, thereby leading to problems in his or her day to day functioning. Dementia usually develops gradually. It is a progressive condition, meaning that the symptoms get worse with time. While initially the symptoms of Dementia may only slightly interfere with the daily functioning of an individual, over time it becomes highly debilitating. Dementia is an umbrella term, the symptoms of which can be caused by several processes such as Alzheimer’s disease, Vascular Dementia, Frontotemporal Dementia, Lewy body Disease and many others.

What are the symptoms of Dementia?

Dementia impacts the overall ability to function, impacting several areas of a person’s life in a negative manner. A key aspect is that an individual may find it difficult to do the same tasks that he or she used to perform earlier with ease. Central to this condition is the effect it has on memory. Individuals may find it difficult to recall information or to remember new information.

Other problems that a person may experience include:

• • Language problems
  • Problems in recognising objects even when he or she can properly see, feel, etc
  • Difficulty in movement, despite intact motor function
  • Difficulty in planning, sequencing, executing, taking complex decisions, calculating, and so on.

Thus, a person with Dementia will typically experience the following challenges:

• Memory loss, especially loss of memory with respect to recently learnt information or even personally significant information. For example, initially it may begin with forgetting a recent event and slowly, as the condition worsens, the individual may find it difficult to recollect the names of a close friend or family member.
• Problems in activities that an individual could previously do with ease. For example, going grocery shopping and calculating the monthly expenditure.
• Problems with understanding spatial relationships, such that judging distance while driving becomes impaired.
• Confusion with time and date, and even with the place that they may be in.
• Finding it difficult to communicate because of decreased vocabulary, struggling with finding the words, repeating themselves or identifying things with the wrong name (like calling stomach a food vessel)
• Finding it difficult to recognise and name objects, persons, places, etc
• Inability to identify the pros and cons or make higher level judgements that may require taking into account more than one aspect of the problem.
• Decrease in social and professional interactions owing to the above mentioned difficulties.
• Changes in personality or mood or both. It is commonplace for those with Dementia to feel confused, irritated, frustrated, sad and so on.

What are the problems that a caregiver can face?

Individuals with Dementia display certain behaviours owing to their condition, which can be stressful for the family or caregivers to handle. These behaviours may include:

• Wandering, restlessness, sleeplessness, for which, the reason is difficult to pinpoint.
• Poor self-care, combined with refusal to accept help may prove challenging to handle.
• Irritation, anger, depression, withdrawal from daily activities. When a person with Dementia feels frustrated or angry, the caregiver stress increases manifold.
• Repetitive behaviour, for example asking the same question several times.
• Hallucinations, delusions that may be difficult to distinguish from reality.

At what age does Dementia begin and how common is it?

Generally, Dementia begins in old age. However, in some cases, it can begin by the age of 45-50 years, and is known as early-onset Dementia. Dementia is seen to be prevalent in about 5% of those aged 65, but this rate increases to about 20-40% in those over age 85.

What are some common myths about Dementia?

Dementia is part of aging. While some changes are expected with old age, Dementia comes with a host of deteriorative changes in a person’s ability that is not a part of the normal aging process.

Dementia means having to live a bleak life: Many people diagnosed with Dementia continue to live their life productively, pursuing their hobbies and having a well-established relationship with friends and family

Once diagnosed with Dementia, no treatment is helpful. While it is true that there is no cure for certain Dementias, a number of treatment and therapeutic options are available that enhance the quality of life of those suffering from Dementia. These help alleviate some of the symptoms and enable the individual to live a productive life despite the diagnosis.

What causes Dementia?

• • Dementia is caused due to the degeneration of brain cells faster than with the normal ageing process. This degeneration could be a result of a variety of reasons such as infections such as tuberculosis and meningitis; lack of oxygen due to carbon monoxide poisoning, ingestion of toxic substances, nutritional deficiencies, or even certain disease processes.
  • The risk of Dementia, specifically Alzheimer’s disease increases in those whose parents or a close family member suffers from dementia. This suggests a genetic basis. Four genes have been identified to play a role in causing Dementia. These genes interfere with the functioning of the brain cells or they cause death of neurons. APOE gene, Presenilin 1, Presenilin 2, Trisomy 21
  • Mothers who gave birth to children with Down’s syndrome prior to age 35 have higher risk of developing Dementia.
  • Treatable Dementias and Manageable Dementias: These symptoms of Dementia can be caused due to a variety of conditions, some of which are treatable, while some can only be managed.
    Treatable Dementia can be caused due to:
    • Medications
    • Depression
    • Vitamin B12 deficiency
    • Chronic Alcoholism
    • Tumours, clots or infections in the brain
    • Metabolic imbalances such as thyroid, kidney or liver disorders

Dementias that can only be managed, not treated completely are caused due to:

• • • Alzheimer’s Disease: This is the most common type of Dementia. A person with Alzheimer’s disease generally experiences memory impairment, gradually declining cognitive skills, language problems, difficulty orienting self and nearly all the symptoms described above. The prominent feature in Alzheimer’s disease is memory loss. The person may experience delusions and hallucinations as well.
    • Frontotemporal Dementia: The prominent feature is personality changes, in which a person may show inability to control inappropriate behaviour; lack of sympathy, obsessive or repetitive behaviour, as well as a lack of interest. Another common symptom is the reduction in linguistic skills, specifically inability to find the correct words or names. There may not be difficulties with memory. The individual may face problems in social situations as well in higher level reasoning
    • Vascular Dementia: Vascular Dementia is caused when constriction of the blood vessels leads to lack of oxygen and nutrients to the brain cells. This and Alzheimer’s disease together form majority of the causes of Dementia. The key symptoms are problems in attention and planning, sequencing and making decisions.
    • Lewy Body Dementia: Lewy body Dementia has symptoms such as progressive loss of memory, reasoning, calculations, language and other cognitive skills, with a more rapid progression. It is accompanied with inconsistent periods of attention and confusion; hallucinations, disturbances in movement as well as tremors.
    • Other conditions include Huntington’s disease, Creutzfeldt-Jacob Disease as well as Pick’s disease among others.

Risk factors:

• • • Age: Risk for Dementia doubles every 5 years after the age of 65
    • Women have a higher risk of developing Dementia. This is suspected to be related to the findings that women generally live longer than men and hence advanced age and loneliness play a role in the development of Dementia
    • Feelings of loneliness and depression also increase the risk of Dementia
    • Smoking (present or even past history)
    • Lesser years of formal education
    • Less complex jobs
    • High-fat, high cholesterol diet
    • Obesity
    • Trauma to the brain

What are the treatment options available?

Treatment for Dementia involves:

• • Medications for memory loss, sleep disturbances, cognitive functioning, attention, learning, reason and language
  • Therapeutic interventions to reduce delay the progression of the disease process, to reduce behavioural symptoms such as wandering which may prove to be very dangerous.
  • Cognitive Stimulation Therapy: Effective in improving the cognitive functioning and language skills of those diagnosed with Dementia.
  • Reminiscence therapy has shown to significantly improve the quality of life of those suffering from Dementia.
  • Support groups for care-givers for emotional support as well as to share effective strategies for care-giving.
  • Changes in the home environment and training of the care-givers to ensure a risk-free and independent life for the individual
  • As a caregiver, what can I do?Given below are some tips that can be useful for caregivers of those with Dementia:
    • • Reduce clutter in their environment. Too many objects could cause more distress
      • Refrain from asking questions. Instead, give choices, and let the person make a decision. This reduces their confusion, and at the same time gives them some control.
      • Put up pictures around the house of the memories that you have had together. Talk about them often.
      • Try and keep your calm around them even if they are distressed.
      • Give instructions one at a time. Keep it simple.
      • Before talking, try and get their attention. Speak in a pleasant, clear and audible voice, without shouting or yelling.
      • Try to engage the individual in activities that he or she is fond of and can still do. This could be as simple as listening to their favourite music.
      • Make available prompts, cues and guidance for self-care, and encourage when small steps towards self-maintenance are taken.
      • Make available prompts, cues and guidance for self-care, and encourage when small steps towards self-maintenance are taken.
      • It is okay for a caregiver to take a break. For some time, hand over the care-giving duties to someone else you can rely on and take a break.
      • When care-giving becomes difficult and frustrating, it is important to remember that it is the disease that is causing the person to act in undesirable ways.

    How Do I Prevent Dementia?

    • • • Maintain a healthy lifestyle with adequate sleep, regular exercise and healthy food
        • Keep your mind engaged in complex tasks, throughout your life and even post retirement
        • Engage yourself in a longer duration of formal education (learning or teaching)
        • Maintain a good social support system of family, friends and others
        • A triad of more education, complex jobs and high engagement in social activities could help delay the onset of dementia to a great extent.

    If you detect any changes in memory or behaviour and suspect dementia, it is crucial that you take proactive steps in the very beginning. This could help delay the onset of Dementia, thereby allowing you to live a symptom free life for a longer period.

    Diagnosis of Dementia requires comprehensive testing and assessment so as to rule out the treatable causes of Dementia. Investigations such as blood test or spinal tap (to identify presence of APOE gene), MRI to detect changes in brain functioning, clinical assessment by a clinical psychologist to detect the change in cognitive functioning are necessary for coming to a diagnosis of Dementia.

    Our team has a well-balanced network of doctors and psychologists who will be able to help you through the process of getting an accurate diagnosis. Additionally, through team consultations and collaborations, a care plan that includes pharmacological and non-pharmacological treatment will be formulated and implemented to ensure the best possible quality of life.

    References:

    • • Abnormal Psychology – Butcher, Mineka, Hooley
      • Abnormal Psychology – Barlow, Durand
      • Abnormal Psychology – Halgin, Whitbourne
      • Synopsis of Psychiatry – Kaplan, Sadocks
      • Identifying and Treating Behavioral Symptoms in Dementia – Laura N. Gitlin, Ph.D.
      • Treatment for Behavioural Symptoms – Alzheimer’s association?
      • 2015 Alzheimer’s Disease Facts And Figures – Alzheimer’s Association
      • Dementia Care tips – Homewatch Caregivers
      • Myths and realities of Alzheimer’s disease – Alzheimer’s Society Canada
      • Myths about dementia – Dementia Dynamics