Cognitive Impairment and Dementia

"Senile dementia" and "cognitive impairment disorder" actually refer to the same type of disease, with the terminology evolving over time due to changing societal perspectives. In Hong Kong, "senile dementia" was commonly used in the past to describe this type of neurodegenerative disease. However, due to its negative and discriminatory connotations, the term was officially changed to "neurodegenerative disorder" in 2010 and further standardized to "cognitive impairment disorder" in 2013.

The symptoms of dementia (also known as Alzheimer’s disease) progressively worsen over time. Below are common categories of symptoms associated with the condition.

Memory Decline

Memory loss is one of the earliest and most common symptoms, with short-term memory deterioration being especially noticeable.

• Forgetting events: Frequently forgets recent occurrences—for example, insisting they haven’t eaten when they just did.
• Repeating questions or stories: Repeats the same question or story multiple times, even if they were just mentioned.
• Forgetting important dates and appointments: Such as doctor visits, birthdays, or payment due dates.

Decline in Language and Comprehension Abilities

As the condition progresses, patients may gradually experience difficulties in both verbal expression and comprehension:

• Difficulty expressing thoughts or finding the right words: Even when they have something in mind, they may struggle to articulate it, often using incorrect words or forming confused sentences.
• Problems understanding others: They may respond slowly to simple instructions or everyday conversations, or may be unable to grasp what others are saying.
• Inability to follow conversations: During discussions, they may go off-topic, give irrelevant answers, or suddenly fall silent or lose track of the conversation.

This type of language deterioration not only hampers communication but also leads to greater social difficulties and daily life challenges.

Executive Function Impairment

In individuals with dementia (Alzheimer’s disease), executive functions gradually deteriorate, affecting their ability to plan, organize, and complete tasks:

• Difficulty completing daily tasks: Activities that were once familiar—such as cooking, cleaning, or managing finances—become challenging and often require assistance.
• Inability to follow complex procedures: Tasks that involve step-by-step processes, like operating household appliances or using public transport, may no longer be performed correctly.
• Struggling to organize activities or respond to unexpected situations: Patients react slowly to new scenarios, lack problem-solving skills, and may become anxious or frustrated as a result.

These impairments significantly impact the patient’s ability to live independently and increase the caregiving burden on families.

Disorientation and Loss of Spatial Awareness

Dementia (Alzheimer’s disease) affects the brain’s ability to recognize time, place, and people, often leading to the following situations:

• Confusion about time, place, and people: Patients may not know where they are, why they’re there, and may fail to recognize familiar people or mistake others for someone else.
• Getting lost in familiar places: Even in neighborhoods they’ve lived in for years, patients may suddenly be unable to find their way home.
• Unawareness of dates and time of day: They may struggle to distinguish between day and night or remember the correct date and year, leading to disordered daily routines.

These symptoms increase the risk of patients going missing and may also cause them to feel fearful or anxious about their surroundings.

Decline in Judgment and Attention

People with dementia (Alzheimer’s disease) often struggle with decision-making and maintaining focus. Common signs include:

• Making illogical decisions: For example, wearing inappropriate clothing for the season (like a down jacket in summer), or becoming overly concerned about trivial matters.
• Increased vulnerability to scams or impulsive actions: Such as falling for phone scams, overspending on unnecessary items, or making risky or unnecessary financial commitments.
• Difficulty concentrating: Unable to focus for long periods on reading, watching television, or engaging in activities that require sustained thinking, and becoming easily distracted or irritable.

These changes may not be obvious in the early stages but tend to worsen over time, eventually impacting daily life in meaningful ways.

Emotional and Behavioral Changes

Dementia (Alzheimer’s disease) not only affects memory and cognitive functions but also leads to noticeable changes in emotions and behavior. Common manifestations include:

• Increased anxiety, depression, and irritability: Patients may feel unsettled due to memory decline or loss of independence, leading to frequent mood swings and emotional outbursts over minor issues.
• Delusions: For example, suspecting family members or caregivers of theft or harm, or firmly believing things that do not align with reality.
• Abnormal behaviors: Such as aimless wandering, repeating the same actions, or uncontrollable anger. These behaviors can pose risks to the patient or those providing care.

These symptoms not only impact the patient’s quality of life but also place a significant emotional and physical burden on caregivers. Early professional support and diagnosis are strongly recommended.

Changes in Social Behavior and Personality

People with dementia (Alzheimer’s disease) may experience noticeable changes in personality and social behavior, including:

• Loss of interest in people and activities: They may stop participating in previously enjoyed activities, show apathy toward their surroundings, and lack motivation.
• Becoming withdrawn, isolated, or lacking confidence: Patients may avoid social interactions due to difficulties expressing themselves or fear of their condition being noticed.
• Extroverts becoming quiet and reserved: A complete personality shift may occur, with individuals becoming silent or passive and losing interest in connecting with family and friends.

These changes can be challenging for families to cope with and may affect the patient’s mental well-being. Early recognition and professional support are recommended to help slow down disease progression.

Causes of Dementia (Alzheimer’s Disease)

Dementia can be broadly categorized into three main types: Alzheimer’s disease, vascular dementia, and other causes. In severe cases, patients may lose the ability to care for themselves and become bedridden for extended periods. This can lead to various health complications, including a higher risk of developing serious pressure ulcers, aspiration pneumonia, and rapid weight loss—all of which can result in serious consequences.

Risk Factors for Cognitive Impairment Disorder (Dementia)

• Aged 65 or above
• Family history
• High blood pressure
• Heart disease
• Diabetes
• Stroke
• Depression
• Anxiety
• Previous brain injury

Cognitive impairment disorder is diagnosed through an assessment of cognitive abilities. The evaluation consists of four components: medical history review, targeted physical examination, mental and psychological assessment, and laboratory tests and imaging. These help determine the cause of cognitive impairment, the degree of brain degeneration, behavioral and mental states (e.g., presence of delusions or depression), and the condition of the patient’s caregivers.

• Targeted Physical Examination: Includes neurological and cardiovascular assessments to check for conditions such as stroke, high blood pressure, or silent atrial fibrillation.
• Mental and Psychological Assessment: Patients undergo cognitive tests to evaluate their cognitive abilities.
• Laboratory Tests and Imaging: Blood tests, brain MRI, or PET scans are used to diagnose and assess the severity of the condition.

Treatment Methods:

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.

Relief Strategies

To slow the progression of brain degeneration, it is essential to keep the brain active through frequent use and thinking, in addition to ensuring adequate intake of vitamins B12, C, and E. A deficiency in vitamin B12 may contribute to brain degeneration, while vitamins C and E, with their antioxidant properties, can protect nerve cells and benefit blood vessels. Numerous studies abroad have shown that older adults who follow a Mediterranean diet—rich in fish, vegetables, low in meat, and using olive oil—may reduce the risk of developing brain degeneration.

Cognitive impairment disorder is a degenerative disease, with the risk increasing with age. However, this does not mean it cannot be prevented or delayed. Numerous studies show that improving lifestyle, managing chronic conditions, and maintaining mental health can help reduce the likelihood of developing the disease.

Continuous Learning and Brain Stimulation

The brain, like a muscle, needs regular exercise to stay active. Continuous brain stimulation can help delay cognitive decline:

• Develop habits like reading, writing, learning a new language, or playing a musical instrument: Acquiring new skills strengthens connections between neurons, maintaining brain flexibility.
• Engage in activities requiring thinking or strategy: Games like mahjong, Go, or Sudoku, which involve logic or memory, help enhance focus and logical thinking.
• Try new things: Whether it’s traveling, tasting new foods, taking different routes, or joining new hobby classes, these activities stimulate the brain to form new connections and response pathways.

Continuous learning and exploration can effectively delay brain degeneration, reduce the risk of cognitive impairment disorder, and are key steps in maintaining healthy cognitive function.

Maintaining Social Connections

Social interaction not only supports emotional health but also has a positive impact on preventing cognitive impairment disorder.

• Stay connected with family and friends to avoid social isolation: Regular communication with loved ones stimulates language and memory skills, reducing feelings of loneliness.
• Participate in community activities, interest groups, or senior centers: These activities enhance life satisfaction and keep older adults active.
• Maintaining social interactions can lower depression risk and slow brain degeneration: Studies show that socially active individuals experience slower cognitive decline and exhibit fewer symptoms of depression and anxiety.

Maintaining stable social relationships is an essential component of preserving mental health and brain vitality.

Regular Exercise

Exercise plays a crucial role in maintaining brain health.

• Engage in moderate-intensity exercise at least three times a week (e.g., walking, tai chi, swimming): Regular aerobic exercise improves cardiovascular function, which is particularly beneficial for older adults.
• Exercise promotes blood circulation and enhances oxygen supply to the brain: Increased oxygen and nutrients support the activity and function of nerve cells.
• Research shows that exercise reduces the incidence of brain degeneration: Medical studies indicate a clear link between regular exercise and a lower risk of cognitive impairment.

Regardless of age, adopting a habit of regular exercise has a positive impact on delaying brain degeneration.

Managing "Three Highs" and Chronic Diseases

Poorly managed chronic diseases significantly increase the risk of developing cognitive impairment disorder.

• Properly manage high blood pressure, high blood sugar, and high cholesterol: Uncontrolled conditions can impair vascular health, leading to reduced blood flow to the brain and accelerating neurodegeneration.
• Patients with diabetes and cardiovascular diseases should attend regular follow-ups: Controlling conditions through medication and lifestyle changes can prevent complications and long-term brain damage.
• Maintaining overall health slows brain function decline: A healthy body is a key factor in delaying cognitive decline.

Actively managing chronic diseases not only supports physical health but also protects brain function.

Healthy Diet

A balanced diet is crucial for brain health, and the following dietary habits can help prevent cognitive impairment disorder:

• Adopt a Mediterranean diet or a high-fiber, low-sugar balanced meal plan: Research indicates that the Mediterranean diet can reduce the risk of brain degenerative diseases like Alzheimer’s.
• Consume more dark-colored vegetables, whole grains, deep-sea fish, olive oil, and nuts: These foods are rich in antioxidants, Omega-3 fatty acids, and vitamins, which help protect brain cells.
• Avoid excessive red meat, processed foods, and trans fats: These high-fat, high-salt foods accelerate aging and pose threats to vascular and brain health.

Improving dietary habits not only benefits cardiovascular health but also helps delay brain degeneration.

Good Sleep and Emotional Management

Maintaining stable emotions and adequate sleep helps protect brain health and prevent cognitive impairment disorder.

• Recommended sleep of 7 to 8 hours per night: Deep sleep aids the brain in clearing metabolic waste, reducing the accumulation of β-amyloid proteins associated with Alzheimer’s disease.
• Prevent and address depression and anxiety, seeking professional support if needed: Prolonged low mood and excessive stress can impair brain function, increasing the risk of cognitive impairment.
• Establish regular routines and relaxation techniques: Practices such as deep breathing, meditation, or listening to soft music can relax the nervous system, improve sleep quality, and benefit cognitive health.

If you or a family member experience memory decline, reduced judgment, or abnormal behavior, consult a doctor promptly for cognitive assessment and early intervention. Even if prevention is not entirely possible, early management can significantly improve the quality of life for patients and caregivers.

Establishing a Consistent Daily Routine

Maintaining a consistent daily routine is especially important for individuals with dementia. Performing activities such as eating, sleeping, and bathing at the same time each day helps foster a sense of familiarity and security. Encouraging patients to stay in familiar environments and avoiding frequent relocations or sudden changes can reduce feelings of anxiety and confusion. Additionally, using calendars, reminder cards, or visual cues can help patients remember schedules, locations, and daily tasks, thereby enhancing their independence and quality of life.

Maintaining Effective Communication and Emotional Support

When communicating with individuals with dementia, it’s essential to use simple and clear language. Avoid long or ambiguous explanations, as straightforward communication helps patients better understand and respond. A warm smile and eye contact not only convey care and support but also enhance their sense of safety and trust.

If the patient exhibits repetitive questioning or delusional thinking, caregivers should remain calm and respond with patience. It’s best to avoid arguing or directly contradicting the person, as doing so can trigger emotional distress. Instead, fostering a calm and reassuring environment is key to more effective communication.

Managing Behavioral Changes in Patients

When individuals with dementia exhibit behavioral changes such as wandering, hoarding, or mood swings, caregivers should first try to identify potential underlying causes—such as hunger, physical discomfort, or emotional anxiety. Redirecting the patient’s attention or offering safe alternative behaviors—like soft cushions, tactile toys, or simple activities—can help ease agitation and improve emotional stability.

It is also recommended that caregivers keep a regular log of these behaviors, including the time, setting, and reactions. This record can help healthcare professionals better understand the progression of the condition and adjust the care plan accordingly.

Self-Care for Caregivers Is Equally Important

Caring for someone with dementia is a long-term and demanding task, making self-care for caregivers equally essential. It’s important to actively seek help from family members to share caregiving responsibilities and avoid physical and emotional exhaustion. Caregivers should also schedule personal time for rest and engage in activities they enjoy to maintain mental health and life balance.

In addition, joining support groups or community networks provides not only practical caregiving tips and resources but also valuable emotional support and connection with others in similar situations.

What’s the Difference Between Dementia and Normal Age-Related Memory Loss?

Occasional forgetfulness is a normal part of aging, and individuals are often able to recall the information later or with the help of prompts. In contrast, dementia significantly interferes with daily life—for example, asking the same question repeatedly or forgetting familiar people or places.

Can Dementia Be Cured?

Currently, there is no cure for dementia. However, early diagnosis and timely intervention can help slow cognitive decline, improve quality of life, and reduce the burden on caregivers.

How to Care for a Dementia Patient After Returning Home

Once a person with dementia returns home, it’s important to provide a stable, safe, and familiar environment. Maintaining a consistent daily routine—such as fixed times for meals, sleep, and bathing—helps reinforce a sense of familiarity and structure. The home should be kept tidy and clutter-free to minimize the risk of falls.

Caregivers should monitor the patient’s health, ensure timely medication, and engage them in simple activities like walking or folding laundry to foster a sense of participation. When communicating, use short, clear sentences and offer plenty of patience and emotional reassurance.

If there are concerns about the patient wandering, consider using location-tracking devices or anti-wandering wristbands. Caregivers must also take regular breaks and tend to their own well-being to maintain physical and mental balance.

If a Family Member Has Dementia, Will I Inherit It Too?

Having a family history of dementia does increase your risk, but it does not mean you will definitely inherit the condition. Adopting a healthy lifestyle and managing your overall well-being can help reduce the likelihood of developing dementia.