Dementia

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 dementia patients 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 who 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 medication, 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 dementias. 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 sudden weight loss.

	Proportion	Cause
Alzheimer’s Disease	Approximately 70% of all cases	The disease develops in the patient’s brain cells and plaques form, disrupting communication between brain cells and affecting the brain’s ability to receive external information. Patients gradually lose certain cognitive and mobility skills.
Vascular Dementia	Approximately 20% of all cases	Caused by stroke or chronic cerebral embolism, which damages the brain and leads to brain degeneration.
Other Dementias	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?

As dementia is not a specific disease but describes a variety of symptoms, diagnosis is determined through cognitive assessment. The assessment is roughly divided into four parts: (1) a review of medical history; (2) a targeted physical examination; (3) mental and psychiatric assessments; and (4) laboratory tests or scans; and 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 hidden 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

While there is currently no cure for dementia, early intervention and treatment can help manage or improve symptoms. Depending on the patient’s condition, doctors may recommend treatment through medication and/or non-pharmacological approaches.

Medication

Two commonly used medications include cholinesterase inhibitors and memantine. The former is used to improve a patient’s memory and cognitive abilities, 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 mental condition, doctors may also prescribe various additional 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 cognitive function 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 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.

A 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.

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