“Ask Dr. HKSH” – Dementia

Dr. LEUNG Man Fuk, Edward

Specialist in Geriatric Medicine

Q1. How can dementia be detected early?

Early detection of dementia begins with patients and their family members being aware of any recent changes in memory or thinking abilities. Common early signs include forgetting information that should normally be remembered, making repeated phone calls shortly after a previous conversation, or repeatedly asking the same questions or reminding others about the same matters. These are the common early symptoms. If such symptoms are noticed, medical advice should be sought as early as possible so that appropriate assessments and investigations can be arranged for diagnosis.

Q2. How is dementia diagnosed? Why are so many tests needed?

Dementia is a general term that encompasses a range of conditions, including Alzheimer’s disease, vascular dementia, etc. There are also some treatable conditions, such as hypothyroidism, vitamin B12 deficiency, brain tumours, and certain infectious diseases.

When early symptoms appear, it is important to seek medical attention and identify the underlying condition that is reversible. For example, symptoms caused by hypothyroidism or vitamin B12 deficiency may resolve with supplementation, and patients with a brain tumour may recover following appropriate management. It is also important to determine if the patient has Alzheimer’s disease or cerebrovascular diseases. Although these conditions may continue,  early diagnosis can contribute to timely treatment and help slow down the progression.

To establish a diagnosis, doctors will usually recommend a series of investigations for patients suspected with dementia, e.g. assessment of vitamin B12 levels and thyroid function. Brain imaging is also recommended, with MRI being one of the basic investigations. It can clearly identify brain tumours, hydrocephalus, or cerebrovascular diseases. If Alzheimer’s disease is suspected, blood tests are now available to detect related biomarkers in blood and determine the likelihood of Alzheimer’s disease.

Q3. What are the stages of dementia?

Dementia usually progresses in three stages: early, middle and late stages. In the early stage, patients often experience memory impairment, forgetfulness, or occasional difficulty in decision making. But they can still live independently, including getting out of bed, using the toilet, and managing their daily activities. They also retain a certain level of analytical ability. These are the typical features of early-stage dementia.

The middle stage is marked with a significant deterioration. Patients may have increasing difficulty making decisions and keep repeating certain behaviours. They are also more likely to become forgetful, get confused, and may even develop abnormal behaviours. These are common features of middle-stage dementia. Patients at this stage may require care and supervision from others and also assistance from a domestic helper.

In the late stage, or more severe stages, patients may require assistance with their daily living, including toileting. They may also experience difficulty eating. In more advanced cases, patients may lose appetite or develop swallowing difficulties. Mobility may become impaired as the disease progresses, resulting in prolonged sitting or bed confinement. In the most advanced stage, dementia may lead to death.

Q4. How is dementia treated?

As mentioned earlier, some conditions such as thyroid disorders, vitamin B12 deficiency, and certain infections, can be treated according to the underlying cause. The most common cause of dementia is Alzheimer’s disease. In the past, treatment for Alzheimer’s disease mainly focused on managing symptoms, with medications used to improve memory. In recent years, new treatments have been developed to target and remove abnormal proteins in the brain, thereby reducing the damage they cause to brain tissues. This represents a major breakthrough in treatment. Through an 18-month course of injections, these harmful substances in the brain can now be removed. Before treatment, patients will need to undergo appropriate assessments, including blood tests and brain examinations, to determine whether they are suitable for this new therapy.

Q5. How should caregivers communicate with a dementia patient in daily life?

Many people with dementia do not recognise that they have the condition. They may not realise that memory impairment is a symptom and may be unaware of their own difficulties. It is important to understand that their memory and cognitive abilities have declined. After diagnosis and assessment, doctors can help explain the condition to family members and encourage them to learn more about the patient’s symptoms.

Behavioural issues may also arise, e.g. the patient may repeatedly carry out the same action, and family members may mistakenly the patient for being uncooperative, which is often due to forgetfulness. A better understanding of the patient’s condition allows family members to empathise with the fact that he or she simply forgets what needs to be done, and can respond with patience, understanding and reassurance. This can help reduce conflict and alleviate emotional distress.

For more severe behavioural problems, medications may sometimes help stabilise the patient’s mood. About 10% to 15% of patients may develop behavioural disturbances. In some cases, sedative medications may be prescribed to help them restore emotional stability, and facilitate care by family members.

Q6. How can dementia be prevented?

Dementia includes Alzheimer’s disease, while another common type is vascular dementia. One of the key measures in preventing dementia is to reduce the risk of cardiovascular diseases, particularly the so-called “three highs”: high cholesterol, high blood glucose and high blood pressure. In fact, for individuals aged over 40, lowering cardiovascular risk factors can help reduce the likelihood of developing dementia later in life.