Dementia: Timely Assessment and Early Intervention

Dr. LEUNG Man Fuk, Edward

Director, Geriatric Medicine (Healthy Ageing)

Honorary Consultant in Geriatric Medicine

Specialist in Geriatric Medicine

The incidence of dementia increases with age. With the growing aging population, it is projected to rise markedly in future. According to a recent study of the Department of Health and the Census and Statistics Department, the total number of dementia patients could rise from 100,000 in 2009 to 330,000 in 2039. 

Causes of Dementia

The causes of dementia are myriad, with Alzheimer's disease (about 60%) and blood vessel blockage (about 35%) being the two most common ones.

Other medical causes are:

- Brain tumour

- Hydrocephalus

- Encephalitis

- Subdural haematoma

- Brain infections

- Hypothyroidism

- Vitamin B12 insufficiency

Stages of Dementia

There are three stages for dementia, i.e. the early, intermediate and late stages, each of which is presented with different symptoms:

1. Early Stage

Memory loss, especially short-term forgetfulness, is the earliest symptom in this stage. Such lapses may occur quite often and can seriously affect daily lives, e.g. repeated purchase of the same thing, difficulty thinking of common words while speaking and wrong decision-making. 

2. Intermediate Stage

The symptoms in the early stage could become more noted during the intermediate stage, especially memory loss. Patients may often forget the names of friends, fail to recognise relatives as and repeat certain acts, such as calling children by phone. 

Other issues include getting lost easily even in familiar places, problems with other day-to-day activities, such as banking matters, changing money and shopping, as well as increased difficulty in speech and communication. Increased irritability and mood changes are also common.  

3. Late Stage

With long-term memory intact but most of their short-term memory lost, late-stage patients tend to keep talking about their past.

Due to problems with self-care and incontinence, they may also become dependent on others in daily activities.

Some patients may suffer day and night reversals and get lost easily, while others may experience behavioural problems and bad tempers, even hallucination and mental confusion. Walking difficulty due to long-time confinement to chair or bed, swallowing problems or refusal to eat are noted in severe cases.

With myriad causes and clear symptoms, dementia can cause a direct and adverse impact on the daily lives of patients. Family members and carers are advised to keep a close watch on the elderly for any changes in lifestyles, and seek immediate, proper medical attention before too late. 

Diagnosis

Dementia may not be necessarily caused by brain degeneration. About 5% of cases can be attributed to treatable conditions such as hydrocephalus, hypothyroidism, vitamin B12 insufficiency, encephalitis, etc., and are reversible following timely and proper treatment.

Treatment

The mainstay of treatment for dementia includes:

- Medications or behavioural therapy

- Enhancing phsycial well-being

- Exercises

- Social activites

- Ensuring patient safety

- Long-term care plan, including arrangement of enduring power of attorney and advance directive

Approved by the U.S. this year, a medication against Alzheimer’s disease shows good promise in treating early-stage dementia. It is expected to put into clinical treatment in Hong Kong following approval in other European countries, offering hopes to dementia patients and their family members.