Care Guide: Understanding Dementia
Imagine your life at 60. You and your family deciding to eat out for dinner and you forgot where you placed your house keys. A few months later, it became forgetting what you read in the news that morning.
“I’m just forgetful lately.” You tell your family when they ask what’s wrong.
Frustration kicks in as you start struggling to remember what time it is, getting angry at yourself when you can’t remember recent events and lashing out at your loved ones who noticed a change in your behaviour. What was assumed to be simple forgetfulness turned into something bigger.
Can you imagine it? That’s what a person with dementia experiences every day.
In Singapore, approximately one in 10 people aged 60 may have dementia.
Do you have a loved one living with dementia?
So what is dementia?
Dementia is a chronic and progressive illness that affects the brain, caused by damaged to the brain and its cells, leading to progressive memory loss, decline in intellectual function and personality changes. The person’s impairment is severe enough to compromise a person’s day-to-day functioning and represents a decline from previous level of performance. Contrary to popular belief, dementia can happen to anyone but typically affects elderly aged 60 and above.
A common misconception that dementia is also known as Alzheimer’s disease. In fact, there are many different types of dementia. Alzheimer’s disease – the progressive brain degenerative disease – is the most common type, accounting for 50%-70% of all dementia cases. It is associated with accumulation of brain deposits, destroyed nerve cells of the brain and shrinkage of the brain.
Another type of dementia is Vascular dementia, caused by conditions that block or reduce blood flow to the brain, resulting in brain cells being deprived of vital oxygen and nutrients. It can occur after multiple small strokes or major strokes, with varying symptoms depending on the severity of blood vessel damage and which part of the brain is affected. Health conditions that affect blood circulation may play a part in vascular dementia, which include high blood pressure, diabetes, high cholesterol and heart problems.
There is no cure for dementia. However, there are current treatment to manage behaviour symptoms and delay the progressive of the disease.
The different stages of dementia
There are 3 stages for the progression of dementia. Your loved one may exhibit different behavioural changes as they progress from mild dementia to severe dementia.
- Mild stage: Your loved one may need assistance in their instrumental activities of daily living such as managing finances, paying bills, marketing, operating complex appliances. They may lose track of time and events as well.
- Moderate stage: Your loved one may need the assistance of daily living such as personal hygiene and grooming, toileting, and showering. Sometimes they may experience certain behaviours such as withdrawn, irritability, agitation, wandering and getting lost.
- Severe stage: Your loved one may be totally dependent on you to provide personal care such as showering, toileting and eating. They may be talking lesser and eventually lead to mutism.
How is dementia diagnosed?
You may be noticing your loved ones becoming forgetful, misplacing things and getting lost in familiar environments for example. This may be a sign to get an evaluation for your loved one. Accurate diagnosis for dementia is important as there are some factors such as depression, hypothyroidism and vitamin deficiencies which may exhibit similar symptoms of dementia. Diagnosis is made by a process of comprehensive assessment and to eliminate any reversible conditions. This includes:
- A case history analysis and history taking verified by a family member. This allows the professional to distinguish the significant changes in your loved one’s functioning levels.
- A basic blood test to rule out any treatable medical conditions such as thyroid problems and vitamin deficiencies
- Brain imaging such as CT and MRI scans to determine the structural pattern of brain shrinkage and if there is any signs of associated with stroke diseases.
- Cognitive tests such as Mini-Mental State Examination (MMSE) and Abbreviated Mental Test (AMT). These tests the memory, attention span and concentration, aimed to determine the severity of memory and cognitive deficits. Your physician may refer your loved one for neuropsychological assessment which provides details, standardised assessment across a wide range of cognitive domains in the brain.
- A complete physical examination and psychiatric evaluation to rule out any possible signs of stroke and treatable depression and other mental health disorders.
Early detection and diagnosis enables you to better manage the functional decline due to dementia and its consequences. You would also have a better understanding of the changes in behaviour such as agitation and withdrawal, allowing you to respond appropriately. Finally, you and your family would be able to plan ahead for the future; including your finances, future health choices and medical care.
What can you do next?
Caring for your loved one living with dementia may seem daunting at first, and you want to make decisions in their best interest such as being treated at home or place them in a nursing home. Though the decision is yours, make sure you have consider the various options available out there.
Client Profile: Home Personal Care Client with Dementia
Mr Tan*, age 73*, has been an NTUC Health Home Care client for 3+ years. He suffers from late stage dementia and has difficulty talking, standing and swallowing. He lives in a landed property in Kranji with his wife, son and daughter and domestic helper. Our Care Associate, Ruben, visits him twice a week for 3 hours:
- Companionship: Ruben keeps Mr Tan company from 8-11am twice a week. Ruben will play classical music and do colouring exercises
- Cognitive Exercises: Ruben will also stimulate his memory with stories from the past
- Showering: Ruben helps to shower Mr Tan and change his diapers
- Physical Exercises: Before, Ruben would take Mr Tan to walk in the neighbourhood. But now with limited range of motion, they do simple stretches at home
Client Profile: Home Physiotherapy Client with Dementia
Mrs Lai*, age 76*, suffers from dementia. Dementia clients have inertia to move, so our physiotherapist Christina had to educate her and her family on how to move and how to develop a routine. Mrs Lai has been seeing Christina twice a week for 4-5 months. When Christina first saw her, she would only shower once a month. After therapy, she would shower every other day.
- Day Rehabilitation: Mrs Lai was initially referred to Day Rehab but staff had significant issues getting her to participate. She was then referred to Home Therapy
- Functional Exercises: Dementia clients are not able to focus on typical strength training exercises, so Christina uses functional exercises (e.g. walking down corridor or up and down stairs)
- Exercise via Games: Christina plays card games with her (e.g. Snap) and gets her to stand up and play for as long as she can, to improve balance and standing tolerance.
- Cognitive Therapy: Christina asks Mrs Lai to write down “promises” to herself in her diary (e.g. to shower every other day). Mrs Lai can recognise her own handwriting helps with forgetfulness from dementia .
*Client profiles are based on actual NTUC Health clients. However, all personal data have been disguised for confidentiality reasons.
NTUC Health Services for Dementia
You may visit the NTUC Health website to find out more information on our services. Services such as home personal care services and senior day care centres are some options that provide care for people living with dementia.