DEMENTIA Due Care Needed For Senior Citizens' Mental Health

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July 04, 2006 09:45 AM

Due Care Needed For Senior Citizens' Mental Health

http://www.bernama.com.my/bernama/v3/news.php?id=206405

By Melati Mohd Ariff

KUALA LUMPUR, July 4 (Bernama) -- Hamimah Bee Abdul Kadeer is 70

years old, in good health but taken to see a doctor for memory

lapses.

For about a year now, she has had trouble shopping for groceries

like forgetting to buy certain things and her problems extends to

the kitchen.

Either she puts too much salt or none at all, and at times forgets

to switch off the stove after use. She forgets where she had placed

her stuff and sometimes cannot even recognise those who visit her

including her own grandchildren.

The situation gets worse. When Hamimah cannot find her personal

things, she accuses her daughter of taking them. She also claims

that her daughter has not been feeding her well and accuses her of

being after her wealth and wanting her to die soon.

Hamimah often becomes restless and leaves the house looking for her

husband who had died a long time ago. She also has trouble sleeping.

Sound familiar? What Hamimah is suffering may well be happening to

your mother or grandmother.

SENILITY OR DEMENTIA

Senility or dementia involves memory disorders with accompanying

behavioural deterioration, and this problem is common among the

elderly.

Dementia originates from the Latin word " de " which means " apart "

or " away " and " mens " , " the mind " .

According to Dr Norazam Harun, consultant psychiatrist at Hospital

Permai in Johor Baharu, dementia is a disease closely related to age

and is permanent in nature. It occurs gradually and will change a

person's personality and behaviour.

There are several features of dementia.

These include the difficulty to remember, to make out phrases or

normal spoken words (aphasia), to recognise things that were known

before (agnosia) such as faces or items, and to perform movements

which involve small muscles (apraxia) like buttoning up a shirt.

As a result, those afflicted with dementia lose their ability to

plan, arrange, count and concentrate and are unable to perform tasks

which they easily did before.

" In the many cases I've seen, the patients don't even know they have

dementia. Only the people around them would know, " said Dr Norazam.

" In early stage dementia, the difficulty to remember a new thing

learnt may be an early symptom. Nevertheless, dementia is not part

of the ageing process. "

IMPACT OF INCREASING NUMBER OF DEMENTIA SUFFERERS

Dr Norazam said more focus was being given now on dementia worldwide

as the number of senior citizens increased.

" About 10 per cent of the world's population are those aged 65 and

above. In 2002, there were 635 million people in this category

worldwide and most of them were in developing nations.

" Japan has five million senior citizens, China 30 million and the

United States 34 million. These numbers are expected to increase to

30 per cent come 2050.

" In Malaysia, the number of senior citizens aged 60 years and above

is expected to jump from 1.047 million in 1990 to 3.26 million in

2020, " he said.

Increase in the number of the silver-haired population will

eventually see a rise in the number of dementia sufferers.

But the cost of caring for the elderly with dementia cannot be

measured merely in monetary terms as there are other impacts,

especially on health, physical and emotional well-being.

" The emotional and physical stress on the family, caregivers and

friends of the dementia sufferers must also be considered, " said Dr

Norazam.

He said a study conducted on dementia sufferers and their

caregivers, showed that a substantial number of dementia patients

were being cared for by their spouses (about 50 per cent).

" There was a case of a wife with dementia being cared by her very

sick husband who himself suffered from memory problem. The children

just didn't care, maybe they were too busy with their own life, " he

added.

CAUSE OF DEMENTIA

Normally people with dementia only remember events that happened

long ago. They can give a vivid account of what happened to them

many years back but have problems remembering recent things they did

or experienced.

" They can recall stories about the Japanese Occupation or

independence day, for example. But if we ask them whether they've

eaten or not, they'll say no although they've already had, " said Dr

Norazam.

This relates to the theory on memory.

He explained: " When a person learns a new thing, this will be

registered in the part of the brain called Hippocampus and when it

has been registered, the part of the brain or nerve involved will

form a template or mould.

" That template will be stored in the Hippocampus and the person will

remember it when required.

" But people with dementia are not able to make new templates and

what they have are only old ones. That is the reason why they can

only remember past events. "

He said people with dementia could not make new templates as the

number of brain nerves had atrophied.

The brain of an adult is as big as a medium-sized cabbage, weighing

five to six kilogrammes.

On average, a brain has 100 billion nerves (neurons) and 100

trillion joints (synapses) between the nerves.

Studies on people with dementia show that their brains shrink in

size as nerve endings atrophy (die). Dementia is due to the loss and

reduction of synapses in the brain that leads to the death of brain

nerve cells.

" That's why the person can only recall past events but find it hard

to remember recent happenings, " he said.

TYPES OF DEMENTIA

There are two types of dementia -- degenerative (primary) and

secondary.

Generative dementia is further divided into five conditions --

Alzheimer, the vascular type (after a stroke), " Lewy Body " (such as

Parkinson's), " Frontotemporal (glaring personality changes like

difficulty in controlling emotions) and " Creutzfeld- " (due to

bacterial infections like the mad cow disease).

For the secondary category, it is caused by other medical problems

such as brain tumor, meningitis, deficiency of thyroid hormones and

vitamin B12, and chronic kidney disease that requires dialysis.

For this type, the memory can be recalled if the cause is properly

treated while for the generative type, the problem is permanent and

it occurs gradually.

" Therefore, prevention and early treatment is very crucial, " Dr

Norazam said.

Out of the five degenerative types, the most common is Alzheimer

which affects 50 per cent of dementia cases.

Alzheimer or AD in short, takes after the name of Dr Alois

Alzheimer, a German doctor who discovered this neurological disorder

in 1906 when he found pathological changes in the brain tissue of a

dead woman who suffered from dementia.

Alzheimer involves parts of the brain that control thought,

behaviour, memory and speech.

" Until today, scientists still cannot fully comprehend the cause of

AD and it still cannot be cured.

" Among the main factors for Alzheimer is age. The older the person

is, the higher the risk to get AD, " said Dr Norazam.

Another risk factor is family history. Scientists have discovered

that the genetic factor also has a role in most Alzheimer cases.

" In Malaysia, there is no particular race that is more prone to have

Alzheimer.

" However, in terms of gender, the percentage is higher among

females, " he said.

Why?

" Maybe because their life expectancy is longer than males, " he said.

Besides age, genetic and gender, other factors that contribute to

Alzheimer include smoking, hypertension, high cholesterol and

diabetes.

TREATMENT AND PREVENTION

There are several ways to treat dementia including medical treatment

and food supplements.

" We need to conduct a proper study before we can confirm the

ailment, " said the doctor. " There are people who become forgetful

due to other medical conditions such as deficiency in thyroid

hormones, infection in the brain or body, or excessive intake of

alcohol.

" Some people have memory problems due to anxiety and depression. So,

we need to have a complete study.

" For example, if we question a depressed person, he'll say he's

tired or is not interested to answer but if we ask a person with

dementia, he'll try to answer but the answer is incorrect. There are

many ways for a doctor to examine this such as by taking blood

sample and CT scan of the head. "

Dementia can be prevented, and what is important is to practise a

healthy lifestyle, according to Dr Norazam.

" Be active always and do physical exercise such as walking, jogging

and light movements. Mind exercise such as reading, memorising, for

example, dates, places and people around you, doing crossword

puzzles and keeping track of current developments will also help.

" At the same time, maintain your association and activities in the

community such as by being involved in non-governmental

organisations, and in spiritual and political activities. Continue

with your hobbies. For pensioners, get involve in beneficial

activities and don't just sit in the house. "

He also advised against smoking and consuming alcohol and to eat

well, besides taking less food which contain cholesterol.

He stressed on the need to control illnesses such as diabetes,

hypertension and asthma besides having regular health examinations.

" What's important is to seek treatment when memory diminishes. Don't

delay. There are medications for those who have been diagnosed with

dementia such as Rivastigmine, Donapezil, Galantamine and Memantine.

" The medical treatment is to delay the dementia process so that

sufferers and caregivers can lead quality life as long as possible

before death occurs. Treatment must be from a certified doctor as

medicines purchased from unknown sources can be harmful.

" Family members caring for people with dementia also need to get

counselling from doctors to safeguard their own health and that of

their loved ones, " said Dr Norazam.

-- BERNAMA