Most brain failures occur after 65: Expert
Published on: Tuesday, May 26, 2015
Kota Kinabalu: There are at least five types of dementia, and Alzheimer's disease (AD) is the most common, the others being vascular type, mixed type, Parkinson's dementia and lewy body dementia.Dementia is a chronic disorder of the mental processes caused by brain disease or injury and marked by memory loss or decline in other thinking skills, personality changes and impaired reasoning.Jesselton Medical Centre (JMC) Physician & Geriatrician, Dr Richard Ng said Saturday, approximately five per cent of the Malaysian population above the age of 65 suffer from AD, and likewise, about 20 per cent of the population above 85.ADVERTISEMENT "This is the prevalence rate in Malaysia. Alzheimer's disease is neurodegeneration. It is a progressive disease that destroys memory and other important mental functions."As you grow older, your brain shrinks. Normal brain shrinkage is even but for some reason, the shrinkage is uneven in some people. Some areas shrink more than the rest. When the particular area shrinks more than the rest, you get disease, depending on which area shrinks."If some area shrinks more, you get Parkinson's. If some area shrinks more, you get Alzheimer's. If some area shrinks more, you get fronto-temporal syndrome (a rare disorder related to Alzheimer's disease)," he told reporters after presenting a talk on Brain Failure and Behaviour at the JMC.The talk was organised by the Sabah Alzheimer's Disease Support Association headed by Dr Chris Chong as President. Also present were the Vice-President, Datuk Zahra Ismail and Secretary, Kent Chau.ADVERTISEMENT In his presentation, Dr Ng defined brain failure as intellectual impairment (impaired cognition) caused by disease of the brain. This, he said, is marked by impaired judgement, reasoning, task execution, planning, calculation, memory, orientation, attention and behaviour. Disorientation to person (not recognising close family members) is an indicator of brain failure."Basically, patients with brain failure don't do what they can't do, and do wrong what they can do. The behavioural disturbances in such patients are infinitely complex.
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"They can best be helped by attempting to understand why they behave the way they do," he said.Explaining dementia staging, the geriatrician said it begins with mild cognitive impairment (MCI) characterised by short term memory (STM) impairment but no functional decline."It progresses to early dementia (STM impairment with decline in function, especially executive function) and then to moderate dementia (STM impairment with an element of being disoriented) where the patient begins to need assistance."The next stage is moderately severe dementia (marked by behavioural and psychological symptoms of dementia or BPSD), followed by severe or advanced dementia," he said.According to Dr Ng, 80pc of dementia patients will develop at least one distressing behavioural symptom over the course of their illness. "For instance in STM impairment, one might keep on asking the same question, no matter how often it was answered. There was a patient who was in the habit of phoning her daughter every few minutes to ask her to come back and help her find her missing handbag. The daughter would come home and locate the item but 10 minutes later, she would receive another call again from her mother about the same thing," he related.On another behavioural symptom of dementia, he said it is disorientation to place. "In one particular case, a family member could no longer deal with her mother's night time behaviour. Every night, her mother will be wide awake, talking very loudly, looks for a hammer and attempts to break out of the house, saying that she wants to go home."Sharing a personal experience, Dr Ng recounted how his grandmother from Penang came over to stay with his family in Sandakan for a month because her daughter (in Penang) needed a break from taking care of the old lady. "However, while in Sandakan, my grandmother thought she was still in Penang and kept saying she wanted to go back to her house (saying it was not far away) despite us repeatedly telling her otherwise. On one occasion, she even called the taxi to take her to her house in Penang. This is what we mean by disorientation to place."Disorientation to time is yet another example of behavioural symptom of dementia, Dr Ng said, whereby a person believes himself or herself to be the person he or she was 30, 40 or 50 years ago. "He or she may wake up in the morning 'to send the child to school' when there is no child to be sent. In one instance, an elderly man believed that he had to get up early to open his shop which had actually been closed for the past 20 years. This is what happens as memory regresses," he said, adding that other symptoms include aggression, perception, sleep disturbances, speech/language impairment, and thought dissociation (that is, inability to link an event and the consequence).Sleep disturbances can lead to anxiety, depression and irritability, according to Dr Ng.Touching on depression as a behavioural symptom of dementia, the geriatrician said this condition is manifested by lack of interest, proneness to irritability, hostility and aggressive behaviour. "Other indications are verbal outburst, physical aggression, resistance to bathing or other needs, as well as restlessness."Paranoid delusion, another common symptom of dementia, is a very strong fixed false belief "where the patient believes that the new maid was hired to kill her at night or the patient always accuses the new maid of stealing or the patient is very suspicious of her neighbour."On how caregivers should handle patients with brain failure, Dr Ng said the former would expect illogical behaviour. "Go along with the patient by adjusting your response according to the patient's perception. Try to be objective and detach yourself emotionally."Calling on caregivers to apply the practice of reality orientation, he said this principle teaches that patients with an abnormal concept of reality should have their misconceptions corrected and not reinforced, adding "Reality orientation aims to keep patients functioning in the real world."Offering tips to carers of demented patients, the geriatrician said there are 4 Don'ts – Don't restrict the movement of the patient, Don't cause conflict with the patient, Don't convict the patient and last but not least, Don't evict the patient."Sending your mother or father to the nursing home is not encouraged. This is the last thing you should do as a son or daughter," he advised.Dr Ng recommended establishing a daily routine for the benefit of both caregiver and patient."At 8am, make sure that the demented patient has breakfast with the family. Two hours later, the carer (son or daughter) comes home with a newspaper. Then have a simple lunch with the patient at 12 noon.Stay up-to-date by following Daily Express’s Telegram channel.
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"By 5pm, it is time for an evening walk, followed by family dinner at 7pm. By the next hour, it is ideal for family members to gather around the living-room for a get-together," he suggested.The geriatrician also suggested five other types of therapy that can be applied to help those suffering from dementia – music therapy, pet therapy, massage therapy, reminiscence therapy and aromatherapy.