The elderly ignore symptoms, ascribing them to ageing. However, we must understand that dementia is not a natural process of ageing.
MONICA FERNANDES
Egged on by a friend, I enrolled for a free online beginners course on Dementia run by the Wicking Dementia Research & Education Centre, Tasmania. Initially I baulked at the idea since I have not appeared for an exam for over forty years! But then, I thought, why not accept the challenge? The classes were truly an eye opener.
Dementia occurs among the elderly. It is a broad term to describe a loss of memory, intellect, rationality, social skills and normal emotional reactions. Alzheimer’s disease is the most common form accounting for 50% to 70% of all cases of dementia and is more prevalent among men. One rare form of Alzheimer’s disease that is hereditary is Familial Alzheimer’s disease (FAD). If a parent has a mutated gene that causes FAD, each child has a 50% chance of inheriting it. Alzheimer leads to neurons being destroyed and increasing prevalence of degenerative amyloid plaques or protein fragments called beta amyloid and tangles which are dead and dying nerve cells made of twisted strands of protein which destroy vital cells in the brain. Cell to cell signals at synapses are blocked.
With dementia, the frontal lobe and
the hippocampus get affected thus coming
in the way of memory, thinking, planning
and learning. As the disease progresses, the patient’s personality changes. Regrettably there is no known cure for dementia. But it can be controlled and even prevented with a combination of lifestyle choices and drugs. I was surprised to learn that lifestyle changes are advocated to those in their twenties. Realistically this does not happen as youth are more concerned in living for the moment. Enjoy now instead of bothering what will happen 30 years from now. The elderly ignore symptoms, ascribing them to ageing. However, we must understand that dementia is not a natural process of ageing. Prof. Carol Brayne estimates that approximately 40–50% cases are preventable. If both parents suffered from dementia, there is a higher risk for the child.
Some of the signals of dementia are repeating questions, misplacing items and being unable to find them ever – sometimes accusing others of stealing, decreased judgment, withdrawal from work and society, having issues with solving problems, forgetting a familiar recipe, difficulty in completing regular tasks, confusion with time or place, trouble
in understanding visual images, personality changes.
There are three stages of prevention/ treatment—primary before the onslaught of dementia, secondary which consists of early detection and enhancing quality of life. Tertiary treatment includes interventions of medication and palliative care. Prof. Michael Valenzuela spoke of a cognitive lifestyle and inculcating healthy habits. A multivariate approach to risk reduction is recommended as enumerated here:
• It was observed that those with a college education have a better chance of reducing the risk of cognitive decline in later years than those without. This is because more neural pathways are used. The type of job one does is also important. Does it involve managing others or making decisions? Does it involve problem solving and out-of-the- box thinking? Post retirement pursuits such as contacting and meeting others by doing volunteer work, joining a club, or going to the church or temple and building larger social networks have better cognitive resilience. It’s fun to broaden our horizons by learning a new skill as this involves exercising another part of the brain than hitherto used.
• While solving crossword and other puzzles do help, a better exercise is learning a new language with different rules of grammar. It is also suggested that the puzzles we attempt should gradually increase in difficulty. Computerised brain training was conducted for patients with dementia. It was found that an increase in the level of difficulty of the same exercises increased connectivity between the hippocampus (memory centre) and frontal lobe (planning and problem solving).
• Cardiovascular diseases brought about by smoking, excessive alcohol, diabetes, heart ailments, repeated strokes restrict the blood flow to the brain thus leading to dementia. Prescribed medication such as blood thinners helps to control some illnesses. It was suggested to avoid red meats and follow a Mediterranean diet rich in nuts, whole grains, fruits, vegetables, fish and olive oil.
• Use of drugs like cocaine affect general health and could increase dementia.
• Physical activity improves cognitive ability. Aerobic activity lead to increased heartbeats as our breathing becomes more rapid. Hence we should not saunter but walk reasonably fast, even for 10 minutes, take a break and then continue. Group dancing or ballroom dancing is also suggested as this involves learning steps and social contact with other dancers. It is suggested that we combine aerobic and weight/strength training.
• Repeated brain injuries such as in boxing could result in ‘dementia pugilistica’ due to a series of high impact concussions.
• Depression in late and mid life could cause vascular dementia and increase the risk of Alzheimer. Hence it is important to seek treatment and take the prescribed anti depressants.
• Good quality sleep is important for neurogenesis or growth of new brain cells
in the hippocampus. A new discovery shows that sleep clears the brain of various proteins and harmful toxins including beta amyloid. Sleep improves memory. Obstructive sleep apnea, where the brain is deprived of oxygen for a shortwhile is a risk factor
• We need to control our stress levels as stress releases cortisol. When an excess amount
of cortisol is in our brain, the function of the hippocampus is affected. As part of
our fight or flight response, blood glucose, which is a source of energy, is diverted
from the hippocampus to our muscles.
In addition, cortisol interferes with the neurotransmitters’ activities, which prevents normal memory function. Yoga, prayer, meditation are all ways to control stress.
• A study has suggested that the polluted air we breathe could also have an adverse effect on our brain.
• Researchers rely a lot on MRI scans of patients with Alzheimers. One such study unearthed a surprising fact. Some patients
with more brain damage (Group A) were able to function better than another group (Group B) with less brain damage. A study of their life history revealed that those in Group A had been more mentally active than those in Group B. Perhaps this resulted in Group A having a better cognitive resilience than Group B.
• It is interesting to know that a study was conducted among the West London Indian Asian population who had high risk factors such as diabetes, obesity, high BP and were in the age group of 40 to 70 years. Then the study expanded to those from 30 to 40 years. It was discovered that the participants
were following an unhealthy lifestyle by consuming a lot of fast foods, not exercising, having a diet full of oil, all of which promoted obesity, elevated cholesterol and cardio vascular illnesses. Around 200 younger people of 20 years were then taught how to avoid the pitfalls of an unhealthy lifestyle.
The elderly should not be isolated or made to feel a burden non-contributing member of society. They should be enveloped with love
in the family circle, as difficult as this may sometimes be. People suffering from Alzheimer sometimes get angry. This was beautifully portrayed in the movie The Notebook. It is not known whether this is due to changes in the brain or whether the person finds it a challenge to remember. Past memories are easier for
them to access than memories of something that occurs recently. A friend sent me this very touching video of a prima Russian ballerina. The psychologist showed her a clip of her during a performance of the Swan Lake in her hey days. Suddenly she was transported to happier times and though wheel chair bound, started doing graceful hand movements just like she did several years ago.
While early prevention is preferable, it is never too late to change our lifestyle patterns in order to live a fuller cognitive lifestyle, irrespective of our age. Why not opt for a better quality of life?
∎
