TAKING ON DEMENTIA

STORY / DR PETER LAVELLE

One in five people are expected to have some form of dementia by the time they are 80. So how can you avoid being one of the five? And if you are affected by dementia, how can you slow down the progress of the disease?

Most of us know someone who has dementia. It is a major cause of illness and disability, especially in older age groups, and despite billions of dollars being spent worldwide on dementia research, we have no real clue as to what causes it or how to treat it. At least not yet.

There are several different types of dementia. Alzheimer’s disease is the most common. They all involve destruction of brain cells, by an unknown process, and they all run a similar course. Memory loss is the earliest feature. This includes short term memory loss that gradually worsens, along with trouble in holding a conversation, and trouble planning ahead. The affected person gradually undergoes personality and behaviour changes, that can often be distressing for family and friends. The person becomes less able to undertake normal daily activities and tasks, until they cannot look after themselves and need full time, and eventually terminal care.

How quickly these changes happen varies from person to person. The average life expectancy for someone with Alzheimer’s disease is about eight to 10 years from the time they are diagnosed. But some people will live with Alzheimer’s for longer than 20 years.

Dementia is more common among older people, usually begins after age 60, and gets more frequent with advancing age. In Australia, about one person in five over the age of 80 will have dementia.

It sometimes runs in families, though most people who develop dementia do not have a family history of it. People with high blood pressure, high cholesterol or diabetes that is not well managed also have an increased risk of it.

So how can doctors tell if someone has dementia and not something else? Patients may be tested for thinking, concentration and memory to show if their mental abilities are becoming impaired. A brain scan may also show the brain is a little abnormally shrunken, and there can be some degenerative changes in areas of brain tissue.

But not everyone with dementia shows these changes so brain scans are not a sure way of diagnosing the condition. Only when the battery of blood tests and scans fail to uncover any obvious cause, do doctors diagnose dementia.

Managing a person with dementia

Unfortunately, there is currently no effective treatment for dementia. Yes, there are some drugs on the market that doctors sometimes prescribe for Alzheimer’s disease. They are called cholinesterase inhibitors and they are available at subsidised prices on the Pharmaceutical Benefits Schedule. But at best they slow the progress of the disease by a few months, and they may have side effects such as dizziness. These drugs have no effect on the progress of the underlying disease and their effect is variable. They work on some people but not on others.

What this means, is that management of a person with dementia really comes down to supporting the person to remain independent, with a good quality of life, for as long as possible. The good news here is that they can keep enjoying many of the good things in life, provided they have support, including the company of family and friends, and many of their usual pastimes and interests. And they may remain surprisingly upbeat and positive, despite periods of frustration and anxiety over the difficulties they face. For family, carers and friends, there are a host of issues to be dealt with.

Legal and social issues

Just some of the social issues include finding where the affected person can live. Will they continue to live in their own home, and for how long? When it becomes advanced, what kind of additional help will they need? Home nursing, respite care, meals on wheels, and other community support programs may need to be arranged. Finally, aged care accommodation will be needed, although some can remain at home with nursing help until the end.

There are also legal issues to be addressed. Someone needs to be assigned their power of attorney to look after their financial affairs, and legal guardianship, to be responsible for their medical treatment and make important life and death decisions when necessary. There should also be an end-of-life care plan, so that medical staff know what measures to take when that person is in their final stages of life.

Support organisations such as Alzheimer’s Australia offer invaluable help through support groups, telephone and face-to-face counselling, training courses, help sheets, videos and other information. The Dementia Helpline is great resource and they may be contacted at: 1800 100 500.

Prevention

Now we come to some good news. While there is no actual cure, in many people dementia can actually be prevented, slowed, and/or delayed. A study published in July this year in the prestigious Lancet Journal showed that about a third of cases of dementia can be prevented altogether by following some basic measures. Even in people who have dementia, its progress can be slowed and mitigated by these measures.

So what are they? One important measure is to keep mentally active. Any hobby or activity where you are forced to think such as: playing board games, playing music, reading, going to the theatre or to see a film.

Gardening is also good for prevention because of the planning and thinking it takes. Social and group activities also rate highly (because of the mental activity involved in conversation). These activities keep brain nerve pathways strong and connected.

Regular exercise is another very important measure. Experts recommend at least half an hour, three times a week, of running, swimming, biking or brisk walking. Any smoking should be stopped.

A good diet is also important. People who eat the so-called ‘Mediterranean Diet’ for example, containing plenty of fruit and vegetables, bread and pasta, fish, olive oil and a little red wine, but low in dairy products and red meat, have a lower risk of dementia. People with other medical conditions, especially high blood pressure, high cholesterol or diabetes, also need to have these conditions treated effectively.

On a positive note, due to an increase in better lifestyle measures in the general community, the incidence of dementia is actually falling. So while people are getting older, proportionately fewer of them are getting dementia.

With the billions of dollars spent every year worldwide on dementia research, it is only a matter of time before more effective treatments are developed, and finally a cure. That time may be closer than we think.