Have you had the experience of forgetting the name of a person you should know? I have, and it is quite embarrassing.  More than that it is worrying.  The question on your mind would be, ‘am I getting dementia?’  The world population is aging, and as the greatest risk factor for dementia is age, the [...]

The Sunday Times Sri Lanka

Forgetting – A sign of Dementia?


Have you had the experience of forgetting the name of a person you should know? I have, and it is quite embarrassing.  More than that it is worrying.  The question on your mind would be, ‘am I getting dementia?’  The world population is aging, and as the greatest risk factor for dementia is age, the proportion of people with dementia too is growing.

Dementia is not a specific disease but a catchall term for a number of diseases with a common set of symptoms.  The most important is a decline in memory. The other symptoms are, an impairment of other higher brain skills such as communication, reasoning, judgment and social behaviour, sufficient to cause impairment of every day activities.

The commonest cause of dementia is Alzheimer’s disease. It accounts for nearly 80 percent of dementias.  It is a chronic degenerative brain condition described more than a century ago by the German neurologist Alois Alzheimer.  The next commonest is vascular dementia. This is caused by blockage of the small blood vessels supplying parts of the brain that control higher functions called the cortex. Persons with high blood pressure, diabetes and high lipid levels are at higher risk of developing this type of dementia.

The other causes of dementia are rare and I will not discuss them here.

Can dementia be treated? Yes and no. Controlling your blood pressure, sugar and lipid levels can reduce the effect of vascular dementia. There is no treatment for Alzheimer’s dementia yet, however the progress can be slowed by some medicines, but for best effect they have to be started early.

Can Alzheimer’s dementia be diagnosed early? At present there are no definitive tests but there are indicators, which might help.  One such indicator is mild cognitive impairment (MCI).  Typically in MCI there is difficulty in remembering the names of people met recently, a tendency to misplace things and trouble following a conversation. These symptoms are less severe than with Alzheimer’s dementia.  If you think you have such problems consult your doctor who should direct you to formal testing.  These tests include a battery of pen and paper tests, which evaluate different aspects of your brain functions. A few of these tests have been validated for Sri Lanka and are available in Sinhala  (Tamil version for Sri Lanka pending).  Depending on the results, blood tests and brain imaging may be necessary. This is to look for medical problems that might affect the brain.

Should you worry if you are diagnosed as having MCI? The good news is that most persons with MCI do not progress to dementia. Perhaps 10 to 15 percent might do so. In the majority MCI will remain stable and even improve. It would be prudent to repeat the memory testing every six months to detect any deterioration.

MediScene continues our series by Consultant Psychiatrist Prof. Raveen Hanwella. Prof. Hanwella is attached to the National Hospital and the Department of Psychological Medicine, Faculty of Medicine, University of Colombo.Something bothering you? Please write in to Prof. Hanwella C/o MediScene, The Sunday Times, No. 8, Hunupitiya Cross Road, Colombo 2 or e-mail: raveensundaytimes@gmail.com

Can anything be done to prevent or reduce the risk of MCI progressing to dementia?

On March 3, the results were released ahead of publication of an interesting study done at the Mayo Clinic for the Study of Aging. The team followed nearly 2000 cognitively normal persons aged 70 and older from 2006. The participants provided information on how much they engaged in mentally stimulating activities over the past one year. The researches compared those who engaged in such activities at least once a week with those with less activity. During a period of 4 years, they found that the group with higher activity levels were less likely to develop MCI than the group with less activity.

The study found that playing games such as playing cards and doing crossword puzzles reduced the risk of MCI.  The other activities that reduced risk were reading magazines, doing crafts such as knitting, woodworking, pottery, quilting, sewing, using the computer to search the internet, playing computer games, conducting research, and being socially active. For Sri Lanka it would be interesting to do a similar study with culturally appropriate activities.

A Danish study reported in June last year showed that moderate to intensive aerobic exercise improved memory and other thinking functions in persons already diagnosed with Alzheimer’s dementia. Previous studies have shown that moderate physical activity improves functions in older adults at high risk for dementia.

Several companies now market online cognitive training programmes. The business has grown from 200 million dollars a year seven years ago to two billion dollars last year. These companies allow subscribers to work on cognitive training programmes on their computers or tablets. These tasks may include learning lists of words, a set of pictures or a route to a set target. Do they really work and is it worth the money?  There is no question that cognitive stimulation improves brain function. But some experts are critical that people may be sitting at a computer three times a week rather than spending that time taking a brisk walk. Also there is concern that people engaged in playing brain games may become less socially engaged. If older persons are engaged in work or socially stimulating activities such behaviours would provide more varied cognitive stimulation than computer games.

If any reader is interested, the Department of Psychiatry, Faculty of Medicine Colombo offers cognitive testing. Please contact Ms Sandya on any weekday between 8.30 am and 4.00 pm on 011 2691688 for more information.

In summary, if you want to keep your brain healthy, engage in mentally stimulating work, interact with people, keep your social networks active. It is important to eat healthy foods, keep your weight down and your blood pressure, blood sugar and cholesterol at normal levels. Most of all be active and exercise regularly. A simple formula indeed but as most simple things go, so difficult to do.

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