Not just the elderly -- Dementia (by GERALDINE LING)

The following is a report by GERALDINE LING in Mind Your body of the Straits Times dated 18 February 2010, Thursday.

Not just the elderly
Dementia can hit those who are below 60. GERALDINE LING finds out that there is no cure, although the disease can be slowed down with medication and structured programmes


Young onset Alzheimer's Disease - a form of dementia which strikes people under the age of 60 - creeps up slowly, like a thief in the night.

It can rob an energetic, thoughtful and caring person of his true nature, causing him to be moody, forgetful and withdrawn. He may also start to forget things that had been told to him only minutes earlier.

Gradually, he may find it harder to function at work. He could shout at his colleagues and forget to attend important meetings. Eventually, he may have to resign from his job.

If married, the primary caregiver may be the spouse. If there are young children, a change in the parent's behaviour can puzzle them and cause added stress in the household.

If the person is single and without family, finding a caregiver to look after him as the disease progresses may be hard.

These are some of the typical characteristics of a person with young onset Alzheimer's, said Dr Philip Yap, a consultant at the department of geriatric medicine at Alexandra Hospital.

This condition usually affects older people, but in the case of young onset Alzheimer's, the symptoms become evident even in middle-age.

Of all patients diagnosed with dementia, less than 5 per cent have young onset dementia, said Dr Yap.

Although dementia is common in the elderly, it is not caused by the ageing process alone, said Dr Irwin Chung, the director of medical services at Ang Mo Kio-Thye Hua Kwan Hospital.

In dementia, brain cells die at a faster rate than normal, leading to memory loss and function.

Besides poor short-term memory - patients ask the same questions repeatedly - there may also be personality changes, said Dr Seng Kok Han, a consultant at the department of geriatric psychiatry at the Institute of Mental Health.

For example, patients may become irritable or fearful.

In Singapore, the common types of young onset dementia are Alzheimer's disease, vascular dementia and frontotemporal dementia.

Death of brain cells

Alzheimer's is caused by changes to the nerve cells in certain parts of the brain. These alterations result in the death of many brain cells, said Dr Chung.

In vascular dementia, the death of brain cells is caused by a stroke - often minor and unnoticed - or other changes in the brain's circulation.

Frontotemporal dementia is caused by damage to the brain's frontal lobes - responsible for complex thoughts and planning - triggering impaired social behaviour, said Dr Yap.

Patients are likely to display personality and behaviour changes, like laughing at inappropriate things or dancing in the middle of the road.

A study conducted by the Mayo Clinic showed that one of the common causes of young onset dementia is a neurodegenerative disorder, like frontotemporal dementia.

Compared to older patients with dementia, who are often retired, younger patients may face difficulty at work as their symptoms may be mistaken for a lack of diligence or motivation.

They may have to resign from work, which can cause them financial problems.

In older people, the two most common forms of dementia are Alzheimer's disease and vascular dementia, with the latter being more prevalent in Singapore, said Dr Chung.

'Unfortunately, some can suffer from both Alzheimer's and vascular dementia,' he said.

3 stages of dementia

Dementia patients often go through three stages - early, moderate and late.

In the early stage, most patients appear normal and have no problems with self-care, said Dr Yap. But, already, there is a gradual decline in memory, thinking and behaviour. They are also likely to have problems finding their way around in new and unfamiliar places. They may lose interest in hobbies or find themselves depressed and irritable.

'Often, patients realise this and try to compensate for poor memory by using a diary or jotting down things to do,' said Dr Yap.

In the moderate stage, memory and intellectual lapses are more prominent. Delusions and paranoia will emerge. Family members will start to notice changes in behaviour. Towards the end of this stage, patients will have difficulty coping with self-care, like dressing, bathing and using the toilet, said Dr Yap.

By the late stage, patients will be completely dependent on others for basic needs like feeding. They lose the ability to speak and fail to recognise friends and family. They are also less mobile and may become chair- or bed-bound.

In the bed-bound stage, said Dr Yap, many may develop swallowing problems and become malnourished. Patients are also prone to infections like pneumonia, urinary tract infections and bedsores.

Most eventually die from infections, especially pneumonia.

At present, dementia has no cure.

'But the progression of early and middle-stage dementia can be slowed down by cholinesterase inhibitors such as donepezil, rivastigmine and galantamine,' said Dr Seng.

Cholinesterase inhibitors are believed to arrest an enzyme called cholinesterase, which breaks down acetylcholine, a substance in the brain which has a key role in memory and learning.

Other options may be in the pipeline. Said Dr Yap: 'Apart from medication, there is now evidence that non-pharmacological measures, including structured day activity programmes, can help maintain patients' quality of life.'