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Dementia: What it is and what it is not

Guam experts tackle the dreaded disease

 


By Jeni Ann Flores

 


Where are my keys?! In the fridge?! Why on earth are they in the fridge?! Cell phone? In my purse. Who is this? Appointment? I have an appointment tomorrow? I forgot all about it already. Dang! I think I have dementia.


This is a typical day for this 65-year-old retired professional.  Her mother had dementia. She lays awake at night wondering if she has it as well. The dreaded “D” word.


No, despite often losing her keys and missing appointments, she does not yet suffer from dementia. What she is experiencing is aging.


Just the same, aging can be a precursor for dementia. Diabetes, high blood pressure, heart disease, lack of exercise, these may increase her chances for getting dementia as she continues to age.


If you forget names and appointments but remember them later; get confused with time and day of the week but figure it out later; have vision changes due to cataracts; sometimes have trouble finding the right word; misplace things but are able to retrace your steps and find them later; sometimes feel introverted and become irritable when routine is disrupted—these are all signs of aging, according to Guam neurologist Dr. Ramel Carlos.


So what is dementia and how is it different from aging?


Dementia is an umbrella term, according to Carlos, for a group of neurocognitive disorders. It is a progressive disease that eventually damages one’s ability to carry out routine functions.


You likely have dementia if your memory loss disrupts daily living; challenges planning or solving problems; makes you unable to complete tasks; you get confused with time and place; have difficulty understanding visual and spatial relationships; have trouble speaking and writing; withdraw from others and have mood and personality changes; or misplace things without being able to retrace your steps.


Metabolic diseases, such as diabetes, high blood pressure and high cholesterol; lack of exercise; and excessive tobacco and alcohol use can increase one’s chances for dementia.


The chances of getting dementia also increase with age. The risk doubles every five years after age 65 and about 70 percent of those affected are women.


Dementia is expected to be a global health crisis. Advances in medicine, technology and lifestyle mean we are living longer. This means there are more older people in the population.



Currently, about 50 million people worldwide suffer from some form of dementia. The World Health Organization expects that number to rise to about 139 million by 2050. Japan, Sweden, Norway, Finland, Canada and the United States have some of the highest rates of dementia.



Alzheimer’s is the most common form of dementia. Other forms of dementia are dementia with Lewy bodies, Parkinson’s, Wernicke-Korsakoff syndrome, frontotemporal dementia, and Huntington’s. The actor Bruce Willis was recently diagnosed with frontotemporal dementia or FTD.


By age 45, the lifetime risk for Alzheimer’s is one in five for women, and one in 10 for men. The risk grows as we get older.  There is a 35 percent risk for Alzheimer’s after 85 and 50 percent risk after 90. Women generally have a higher risk than men, possibly due to hormonal and genetic factors. There are also more women with dementia simply because women tend to live longer. Having a family history of Alzheimer’s can increase your risk.


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Once diagnosed, the prognosis varies but the disease is progressive. Dementia care is a family and community affair. Spouses, children and grandchildren, are usually involved in the comprehensive care of patients. At its most severe, dementia patients are like dependent children or babies.


The social, emotional, financial and physical toll on family caregivers is incredible.  When you meet a person caring for a loved one with dementia, be especially kind and tender with them. They walk a difficult and painful path. They are the privileged few caring for loved ones who once were old and now are young. Listen to their stories with compassion.


On Guam, the resources are thin compared to other areas in the U.S.


Recently, the University of Guam, led by Dr. Ian Twaddle and his team, sponsored “The Journey of Caregiving,” a dementia-care conference funded by the Guam/Micronesia Geriatric Workplace Enhancement Program.


There is a thriving support group that meets on Zoom once a week to provide support and training for caregivers of persons with dementia.


But cases are growing and will achieve critical mass. More needs to be done soon for patients and their caregivers.


Unfortunately, according to Carlos, Guam does not have a registry or system that collects the incidence of dementia on island. The rate of dementia on Guam has not been established, making it impossible to determine its possible uniqueness and compare it with other jurisdictions.

“People are getting diagnosed only when they are brought by their family or caregiver, which is typically in the mid to later part of the disease. Once diagnosed, discussion can begin regarding how to improve and extend the quality of life for the patient, lifestyle changes, treatment of various co-morbid diseases, as well as discussion regarding caregiving and long-term care needs of the patient,” Carlos said.


The good news is that 40 percent of dementia cases can be prevented.


Dementia is caused by different diseases that gradually destroy nerve cells and damage the brain, leading to cognitive decline. Hearing loss, hypertension, obesity, depression, smoking, diabetes, excessive alcohol intake, head injury and air pollution may increase one’s risk for dementia. Education, physical activity and social contact can reduce the risk.


There is growing evidence for brain plasticity, or the brain’s ability to change and adapt based on new experiences. Carlos uses letters of the word dementia to prescribe lifestyle choices for a healthier brain: Diet, Exercise, Mental engagement, Exploration, Naps and sleep, Treat all diseases, Interaction with others, Activity and adaptivity.






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