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Understanding dementia

Contributed by Aina Ismail, Hazirah Hj Jeffery, Syairah Rosli & Zanah Morsidi

Dementia is called penyakit lali or sakit tua and has always been assumed to be a normal part of ageing for older people. As a group of students from Universiti Brunei Darussalam (UBD) undergoing a Community Outreach Programme (COP) that fosters the significance of moral and social responsibility for the community, either locally or abroad, as part of our Discovery Year, we understood and learnt a valuable lesson that the above assumption about dementia isn’t true.

Dementia or Demensia involves the loss of cognitive functions such as thinking, remembering, and learning, where people living with dementia also may have behavioural changes and lose some of their abilities, interfering with their daily lives.

As students volunteering for Demensia Brunei, our mission is to raise awareness for the community of Brunei to take into account the progression and reality of this condition.

The World Health Organization (WHO) has estimated that more than 55 million people are living with dementia worldwide, and the cases will rise up to nearly 10 million every year.

There are signs and symptoms to look out for dementia. These symptoms may start mild, but they will worsen over time.

EARLY STAGE OF DEMENTIA

Memory loss is one of the most well-known early signs of dementia. A person may be unable to recollect recent events or maybe constantly misplace personal belongings (such as keys or glasses) throughout the house. Cognitive difficulties, such as thinking and planning, are also typical at this stage. Making complicated decisions (such as financial decisions) or addressing problems, for example, is getting increasingly challenging.

Another early indication is the lack of language and communication abilities, as they may struggle to find the proper sentence or unable to follow subjects of discussion within a conversation. Mood and emotion changes are frequent during this stage, with the individual becoming restless, afraid, sad, or on the verge of developing depression as well as irritability, frustration, and lack of interest.

THE MIDDLE STAGE OF DEMENTIA

The progression of the condition may be seen as the phases increase. When the signs of dementia become clearer in the middle stage, the individual becomes more reliant on others for help in managing their everyday lives. This is also the stage where there will be evident changes of behaviour.

Some of the symptoms of this stage include: deterioration in existing memory, thinking issues, and communication skills, evident in this stage where people with dementia will have difficulty in recalling, remembering, speaking, and utilising language. Challenges with orientation occur, where they get confused about time and space. Physical and behavioural changes at this stage include agitation and restlessness, screaming or shouting, repetitive behaviour, following their caregiver around, sleep disturbances, and loss of inhibitions.

These changes also make people with dementia struggle with emotion management. They might be responding to a loss of independence, a misinterpretation of their circumstances, or irritation for not being able to communicate their wants openly.

THE ADVANCED STAGE OF DEMENTIA

The pre-existing symptoms of dementia grow more severe as the condition worsens, requiring full-time care and assistance with everyday activities and personal care. At this point, however, the most visible symptoms are altered perceptions and physical problems, and the symptoms of all types of dementia merge into one another.

Memory and language difficulties:

They may have trouble remembering recent occurrences and may believe they are in a different time period. They may also lose their ability to recognise familiar locations, items, and people, as well as themselves, because they will only be able to recall their existence during the period in which they became bound to.

In terms of language, adults may lose their taught language and just retain the language they learnt as a child. Their communication may be limited or non-existent, but they comprehend through body language and facial expression and may use this to express their needs or feelings.

Mood, emotions and perceptions:

The most common symptoms are depression, apathy, delusion, and visual and auditory hallucinations and this helps to explain how a person’s perspective of reality changes. They are more likely to respond to sensations than to words at this point.

Changes in behaviour:

Aggression is frequently perceived as retaliation to personal care as they feel terrified, intimidated, or confused. They may punch, scream, or push caregivers away. They may grow agitated because they are looking for someone or something. A sudden shift in behaviour might indicate medical unwellness, such as pain or infection. As a result, it is important for caregivers to be on the lookout for sudden behavioural changes.

Finally, physical difficulties in advanced dementia include: walking difficulties – risk of falls, requiring great deal of assistance in eating, losing weight, difficulty swallowing, and losing control of their bladder and bowels.

Blood clots and infections are more likely in people with limited mobility. These can be life-threatening; therefore, it is important that the individual is helped to be as mobile as possible.

RISK FACTORS OF DEMENTIA

The influencing factors of dementia can be divided into non-modifiable and modifiable risk factors.

Non-modifiable risk factors are those which cannot be changed such as age, gender and genetic inheritance.

Age is the biggest risk factor for dementia. Dementia affects one in 14 people over the age of 65 and one in six over the age of 80. Dementia is not part of normal ageing. However, the older you become, the higher the risk.

Women are more likely to get Alzheimer’s disease than males, while both genders are at equal risk of developing the other subtypes of dementia. The causes behind this are unknown.

With regards to genetic inheritance, the influence of the Alzheimer’s disease gene being passed on from parents is small.

If a person’s parents or other family members develop Alzheimer’s, their chances of developing Alzheimer’s are only slightly higher than for a person with any cases of Alzheimer’s in their immediate family.

Meanwhile, some risk factors are modifiable, meaning that they can be changed. These modifiable risk factors should be considered for intervention to reduce the risk of developing dementia. Environmental factors such as air pollutants and exposure to aluminium may contribute to the onset of Alzheimer’s disease.

An unhealthy way of life is also a risk for dementia. For example, unhealthy unbalanced diet, physical inactivity, obesity, lack of sleep, smoking, and mental health issues may lead to dementia.

In terms of general health, high cholesterol and diabetes increase a person’s risk of developing vascular dementia but are also linked to an increase in Alzheimer’s disease.

These modifiable factors are risks that can be prevented through lifestyle choices.
It is never too late to improve our lifestyle to prevent dementia.

How can we reduce the risk of developing dementia? Engage in physical activity; avoid smoking and alcohol consumption; keep track of your food intake, blood pressure, sugar intake, cholesterol and weight; stay connected socially and maintain interactions to avoid depression and reduce stress; test your brain by attempting something new; safety first to reduce the chance of falling; installing handrails on stairs and grabrails especially in the bathroom.

HOW TO REACH OUT FOR HELP

The best place to reach for help is to book an appointment with a doctor at your nearest health centre to get checked. After the doctor’s assessment of the possible signs and symptoms, they will offer a preliminary diagnosis and/or refer to a specialist.

Although these signs and symptoms of dementia have been overlooked as a natural part of aging for decades in Brunei, it is important not to ignore or dismiss any changes in memory or function and resolve the concerns of you or your loved ones. It is important to reach out and seek professional help to support and improve their quality of life as well as to ensure their safety.

Demensia Brunei plans activities and events to spread awareness regarding the realities of dementia and to encourage healthy aging among Bruneians.

To know more about dementia, visit Demensia Brunei on social media platforms.

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