An overview of dementia and its impact

December 10, 2022

Healthcaretoday, Dementia, Alzheimer's disease, Vascular dementia, Mixed dementia, Frontotemporal dementia, dementia with Lewy Bodies, depression, hypertension, diabetes, obesity, alcohol, loneliness,

Dementia is not a normal part of aging; rather, it can lead to significant disability and dependency in individuals affected.

Dementia is a syndrome characterized by the progressive deterioration of cognitive functions, including memory, thinking, orientation, and emotional control. It is important to note that dementia is not a normal part of aging; rather, it can lead to significant disability and dependency in individuals affected. The condition often presents with behavioral and psychological symptoms, increasing reliance on caregivers and potentially leading to nursing home admissions.

A lack of awareness and understanding surrounding dementia contributes to stigmatization and delays in diagnosis and care. The physical, psychological, social, and economic repercussions of dementia extend beyond the individual, affecting families and society as a whole. Current estimates suggest that approximately 50 million people worldwide are living with dementia, with 60% residing in low- or middle-income countries. Approximately 10 million new cases are reported annually. In Malaysia, the estimated number of people with dementia was 123,000 in 2015, projected to rise to 261,000 by 2030 and 590,000 by 2050. The National Health and Morbidity Survey 2018 reported a prevalence of 8.5% for probable dementia among the elderly population.

Types of dementia
According to the Clinical Practice Guidelines 2021 - Management of Dementia (Third Edition) by the Ministry of Health Malaysia, Alzheimer's disease accounts for 60-70% of all dementia cases, followed by vascular dementia, mixed dementia, frontotemporal dementia, dementia with Lewy bodies, and Parkinson’s disease dementia.

Alzheimer’s disease: Often begins with gradual episodic memory impairment. Early-onset cases (under 65 years) may present with behavioral or language variants while retaining memory until later stages.

Vascular dementia: Linked to cardiovascular risk factors, it typically manifests with impaired executive function and slowed processing speed.

Mixed dementia: A combination of two or more types, most commonly Alzheimer's disease with vascular pathology.

Frontotemporal dementia: Early symptoms include personality changes and executive dysfunction before memory issues arise.

Dementia with Lewy Bodies: Characterized by fluctuating cognitive decline and visual hallucinations, with motor symptoms appearing at least a year prior to dementia diagnosis in Parkinson’s disease dementia.

Risk factors for dementia
Risk factors for dementia can be classified into non-modifiable and modifiable categories.

Non-modifiable risk factors:

Age: Individuals aged 65 years and older are at higher risk.
Gender: Women have a higher risk, particularly for Alzheimer's disease.
Genetics: Early-onset Alzheimer’s accounts for 6-7% of cases, with some exhibiting autosomal dominant transmission.
Late-onset Alzheimer’s involves multiple genetic factors, including the presence of the APOE ε4 gene variant, which may increase the likelihood of developing the disease.

Modifiable risk factors:

Cardiovascular health: Conditions such as hypertension, diabetes, and obesity are significant risk factors. Proper management of these conditions can improve cognitive function.
Psychiatric illness: Late-life depression is associated with a two-fold increased risk of dementia.

Lifestyle choices:

Smoking: Tobacco use is linked to cognitive impairment.
Alcohol consumption: Excessive alcohol intake increases dementia risk.
Physical inactivity: Low levels of physical activity are associated with higher incidence rates of dementia.
Social relationships: Low social engagement and loneliness can elevate dementia risk.
Environmental factors: Exposure to air pollutants and environmental tobacco smoke has been associated with increased dementia risk.

Risk reduction strategies
The World Health Organization (WHO) recommends several strategies for reducing the risk of cognitive decline and dementia in individuals with normal cognition. These include:

Engaging in regular physical activity
Quitting tobacco use
Managing alcohol consumption
Controlling hypertension and diabetes
Maintaining a healthy weight
Managing cholesterol levels
Adopting nutritional interventions
Participating in social activities
Engaging in cognitive exercises
Addressing depression and hearing loss

The importance of awareness and proactive management of risk factors cannot be overstated, as they play a crucial role in potentially delaying or preventing the onset of dementia.