Dementia and Prevention
BACKGROUND
What is cognitive impairment ?
Cognitive impairment is also known as "dementia". For patients with Alzheimer's Disease, the cognitive function will gradually decline, including memory, concentration, executive function, visual, spatial judgment ability, hand-eye coordination, language ability and sensory changes.
Dementia can be divided into the following categories
Alzheimer's Disease
The most common type of dementia, accounting for about 65% of all cases in Hong Kong. At present, the cause of the disease has not been discovered in medicine. Once the disease is contracted, the decline of the patient's ability is gradual and the six cognitive abilities will be gradually lost.
Vascular NCD
The most common type of dementia, accounting for about 65% of all cases in Hong Kong. At present, the cause of the disease has not been discovered in medicine. Once the disease is contracted, the decline of the patient's ability is gradual and the six cognitive abilities will be gradually lost.
Frontotemporal NCD
A rarer form of dementia that primarily affects the frontal and temporal lobes of the brain. After the onset, patients experience significant memory and language problems.
Other cognitive disorders
Including Huntington's disease, Parkinson's disease, Creutzfeldt-Jakob disease, Niemann-Pick disease type C
The situation of dementia in Hong Kong
Cognitive decline is a problem faced by most of the elderly. In Hong Kong, 1 in 10 elderly people over the age of 70 suffer from dementia, and 1 in every 3 elderly people over the age of 85 suffer from dementia . It can be seen that as the elderly grow older, the chances of suffering from cognitive impairment diseases will increase. Since there is still no drug that can cure dementia in the world, most people ignore the horror brought about by dementia, resulting in missing the golden period for the best prevention of dementia patients.
Cognitive Dysfunction
Executive function
Difficulty to performing familiar tasksDifficulty in planning, organization and decision making
Learning and memory
Short-term memory loss
Attention
Increased difficulty in concentration and easy distraction
Language
Forgetfulness, especially names of people and objectsDifficulty in following conversation involving more than one person
Orientation
Confusion in time and places
Social cognition
Lost in initiatives to socialise
Dementia Treatment Methods
5
Two major approaches to treating cognitive impairment
In order to reduce cognitive decline or suffer from dementia, drug treatment or non-drug treatment can be used to delay the disease.
5.1
Medical treatement
Although the use of drug therapy cannot achieve a permanent therapeutic effect, it can help reduce the rate of memory and mental function decline in patients with dementia. However, we must not ignore the side effects of drugs. Most of the drugs used to treat dementia are very powerful. Such as insomnia, nausea, vomiting, headache, dizziness, fatigue, muscle cramps, etc. However, this is just a side effect derived from the drug. The serious thing is that dementia drugs may cause patients to become dependent, especially when the elderly try to quit the drugs without proper care or supervision of therapists, there is a high possibility of withdrawal symptoms, and the consequences may vary. It can be seen that the effect of drug treatment brings various side effects and is difficult to be effective in long-term treatment methods.
5.2
Non-drug treatment
The issue of cognitive impairment has been receiving attention all over the world. In recent years, the non-drug treatment of dementia has developed rapidly and diversified. Interesting and innovative training has gradually replaced traditional cognitive training methods. There are also different studies in foreign countries that have explored and demonstrated the non-drug treatment of cognitive impairment. Studies have shown that non-pharmacological training can significantly improve the cognitive function of the elderly. Through multiple and corresponding cognitive training, patients with dementia can keep their brains stimulated so as to slow down the rate of decline. At the same time, appropriate cognitive training can help patients with cognitive impairment take care of their physical and mental health, increase their social activities and improve their quality of life.
Prevention
Calligraphy Therapy
Research has shown that calligraphy can significantly improve CMMSE global score and cognitive functions such as memory, attention, and orientation for older adults with mild cognitive impairment. Other than a positive impact on cognitive health, calligraphy can also lead to an improvement in mental and physical health. In particular, it can lead to a reduction in stress, decrease in blood pressure, and improve in mood.
Reference:
Chan, Sam C C et al. “Chinese Calligraphy Writing for Augmenting Attentional Control and Working Memory of Older Adults at Risk of Mild Cognitive Impairment: A Randomized Controlled Trial.” Journal of Alzheimer's disease : JAD vol. 58,3 (2017): 735-746.
Mahjong Therapy
Mahjong Therapy can delay cognitive decline and prevent dementia in older adults, even for those with significant cognitive impairment. In particular, it has been shown to significantly improve short term and verbal memory, MMSE scores, attention, and hand-eye coordination. Also, studies have shown that playing mahjong lead to a drop in depression score and feelings of loneliness as well as an improvement in self confidence and moods. Thus, mahjong therapy can have a significant positive effect on players' cognitive and mental health.
Reference:
Cheng, Sheung-Tak et al. “An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia.” International journal of geriatric psychiatry vol. 21,7 (2006): 611-7.
Game-based Intervention
Game-based intervention can have positive impact on players' cognitive, physical, and mental health. Research has shown that cognitive activities can improve executive functioning and delay memory decline, which is often a predictor for dementia [1]. Game-based intervention can also alleviate mood and improve balance and gait in older adults [2]. Furthermore, it can reduce behavioural symptoms for people with dementia and increase their interactions with family, caregivers and other patients [3].
[1] Hall, C B et al. "Cognitive activities delay onset of memory decline in persons who develop dementia." Neurology vol. 73,5 (2009): 356-61
[2] Zheng, Jiaying et al. “Game-based interventions and their impact on dementia: a narrative review.” Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists vol. 25,6 (2017): 562-565.
[3] Narme, Pauline. “Benefits of game-based leisure activities in normal aging and dementia.” “Intérêts des activités ludiques dans le vieillissement normal et chez les patients présentant une pathologie neurodégénérative.” Geriatrie et psychologie neuropsychiatrie du vieillissement vol. 14,4 (2016): 420-428.
Art therapy
Art therapy can help people with dementia stimulate the cognitive function of the brain through different art forms including visual art, creative writing, music, dance and sports. Because artistic expression is an effective way to let go of emotions, art therapy is more effective in improving some patients with language impairment.