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How is dementia treated?

Most causes of dementia cannot be cured. This includes the commonest cause of dementia which is Alzheimer’s disease. However, there are treatments available in Alzheimer’s disease to ameliorate the cognitive, functional, behavioural and psychological symptoms of the disease.

There are currently two classes of drug approved to treat the cognitive and functional symptoms of AD: the cholinesterase inhibitors donepezil, rivastigmine and galantamine, and the NMDA receptor antagonist, memantine.  On the PBS, donepezil, rivastigmine and galantamine are licensed for mild to moderate AD, and memantine for moderate AD. Many other putative disease-modifying agents have been studied but failed to show a benefit, or are currently undergoing clinical trials.

Behavioural and psychological symptoms are common in Alzheimer’s disease, particularly in the later stages. These include anxiety, agitation, aggression, and psychosis (delusions and hallucinations), and are often treated with neuroleptic or antipsychotic medications.

Some medications that target arthritis have shown some promise in treating Alzheimer’s, however more work needs to be done to know if these approaches will provide a long-term benefit.

What is the prognosis for dementia?

Alzheimer’s disease is a progressive condition which causes a decline in cognitive functions over time. The average life expectancy for someone with AD is very variable, and ranges from 5 to 10 years or more. Individuals with AD have been known to live up to 20 years after the onset of symptoms.

What is cognitive neurology?

Cognitive neurology is that branch of neurology which focuses on brain diseases that cause impairments in mental functions. A practitioner in cognitive neurology will provide comprehensive assessment and treatment of difficulties relating to thinking, memory, language ability, attention and other cognitive functions. Dr Swee Tan [put link here] specialises in cognitive neurology.

What is a comprehensive memory and dementia clinic?

A comprehensive memory and dementia clinic is a multidisciplinary service which provides expert assessment, treatment, education and support for individuals with cognitive complaints and their carers. The specialist team usually comprises a cognitive neurologist, a neuropsychologist, an occupational therapist, a psycholoigist/family therapist and a registered nurse.

Precision Brain and Spine Centre will soon be opening its comprehensive Memory and Dementia Clinic [put link here].

I keep forgetting things- does that mean I have early dementia?

No, it doesn’t! Our memory can be classified into different types: Episodic, Semantic , and Procedural.

Episodic memory describes our recollections of specific events and situations we have experienced. It records the times, places, emotions and other contextual information associated with autobiographical events, in other words, the ‘what’, ‘where’ and ‘when’ of our daily lives. Episodic memory is known to decline with normal aging. This leads to occasional forgetfulness, such as misplacing the keys, or arriving at the supermarket and forgetting what you were there to get, or forgetting where you left your car in the parking lot.

Semantic memory is our memory of general facts, meanings, concepts and knowledge about the world. This is not tied to specific experiences. For example, the knowledge that Paris is the capital of France, or that clocks are used to tell the time. Our vocabulary and understanding of language also falls under the category of semantic memory.

Procedural memory is the memory of how to perform particular actions, such as how to tie a shoelace or drive a car.

Neither semantic memory nor procedural memory should not decline with normal aging.

In normal aging, memory lapses are occasional, do not significantly interfere with everyday life, and do not generally elicit much concern by family members.

Dementia, on the other hand, is characterized by persistent and progressive memory loss which affects one’s ability to work or carry out day to day activities such as managing one’s finances, paying the bills, or even how to dress or bathe. Individuals with dementia may be completely unaware that they have forgotten, which is not the case in the forgetfulness associated with normal aging.

Apart from memory, other brain functions that decline modestly with the normal process of aging are:

  • information processing speed and reaction time
  • the ability to learn something new or to recall new information (e.g. names, dates, events)
  • the ability to do more than one task at a time (multitask) or shift focus between tasks
  • spontaneous word finding (“tip of the tongue” experiences) and verbal fluency (takes longer to “get the words out”)

If you are experiencing memory problems beyond what you would normally expect, that does not necessarily mean that you have dementia. Our memory can also be affected by a variety of reversible physical and psychological conditions, such as:

  • anxiety
  • depression
  • infections
  • medication side effects
  • ·nutritional deficiencies
  • substance abuse
  • thyroid imbalance

If you are concerned about memory difficulties, it is important to see your doctor to discuss your concerns.

What is a neuropsychology evaluation?

Cognitive assessment is an objective assessment of an individual’s cognitive functions conducted by an examiner using standardized testing methods. It examines different aspects of cognition such as intelligence, memory, language function, problem solving, concentration and attention, visual/spatial perception, motor abilities, emotional characteristics and behaviour.

Cognitive assessment may consist of a brief, screening assessment using a screening tool such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MOCA). These tools generate test scores which are compared to those of the general population to determine whether one’s performance falls below what is expected for the individual’s age and educational background. However, brief screening tests can miss subtle cognitive abnormalities, especially in people with a high level of cognitive ability prior to the onset of symptoms.

A more detailed cognitive assessment is called a neuropsychological evaluation. This is performed by a neuropsychologist, who is an expert trained in this field. It generally consists of an interview in which the neuropsychologist aims to establish the baseline level of cognitive ability prior to the development of symptoms, as well as delineate the individual’s cognitive symptoms. This is followed by structured testing which includes answering questions and completing tasks on paper or on a computer. Such testing is quite in depth and can take several hours or even several sessions. The neuropsychologist then draws together all the information gathered into a comprehensive report which analyses the individual’s strengths and weaknesses, assesses whether the performance falls within the normal range expected, indicates possible diagnoses consistent with the findings, and makes recommendations on treatment and follow-up. Precision Brain Spine and Pain Centre offers detailed neuropsychological assessments.

What is the MMSE?

The Mini-Mental State Examination (MMSE) is the most commonly used test for the evaluation of cognitive impairment. It consists of a brief questionnaire scored out of 30 points and examines cognitive functions including orientation, memory, attention and language function. It is used both as a screening tool for dementia as well as to grade the severity of cognitive impairment. It is a well validated test that is widely used across many countries, having been translated into different languages. However, because it is a brief test, a normal score on the test (27 and above) does not exclude the possibility of mild cognitive impairment or dementia, nor does an abnormal score always indicate the presence of dementia.

What is brain training?

Brain training is the name given to exercises or mental games, generally computer based, which aim to stimulate and enhance cognitive performance in areas such as memory, concentration, processing speed, mathematical skills and more. Many such programmes have been developed and brain training has become a big industry.

The question is whether there is scientific proof that these games are beneficial, in other words, whether gaining proficiency in the narrow tasks being trained for in the games generalizes to improvements in broader cognitive function. This is a controversial area – some remain sceptical but others are cautiously optimistic that there may be long lasting benefits. Research into this question is ongoing. Whatever the case may be, there is no serious harm to computerized brain training, and some will welcome at least the possibility of making a difference to the long term outcome.