What is Dementia?
Dementia is a general term for many types of cognitive impairment afflictions. People with dementia show a visible decline in focus, executive functions, memory, language skills, sense and coordination, and social skills. The decline often affects daily life and may even lead to personality changes, day and night reversals, hallucination and delusion.
A medical diagnosis of dementia is usually based on the “The Diagnostic and Statistical Manual of Mental Disorders” (DSM–5) published by the American Psychiatric Association. Aptitude tests, CT scans, MRI and blood tests are also used to assist with medical diagnosis if specific symptoms indicate cognitive degeneration or other ailments.
Vascular diseases, depression, strokes and obesity are considered risk factors for dementia. Both physical and psychological well-being are vital for striking off dementia.
Currently, the diagnosis of dementia is primarily based on four aspects:
Cognitive Tests
Healthcare professionals may use tools such as the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) and the Functional Assessment Staging Tool (FAST Scale) For Dementia to evaluate various cognitive and functional abilities of individuals with dementia, assisting doctors in making a diagnosis.
Computerized Tomography scan (CT scan) and Magnetic Resonance Imaging (MRI)
Since individuals with dementia may show no significant abnormalities in their scan results or may have similar findings to other conditions, CT scans and MRI scans are primarily used to determine whether symptoms are caused by brain tumors, strokes, or brain hemorrhages.
Blood Tests
- Blood tests can help determine whether symptoms of dementia are caused by other factors such as vitamin deficiencies, liver disease, kidney disease, metabolic disorders, or thyroid disease.
- The new “blood biomarker test”* can assist doctors in diagnosing “Alzheimer’s Disease” at an earlier stage. Depending on the individual’s condition, doctors may recommend one or more of the following blood tests. Abnormal levels in these tests indicate a possible diagnosis of “Alzheimer’s disease”. This test provides doctors with more specific clinical data to support their diagnosis, allowing individuals with dementia to receive early treatment.#
Blood Test | Abnormal Level |
|---|---|
Phosphorylated Tau 181 (p-Tau 181) | Higher than normal levels |
Phosphorylated Tau 217 (p-Tau 217) | Higher than normal levels |
Amyloid Beta 42/40 Ratio (Aβ42/40) | Lower than normal levels |
Neurofilament Light Chain (NfL) | Higher than normal levels |
* A Swedish study published in the July 2024 issue of the Journal of the American Medical Association reported that using both “Phosphorylated Tau 217” and the “Amyloid Beta 42/40 Ratio” blood tests can improve the accuracy of Alzheimer’s disease diagnosis for both primary care and specialist doctors. The accuracy rates increased from 61% and 73% to 91%, respectively.
Clinical Experience of Doctors (history and physical examinations)
Doctors primarily rely on clinical experience, considering the medical history provided by the individual and their family, as well as physical examination results. They also refer to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and other test results to determine whether a person has dementia. The key symptoms include:
- Complex Attention
Difficulty remembering new information (e.g., a recently mentioned phone number or message), easily distracted by environmental stimuli (e.g., TV or conversations), inability to perform mental calculations and slower thinking compared to before
- Executive Function
Unwilling to attempt challenging tasks, can only handle one task at a time, requires assistance with daily chores or decision-making (e.g., making phone calls or shopping)
- Learning and Memory
Repeats the same content during conversation, cannot follow a shopping list to buy all necessary items, needs constant reminders to complete simple tasks, forgets important life events or memories, fails to recall how to perform familiar tasks
- Language
Difficulty expressing oneself or understanding language (e.g., frequently gives vague or unclear responses, makes grammatical errors while speaking, uses repetitive and monotonous speech)
- Perceptual-Motor Skills
Includes spatial awareness, object recognition, movement planning, and hand-eye coordination, struggles to locate specific items in a cluttered environment, difficulty following simple movement instructions (e.g., waving or raising a hand), trouble copying text or simple drawings, difficulty performing familiar activities like knitting or sewing
- Social Cognition
Issues with social interactions, etiquette, and conversations, engages in inappropriate behaviors, shows a lack of respect for family or friends
References：
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision
# The section on “Blood Biomarker Test” was provided by Dr. Bosco Ma, JCCPA Visiting Doctor
Find out some Symptoms of Dementia
- The most common form of cognitive degeneration, accounting for 50-70% of dementia cases; more common among females.
- Slow decline, most common early symptoms are memory loss, difficulties in remembering information and learning new things.
- The second-most common cause of dementia for people aged 65 or above, accounting for 30% of dementia cases; more common among males.
- Closely associated with strokes, heart disease and circulatory problems.
- The second-most common form of dementia among the population aged 35 to 75.
- The first signs are usually memory loss, difficulties in arranging everyday living, prioritisation of issues and emotion control.
- Non-hereditary, caused by the death of cells in the basal ganglia and a part of the brain called the substantia nigra.
- Possible symptoms include visual hallucinations, confusion, daily changes in attention and alertness, sleep disorders, frequent falls, poor judgement and apathy.
- A lack of vitamin B12, thyroid disorders, long-term alcohol abuse, neurosyphilis and brain tumours could also lead to a degeneration of cognitive functions
Aware of the Warning Signs
- Being apathetic
- Unwilling to learn new things
- Declining ability in planning or decision-making
- Accusing others of stealing misplaced items
- Forgetting recent issues
- Being confused about time and location
- Being angry and anxious
suddenly - Loss of interest in previously enjoyed activities
- Difficulty in adapting to changes
- Difficulty in grasping complicated concepts
- Being more subjective
- Repeating speech or gestures
- Unable to handle personal hygiene or manage dietary needs
- Experiencing hallucinations
Keep Track of Dementia Progress
Cognitive decline progresses in broadly three stages. It’s advisable to have professional help to evaluate this. The following can be used for reference.
| Symptom | Early stage * 1st - 3rd year | Mid stage *3rd - 8th year | Late stage *8th - 10th year |
|---|---|---|---|
| Deal with complicated matters unassisted, such as managing bank accounts |  | | |
| Return home from a familiar location |  | | |
| State the approximate date and time | | | |
| Feel what’s happening around | | | |
| Express one’s thought | | | |
| Self-care in daily routine | | | |
| Bowel control | | | |
*the duration in each stage may vary depending on the quality of care.
Treatment
You may be searching for treatments when a loved one is diagnosed with dementia. Appropriate treatment and personalised community support could improve the well-being of people with dementia. Treatments come in two forms: pharmacological interventions and non-pharmacological interventions. Treatment in the early stages can slow down degeneration. Medical and social welfare sectors agree that non-pharmacological interventions should be attempted before medication is prescribed to control emotions or distressing behaviour.
Non-pharmacological Intervention
Psychosocial Activities
Improve communication and emotional well-being through socialising activities to maintain meaningful human relationships
Intelligent Stimulation Training
Improve focus, memory and skills with numbers, languages and problem-solving
Reality Orientation
Guide and remind the people with dementia to recognise things around them, including current date, time and location, to instill a sense of security and keep emotions stable
Reminiscence Therapy
Recount stories from the past to make the people with dementia feel assured and supported, and reinforce long-term memory
Art/Music Therapy
Help the people with dementia relax and express their feelings through art and music, and boost their sense of satisfaction and confidence
Other Means
Calligraphy, multisensory stimulation therapy, aromatherapy, pet therapy and horticulture therapy
Pharmacological Intervention
Drugs for people with Alzheimer's disease
- Acetylcholinesterase Inhibitors or Cholinesterase Inhibitors, such as Donepezil (Aricept®), Rivastigmine (Exelon®) and Galantamine (Reminyl®)
- N-Methyl-D-Aspartate (NMDA) Receptor Antagonists, such as Memantine (Namenda®, Ebixa®)
Drugs for improving behaviour or
psychological symptoms
- Anticonvulsants or Mood-Stabilizers
- Antipsychotics
- Antidepressants
- Anxiolytics
- Hypnotics
Drugs for non-Alzheimer's disease
- Antihypertensive drugs, diabetic and heart disease medications (for people at high risk of vascular dementia)
- Antiplatelet drugs and anticoagulants (for people with vascular dementia to lower the chance of recurrent stroke)
- Vitamins and supplements (for people with dementia related to vitamin B deficiency)
