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Dementia Prevention and treatment

Dementia Prevention and treatment Best Ways for Prevention of Dementia and its Treatment

-For Living a Better Cognitive Life

Taking off from where we left earlier- Memory loss Part 1  and Part 2 – we now move on to the prevention and treatment of memory loss or Dementia. Treatment of dementia with full recovery is difficult, but prevention is very much possible.

I recommend that you read this article till the end. To know if you are at risk for getting dementia, assess your risk by using this article

As we proceed, I will come to this risk assessment in detail.

Before we do that, let’s see what the numbers say about Dementia worldwide and that in India specifically.

What is the state of affairs regarding Dementia/ Alzheimer’s disease in India?

According to the World Health Organization, worldwide 🌐 , the number of patients scenario of dementia is as follows:-

  • Worldwide, around 50 million people have dementia, and there are nearly 10 million new cases every year.
  • Out of the total, about 60 to 70% are that of Alzheimer’s disease.

In India, research shows that 5 to 6% of the older adults aged 65 to 70 years suffer from memory loss and progress to Alzheimer’s disease.

Alzheimer’s Disease is the most common type of Dementia and about 5-6% of people in the age group of 65-70 years in India suffer from this problem.

That is why it is very much important to study more about Dementia, even as the whole world is grappling with the scourge of the COVID-19 pandemic. 

Click this link here to know more.

How to know whether you are going in for Dementia?

Are there any early signs/ symptoms of dementia?  Yes, definitely, a few tell-tale signs which indicate that you or your loved one is going in for Dementia. These are as follows:-

  1. Failing to remember appointments;
  2. Forgetting where you have kept your things like important documents,  keys, etc.;
  3. Can’t remember having taken his or her meals- this may occur a few minutes of just having one’s meal;
  4. Disturbed sleep- a person may get up in the middle of the night and feel as if he has overslept;

As a General Physician, I  usually use the GPCOG test method to decide the Risk of Dementia in a patient. Click here to more about GPCOG

Click this link  here to know more about the cause of dementia in India.

The good physician treats the disease; the great physician treats the patient who has the disease -William Osler Click To Tweet

Prevention of Dementia-

Can we prevent or delay the onset of dementia? Yes, certainly we can. Before we proceed, I would like you to read this beautiful story about caring for your parents if they have dementia.

Now, back to preventing dementia- read on-Infography to showing 6 ways to prevent Dementia

1.Eating right- The Diet

Dementia Prevention and treatment- Diet to prevent Dementia
Diet for Dementia-Infographics source-Dreamstime.

The food that we eat has its effect on almost all parts of the body. E.g., –

  • Eating foods rich in saturated fats or trans fats are not good for the heart(link) and can increase cholesterol levels ( link)
  • A high protein diet is detrimental to chronic kidney disease( kidney failure) and gouty arthritis.
  • Alcohol binging can lead to liver cirrhosis and the loss of memory(Wernicke- Korsakoff disease).

All the above eating habits can also speed up memory loss. The picture below shows what to avoid and what to eat 🤔 to prevent Dementia.

 

Avoid these foods to prevent Dementia
Avoid these foods to prevent Dementia

 

 

 

Foods to eat to prevent Dementia
Eat these foods to prevent Dementia

 

 

 

 

 

 

 

 

Daily consumption of nitrate-rich vegetables such as spinach and swiss chard may prove invaluable in the prevention of neurodegenerative diseases such as dementia and Alzheimers-(Source-Medium.com). There is evidence that foods rich in a chemical called flavanols( that which gives color to fruits and vegetables) can improve your memory- (read here for more).

2. Control blood pressure well if you are under treatment for dementia

Hypertension( link) is a primary cause of Silent Stroke in many people ( we will discuss this in a separate article). If you are undergoing treatment for high BP, be regular to avoid silent stroke s it can also lead to loss of memory.

3. Control your blood sugar if you are a diabetic if you have dementia

Long-term Diabetes causes many complications if not controlled well. One of them is a Stroke. A stroke can damage the memory center in the brain. Those who control their blood sugar well can avoid this complication and memory loss.

4. Regular exercise can help you prevent dementia

Exercise is something which keeps one fit in life from all angles, namely-

  • It helps burn fats, thereby reducing blood cholesterol, which may be causing narrowing of arteries in the brain
  • Keep your heart ticking
  • Improve joint health, especially the knees, and keep you running
  • Maintain your body weight

All these points above also help improve the overall health of the brain- the seat of memory.

5. Avoid head injury to avoid getting dementia

Head injuries are known to cause loss of memory by-

  • Direct injury to the brain causing sometimes irreparable damage
  • The pooling of blood below the skull and compressing the brain

Most of the head injuries occur in vehicular accidents, more so in two-wheeler accidents. Sometimes a fall on the head while climbing or getting down the stairs, mostly in older people, can cause similar effects in a vehicular accident.

6. Taking medicines-

Patients suspected to be going in for memory loss will have to take medicines that can slow down or halt the progress of dementia. These are discussed in detail in the section below. The patient’s family members have to be very regular and prompt while giving medications to ensure that the progress of dementia is arrested.

7. Stop taking Narcotic drugs-

Drugs like cannabis, LSD, etc., can cause dementia.  If any family member or your relatives or friends are on to drugs, do your best to wean them off by counseling them or admitting them to a De-addiction center.

To know more about the prevention of dementia, read here- link.

Here is another good article by Dr. Michael Hunter on how you can prevent Dementia- link

Now that we know how to prevent Dementia let’s move on to the treatment part. Read on-

Treatment of Dementia- Medications

Know different parts of the brain to prevent Dementia
Different parts of the brain.[Source- Pinterest -click for a better view]

Before we proceed to treatment with medicines, let us briefly recollect about the sites in the brain which is concerned for memory storage and/or memory loss- the seat of memory>>this picture-

We should now concentrate on the Temporal part of the brain, which gets affected by dementia and Alzheimer’s disease.

Parts of the brain that store memory and prevent Dementia
Parts of the brain showing the seat of memory[Source-Pinterest-Click for a Better view]

 

 

 

 

 

 

In the temporal region, we have a part called the Limbic System, which contains these areas-

Some medicines work on the limbic system, particularly the hippocampus. Now we can proceed with knowing what medicines are effective and when.

There are 2 major types of memory loss-have a look at this diagram-Different types of Memory loss leading to Dementia

The treatment is based on which type of memory loss a person has.

There are a variety of medicines 💊 for Dementia that can –

  • Halt the progress
  • Control signs and symptoms
  • Improve  memory  📝

In this article, I will only highlight ✨ some of the medicines briefly as these medicines cannot be purchased over-the-counter. These medicines are to be taken strictly under the guidance of a Neuro physician or a Neuropsychiatrist.

Treatment of Dementia-Medicines 💊 to halt the progress

Dementia typically progresses from Mild Cognitive Impairment to full-fledged Alzheimer’s disease. There is no particular drug to prevent or halt this progress. However, there are few medicines to slow down cognitive impairment, and they are as follows:-

  1. Donepezil[ Donep]
  2. Galantamine[ Galamer]
  3. Rivastigmine[ Rivamer]
  4. Memantine[ Admenta]

These medicines are available in different strengths and combinations depending on the stages or severity of the disease. However, one should not self-prescribe these drugs and be taken strictly under a neuropsychiatrist’s supervision.

Treatment of Dementia-Medicines 💊 to Control the Signs and symptoms

Treatment of Dementia also includes some medicines to treat underlying conditions such as Depression, Irritability, Anxiety, Restlessness, Sleeplessness, Tremors of hands, etc. These are some of the medicines-

  1. Alprazolam[ Restyl,Trika,Alprax]-for sleep disturbance
  2. Levodopa[Syndopa]-for tremulousness
  3. Anti-depressant and ani-anxiolytics like-Mirtaz, Pexep, Prodep, Nexito, etc.

Again, these medications are to be taken strictly under the supervision of a Neuropsychiatrist.

Treatment of Dementia-Medicines 💊 to improve Memory

Your Family Physician can prescribe these medications. They are namely-

  1. Ginkgo Biloba[Gingkocer Plus]
  2. Piracetam[ Cognix]
  3. Ayurvedic medicine like Brahmi and Shankhapushpi( Memorin capsules).

The above medicines are useful in Mild Cognitive Impairment. They can improve memory by halting or partially reversing the progress of dementia.

In India, we are blessed with a low rate of Dementia. Read here to know why India has the lowest rate of dementia.

Here are some useful links for the care and the treatment of dementia of the elderly in India:-

1.Link:- Alzheimer’s Association

2.Link:- Evexius Healthcare

3.Link:- Samarth Eldercare

4. Link:- Padirac Innovation 

Finally, if you have someone at home who has dementia and needs help, you can consider moving that person to a place where they care for people with dementia like this place- Carefordementia

Before we wind up, I would recommend you all to-

  • Read this handy blog on caregiving in Dementia- link
  • Listen to this podcast

You can also read this article for a To Do List For Dementia to improve Memory and mental health.

Memory loss due to Silent Stroke

To know memory loss due to Silent Stroke, we should understand what happens in a stroke. This will be discussed in a separate article in the coming days.

In the meantime, you can learn to calculate your risk of getting a stroke by clicking on the link given below.

Stroke Risk Calculator

Check,Change,Control- link

 

 

 

Dementia-Part 2

Loss of Memory Part 2-

What are the Investigations in Memory loss and how to get it done

A Meme on Memory Loss

Introduction-

Welcome back to Part 2 of the series on Loss of Memory. In my last article[Click here in case you have not read it], we discussed the brain’s different parts and their function. Taking off from there, we proceed ahead to learn about the causes and the investigations of Memory Loss.

What are the common causes of Loss of Memory?

Loss of Memory icon
I can’t remember a damn thing!

Before we take up the investigations, let’s see what the common and uncommon causes of loss of memory are-

  1. Old Age-very common. As with other organs of the body, our brain also changes from aging. The brain is known to shrink in size.
  2. High blood pressure- hypertension ( read here to know how)
  3. Head Injury-Most of the head injuries, either due to a fall on the head or due to some vehicular accident, can lead to brain compression due to blood accumulation in a particular area of the brain. In this case, there is a temporary loss of memory.[I will explain this with an example below]
  4. Infection of the brain like Encephalitis.
  5. Drinking Excessive Alcohol – According to research, excessive alcohol causes brain damage, termed Alcohol-Related Brain Damage{ABRD}. Alcohol🍸 affects the area of the brain 🧠 called the Wernicke’s area, where there are nerve cells that help in the comprehension of speech.  

    A person with ARBD may experience all of these types of damage. The
    different types of damage are linked to different types of ARBD. For
    example, Wernicke–Korsakoff syndrome is most closely linked with low
    levels of thiamine [vitamin B1]-Source- Alzeimhers.org.uk

  6. The lack of or absence of blood supply to the part marked Broca’s area and Temporal lobe of the brain.
    Parts of Brain and their functions
    Parts of the brain and their functions- Source-Pinterest

    This mostly causes a condition called stroke resulting in loss of memory and paralysis of some body parts. Sometimes there is a minor cut-off of blood supply leading to temporary memory loss. This is termed Silent Stroke, wherein the patient may complain of weakness of some parts of the body like one hand or leg. He or she may not be able to recall what he/she said a few moments ago.

What’s the difference between Memory loss due to Dementia and a Silent Stroke?

In this article, I will discuss everything about Dementia, which usually occurs as we age.

Read on-

Memory loss due to Dementia/Alzheimers disease-

You must have noticed the changes occurring in our body as we age, namely-

  1. The appearance of wrinkles on the face;
  2. Greying of hair;
  3. Shortening of our height-due to loss of calcium from the vertebral bones;
  4. Changes in our vision- due to cataract of the lens of our eyes, thinning of the retina;
  5. Slowing down of our ability to walk, etc., etc.

As with other parts of the body, the all-important learning center and the center for recollecting and memory-The Brain- also ages accordingly. The ability to grasp what is being said, understand what is being said, and recollect most of the things that have been said also declines. This is the condition which we call Dementia-leading to Memory loss.

What happens in our brain that leads to Dementia?

Our brain is something like a modern computer where data is stored in a place called the Hard-Disk. Similarly, there are parts in the brain, such as the hippocampus, which is the seat of our memory.

Like the computer, which has a memory chip present in the hard-disk and is connected to different parts of the computer by parts called software, our brain has millions of nerve cells called neurons. These are connected by extensions called dendrites.

The dendrites are connected by ends called synapses. These synapses can get disrupted, causing malfunction of brain activity due to to-.

  • Lack of oxygen
  • Reduced supply of energy-giving glucose
  • Some infection in the brain

A Case Study

These conditions mentioned above are the more common ones you come across day-to-day. But there are some conditions like sudden grief[read here] or a head injury that can also lead to temporary memory loss. Like, for instance, this patient who I came across while I was in the second year of my MBBS course-

A 45-year-old male patient was brought to the General Hospital, Solapur, in an unconscious condition. He was badly beaten up with severe injuries to his head. He was being treated by the Civil Surgeon, Dr.Hoshang, at that time.

Dr.Hoshang explained to our group of students, as part of the surgical posting, all the intricacies of head injury that had led this person to this present condition- he was in Coma. The reason for him being in a coma[a state of deep unconsciousness] was a large clot of blood that had formed due to internal bleeding. It was compressing the cortex of the brain.

Dr. Hoshang removed the clot surgically and slowly, over the days, the brain expanded to its normal size. The patient started recovering and was soon out of the coma and regained consciousness. But, as a side effect of the brain’s compression, he had lost his memory and was unable to remember anything. He could not recollect –

  1. His name;
  2. Where was he from;
  3. What happened to him that landed him in the hospital.

Over a period of two weeks, he regained his memory completely and was able to recollect everything. This condition is called Temporary Amnesia.

What is Alzheimer’s disease?

Alzheimer’s disease is one type of dementia and also the most common one to occur. In this type of dementia, there is a loss of memory causing-

  1. Difficulty in retaining recent information. For example, if he has been told to repeat, say the names of a few people he may know, he may not do so.
  2. Inability to recall recent events like conversations, songs which he has just heard, etc.
  3. Trouble in tracking upcoming events like attending an invitation to a party, marriage, etc.
  4. To make repetitive comments ( like the case mentioned above)

You can take a small break here and listen to this short podcast to know more about Dementia and Alzheimer’s disease

 

Are there any tests or investigations to detect Memory Loss?

Yes, there are two tests, namely-

A] The Montreal Cognitive Assessment(MoCA)-

This test is to be carried out by a person trained in this test, such as Neuro physicians or Neuropsychiatrists. The figure shown below is an example of how this test is done.

Montreal Cognitive Assessment test for assessing Memory loss
The Montreal Cognitive Assessment test for assessing Memory loss[Source:-Click here for a better view-Pinterest].
Here the patient’s mental status is evaluated by making them answer a set of questionnaires presented to them as shown above. The level of dementia or memory loss is then calculated as per the points shown on the right-hand side. There is a set of 30 questions that the patient is made to answer.

  • A score of 26 and above is considered Normal.
  • A score of 21 to 26 goes in favor of mild memory loss.
  • A score between 16 to 20 confirms Alzheimer’s disease.

B] The Mini-Mental State Examination test-

This a similar test to MoCA. It is also carried out to judge the mental status of a person suspected of memory loss. This is how it looks like-

Mini Mental State Examination test for Memory loss
Mini-Mental State Examination test for Memory loss[Source:- Click this link for better view-Pinterest]

 

 

You can Download both these tests and evaluate if you are going in for dementia or memory loss. That way, we can take further steps to prevent it[more in Part 3 of this series]

Are there any blood tests /any other tests to detect impending Dementia or Alzheimer’s disease?

Research shows that there are certain proteins responsible for changes in the way we remember and forget. These proteins are-

  1. The tau proteins-p-tau217
  2. Amyloid proteins

These proteins can be detected in the blood by using tests known as Bio-markers – namely-

  1. Certain proteins called Amyloid-beta peptides floating in the blood
  2. A fat-binding protein called apolipoprotein E.

The levels of these protein components are high in the blood in patients with dementia or those going in for Memory Loss. You can get these tests done here in India.

Another way to find is by doing a brain scan called the PET scan. This scan shows the p-tau and amyloid plaques formed tangles in the brain, causing the cells to store the memory to die. For PET scan in India, Click Here.

Watch the video at the end of this article to know how exactly this happens.

What happens in Dementia or Alzheimer’s causing Loss of Memory? The high levels of these proteins in the brain cause plaques and tangles in the brain’s nerve tissues. Watch this very short video- a GIF- showing the involvement of the above-mentioned proteins in causing changes or disruptions in the nerve tissues in the brain leading to the tangles and plaques –

A short video showing what happens in the brain causing Loss of Memory
A short video showing what happens in the brain causing Loss of Memory

Here is another video that will explain to you in detail exactly how these proteins affect our brain leading to loss of memory- link

I have covered almost all the essential tests to rule out memory loss/dementia/Alzheimer’s disease. Before we leave, kindly listen to this podcast on investigations in Memory loss.

We stop here today. But before we go, did you know that the food we eat influences our brain 🧠 health? Here is a very good article that I came across that tells us how eating highly nutritive food cannot only help us keep our general health in good shape as well as our brain health-  Procerahealth.com

In my next blog, which will be published shortly, we will discuss the prevention and treatment of memory loss/dementia/Alzheimer’s disease.

Those with dementia are still people and they still have stories and they still have character and they're all individuals and they're all unique. And they just need to be interacted with on a human level. Carey Mulligan Click To Tweet
Picture reflecting loss of Memory
Dementia- Part1

Memory Loss-Part 1

How to Prevent Loss of Memory and live a Healthy Cognitive Life

Memory Meme

Introduction

As the elderly population increases due to improving lifestyle, doctors are confronted with many cases of Memory loss. If you look at the picture just above the introduction, you can see what I  mean- as we get older, this can be a situation. You will be downright happy to retain your memory and be proud of it, too! Nobody in his or her right mind would like to end up losing his or her memory. Just imagine, if one of your loved ones were to lose their memory, how would you feel about it.

Flashback-

Stressful life is another trigger for Memory Loss. I experienced this first hand when I visited my grandmother 25 years back. My grandmother- my mom’s mom- lived at our native place called Kumbla, a small town on the Kerala- Karnataka border in India. ” Mowma, kashi asa?” I  asked her in Konkani, our mother tongue meaning’ how are you.’ Mowma is grandma in Konkani.

She just stared at me and replied ” Kon re tu? Kasa katir Ayla? Amtlya khampu kayi na.” Meaning ‘Who are you? Why you have come here? We do not have anything to be stolen for’.

My ‘ mowma’ had lost her memory. She was excellent till my uncle got married and left her. My uncle was the only son among six daughters of my grandparents. And he was her heart and soul.

After he left, she went into depression, which ultimately culminated in a total loss of memory. And this devastated all of those who considered her near and dear.

I was her favorite grandson. She did not recognize me. Imagine how I must have felt when she looked at me and asked me those questions!

Apart from memory loss, she had also lost  her her spatial orientation- she had forgotten to use the toilet for her daily routine. She used to urinate and defecate whenever and wherever she was placed at that moment without any inhibitions!

This condition is called Alzheimer’s disease- a type of Dementia or memory loss.

What does it mean to Age Well?

In the past, we have heard people saying, ” The Older, the Wiser.” But, the present-day situation has changed- not every adult older adult is wise. In fact, in many cases, it’s just the opposite- old age has brought with it changes in forgetfulness in some older people. So much so that these people have been put up in Old Age Homes for caretaking.

To age well and keep our memory intact, we have to take care of our brain from as early as our adolescence. How to do it is the purpose of writing this article.

This article is very exhaustive, as we have to understand exactly how, why, and what about losing our memory. So, I have decided to break up this article into 3 parts to for you understand it better

  1. Part 1-where we will discuss all things about the brain and the part responsible for our memory-The Seat Of Memory:
  2. Part 2-where we will discuss tests and investigations for Memory Loss;
  3. Part 3– where we will discuss how to prevent/treat memory loss.

For whom is this article can be useful?

This article has been written not only with older people in mind but also for the younger generations. Why the younger generation? Because the process of memory loss starts much before we reach old age.

Preventive measures are best taken from a young age. After a particular age, say in the 30s and 40s, changes start occurring in the brain, which may not be reversible. I will come to the prevention part as we go ahead.

Where do we stand now?

As the days go by, and as the longevity of many of us increases, we may have many more and more cases of Memory loss. Possibly surpassing almost other causes of old age diseases such as hypertension and diabetes.

Changes in cognition occur as we age. As we age, so does our brain. Just like in heart disease, changes start taking place in the brain naturally due to to-.

  1. Lack of blood supply due to the formation of  plaques in the arteries[similar to that in the heart vessels];
  2. Rupture of blood vessels leading to what is commonly known as Stroke or Brain Hemorrhage.

Our brain is a complex structure. It is full of nerve cells and nerve fibers that connect with connectors called synapses. There are parts in the brain responsible for our memory- I will try to simplify it for better understanding.

{This article here will help you understand the science behind Memory Loss in a better way- link( inside the brain) }

Which part/ parts of the brain are involved in Memory loss?

Before we proceed ahead, let’s see how the brain looks, its different areas, and what function they carry out. Observe- your brain appears like a walnut kernel with the skull bones protecting it just like the outer shell of a walnut[see the picture below]-

Resemblance of wlnut and human brain
The resemblance of walnut and human brain[ Source-Pikrepo]

Let’s now have a look at these two pictures in detail to understand the different parts of the brain and the seat of memory-

Fig.1

The seat Of Memory in the brain
The seat of Memory in the brain-Click on the link to expand-Source-Pinterest

Parts of the brain with their function
Parts of the brain with their function[Source-Click here to expand> Pinterest]
Here we are concerned mostly with areas marked Temporal Lobe and Frontal Lobe in the second picture. These two areas represent our mental abilities- the ability to remember, carry out intelligent tasks, etc. Injury to these areas like a head injury or hemorrhage will affect these areas causing loss of memory.

Are all the parts of the brain interconnected with each other?

All parts of the brain are directly connected. How? You may ask by nerve cells called Neurons that have branches called dendrites. Let’s say you have –

  1. Lost the smell-This sensation comes under the olfactory area- an area marked as the Parietal lobe in Fig 1. For example, if you close your eyes and are made to smell a crushed garlic pod, and you cannot tell what it is, then the memory stored in this area may have been lost. This can be a short term memory loss. This is exactly what happened to many of the COVID-19 patients-the Coronavirus had affected those parts of the brain-area no.2 and 8.
  2. Can’t remember how one person appears or looks– This can occur if an Occipital lobe area has been affected.

Could this Memory loss be a case of what we doctors call Senile Dementia, or could it be a Silent Stroke?

Elderly woman
An old age picture

Many of us are familiar with words like Dementia, Alzheimer’s disease(AD), Parkinson’s disease (PD), etc. You may have also heard someone saying, ” He is demented- don’t listen to him.” Now, in this sentence,  the word demented means foolish. But, in medical terms, Dementia means loss of Memory or Cognition. When it occurs in the elderly, we call it Senile Dementia.

As we age, the brain’s blood supply can get disrupted ( as mentioned above)in a small way. This can lead to the death of a few brain cells causing what we call a Silent Stroke. Here again,  there can be changes in one’s memory, and the person may not remember recent events.

Now, What does this ‘Cognition’ mean?

In simple words, Cognition is the ability to remember and reproduce what we remember. A decline in cognition is called Memory Loss.

We shall stop here as I have come to the end of Part 1 of the Memory Loss Series. Hope you have understood the basic anatomy of the brain and its function. Kindly read and re-read this article because I shall be using many of the words used herein in my next article-especially the link I have provided on Inside the Brain.

You may also listen to this Podcast-Understanding The Brain to know more about the brain.

In my next part, which will be published shortly, we will discuss-

  1. The causes of Memory loss
  2. Dementia and Alzheimer’s disease
  3. Tests and investigations for the above-mentioned illnesses.
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