I. Overview of dementia
As society progresses and the aging of the population accelerates, more and more diseases of old age are coming our way, among which Alzheimer’s disease (dementia) is a common disease that places a heavy burden on the patient’s family and society.
So what is Alzheimer’s disease? Alzheimer’s disease is a brain disease of progressive decline of brain cells. Due to the normal memory and executive functions of the brain cells in charge, once the elderly suffer from this disease, their thinking, memory and executive functions will gradually deteriorate until it affects their ability to live a normal life, and it is the fourth cause of human death after cardiovascular disease, diabetes and cancer.
There are now more than 24 million people living with dementia in the world, and the number is doubling every 20 years, reaching 42 million by 2020 and 81 million by 2040.
Every 7 seconds, a new person with dementia is born worldwide
China is a country with a population of 1.3 billion, and if the elderly population accounts for 10%, there are about 130 million elderly people. According to statistics, the prevalence of dementia among people over 65 years old is about 5%, and the prevalence rises gradually with age, and the prevalence of dementia among people over 85 years old is about 30%.
China’s population is aging before it gets rich, and with the special family structure of 4:2:1, China’s population is aging early and fast. Therefore, dementia patients in China account for 40% of the Asia Pacific region and about 1/4 of the world. China has become the number one country in terms of dementia, and our country is the hardest hit by dementia in the world.
Alzheimer’s disease is a serious public health problem: the prevalence of disability among dementia patients is 30.8%, the mortality rate is 48.9%, the hospitalization rate is 29%, and mental behavior abnormalities account for 75% of dementia patients. The high cost of treatment and care, as well as the cost of lost work for family members, make dementia a constraint on socio-economic development, and its harm far exceeds that of stroke.
However, public awareness of dementia is still very low, and there are still misconceptions – “old confusion is not a disease”, “there is no cure for the disease, no need to see it”. “rehabilitation is useless, the brain is too tired for the patient”, and there is also the problem of shame, other diseases will take the initiative to go to the hospital to see, only Alzheimer’s disease is considered bad to hear, children also feel disgraceful, do not advocate the elderly to go to the hospital to see, so early intervention and early treatment is lost such an opportunity.
Patients with Alzheimer’s disease rarely go to the hospital on their own initiative. For example, according to some statistics, only 14% of people with mild dementia go to the hospital, 25% of people with moderate dementia go to the hospital, and 34% of people with severe dementia go to the hospital on their own initiative.
Therefore, the current situation of dementia in China: three highs and three lows.
Three highs: high prevalence, high disability rate and high burden.
Three lows: low consultation rate, low diagnosis rate, and low treatment rate.
Second, the ten danger signs of dementia
1, memory is declining, affecting daily living activities
For example: putting salt twice in stir-fry, forgetting to turn off the gas after cooking
2. Difficulty in handling familiar things
For example: difficulty in performing daily household chores: not knowing the order of dressing, the steps of cooking
3.Difficulty in language expression
For example, forgetting simple words, saying or writing sentences that are difficult to understand
4. Increasingly confused about time, place and people
For example, not remembering what day it is, what day of the week it is, or what province you are in
5. Judgment is diminishing
For example, wearing a cotton jacket in the hot sun but a thin coat in the winter
6. Decreasing comprehension or ability to organize things rationally
For example, not being able to keep up with other people’s conversations, or not being able to pay various bills on time
7. Often put things in inappropriate places
For example, putting the iron in the washing machine
8.Emotional instability and behavior seems abnormal than before
Such as: rapid emotional ups and downs, become moody and unpredictable
9.Change in personality
Such as: can become suspicious, indifferent, anxious or rude, etc.
10.Loss of initiative to do things
Such as: spend all day, no interest in the previous hobby
When the above signals should be alert. If you experience any of these problems within a few months, you should see a doctor.
Third, what are the differences between Alzheimer’s patients and people with general forgetfulness?
(a) Alzheimer’s patients: cannot remember what happened, even after repeated reminders, while the average amnesiac: only forgets some part of what happened, and usually recalls it when reminded.
Alzheimer’s patients lose the ability to recognize their surroundings, do not know where they are and gradually lose the ability to take care of themselves without any trouble, their thinking becomes more and more dull, their language becomes more and more impoverished, and they lack a sense of humor; while general amnesiacs have no loss of cognitive ability to recognize time, place, people’s relationships and their surroundings, can take care of themselves in daily life, are quite distressed by the memory loss, and often remember a Memorandum
Myth.
It is normal to have a bad memory when you are old, it does not matter
Correct understanding.
Some elderly people have normal memory loss, but some people should be alert to Alzheimer’s disease. It is important to go to the hospital in a timely manner, early detection, early treatment to benefit from early.
Misconception.
There is nothing you can do if you have Alzheimer’s disease, it can’t be cured anyway, so don’t bother so much
Correct understanding.
Alzheimer’s disease is a gradual aging process, mild and moderate patients with treatment will slow down the progress of the disease, and can even restore some of the functions through treatment
Fourth, what are the manifestations and hazards of Alzheimer’s disease?
Memory impairment is one of the main symptoms that can be seen continuously from the early stage to the end of dementia
Doing things to lose things, in serious cases can not remember the home phone, friends’ names, and even some patients forget to turn off the tap or gas, causing safety hazards /
1.Time and place recognition disorder
Orientation disorder refers to the patient’s ability to locate in space and time. Moderate patients often get the evening and morning wrong, make a lot of noise, and some patients clearly get lost near their homes
2.Language communication disorder
Patients can’t understand what their family members say, often answer questions that are not asked, other people can’t understand what they say, and those who used to read newspapers can’t read after the disease.
3. Cognitive and judgmental impairment
In the early stage, patients often forget to pay for groceries, or do not remember how much they paid, and make mistakes in simple addition and subtraction.
4.Ability to take care of oneself
Eating, dressing, urinating and defecating, and washing up will gradually become impaired, early patients can take care of themselves, moderate patients need the assistance of others to complete; severe patients completely lose the ability to take care of themselves, and may even be bedridden for a long time.
5.Disability of daily living ability
Basic life skills, such as using the telephone, cooking, cleaning, chatting with others, etc., will be impaired.
6.Emotional and behavioral changes
Insomnia, nervousness, fear, anxiety, depression and other symptoms may occur, and a few patients may become emotionally unstable, easily lose their temper, and in the advanced stage, they may not care about others, their families and the outside world.
7. Abnormal mental and behavioral symptoms
Some patients think they are not in their own homes and often ask to go home, think they have not retired and ask to go to work, etc. Many patients keep wandering all day long, or follow caregivers, or ask to go out at night, etc. They repeatedly move things and pack clothes. Some patients collect garbage or waste, some patients show reduced activity, sitting
8.Eating and sleeping disorder
The main manifestations are reduced diet and weight loss. Most of the moderate to severe patients have malnutrition, some patients do not know how to eat enough, eating too much, insomnia is very common, some patients sleep during the day, noisy at night, some patients wander around at night
V. Dementia grading
Dementia can be classified into many grades. There is no unified international consensus on grading, but the World Health Organization (WHO) has simply divided dementia into three levels (stages).
Mild dementia: The patient can perform most activities of daily living without assistance.
Moderate dementia: The patient can perform activities of daily living with partial help from relatives, and the patient often needs the company of others. Cannot remember time, often forget where they live when they go out, easily get lost
Severe dementia: The patient is completely dependent on others for care and attention. The patient only remembers things that were familiar to him/her a long time ago, but quickly forgets new things that happened. He/she is completely unable to take care of himself/herself, and needs to be taken care of when eating, dressing and bathing.
VI. Who is prone to dementia?
Older people: dementia occurs in 6% of people over 65 years old and 30% of people over 85 years old.
Genetic factors: People with siblings and parents who have the disease are at several times greater risk than the average person.
People with low education, women, high blood pressure, high blood cholesterol, cardiovascular disease and diabetes
Lifestyle habits: full stomach, over-nutrition, unbalanced nutrition
Previous head trauma
Environmental factors
Smoking, excessive alcohol consumption
Retirement
Death of a family member or friend
Major change in environment
Suffering a major blow
VII. Where to go to see a doctor?
Go to a psychiatric, neurological or geriatric department or memory disorder clinic in a hospital accompanied by someone who knows the patient well.
What information does the patient need to provide?
Age; any recent changes in memory, language, judgment, comprehension, ability to perform daily activities, mood, and personality; any recent physical discomfort; past medical history, including cardiovascular disease, trauma, recent illnesses and treatment; any family members with similar illnesses.
What kind of tests does the patient need to undergo?
Neuropsychiatric examination: neuropsychological test
Imaging tests: computed tomography (CT), magnetic resonance imaging (MRI), SPECT or PET scan
Other auxiliary examinations: cerebrospinal fluid examination, electroencephalogram, electrocardiogram, special hematological examination, genetic examination
VIII. Benefits of early diagnosis for patients and families
For patients.
1.Early help the patient to have a clear understanding of the development of the disease
2.Convey information about the cause and prognosis of the disease
3.Provide an opportunity to discuss problems and arrange the future
4.Help them to seek resources and treatment more actively
For family members.
1. Help caregivers recognize early on the care issues they will face and their role
2.Help them seek resources and help early on
3. provide an opportunity to discuss prognosis and organize work life
IX. What should the patient do when dementia is detected?
Keep an optimistic attitude – you should accept the reality of the disease, face the inconvenience of the disease, keep a positive attitude, face the disease optimistically, and have hope
Stay in touch with the environment – go for walks with others, be with people who can share your happiness; join a patient’s home, communicate with other patients, do not close and isolate yourself, go out and do more activities
Seek early medical treatment – receive medication and take it regularly for a long time
Live each day well – do what you like and remember the important and meaningful things in your life
Enjoy every moment – feel the joy of life in nature
Keep up hobbies – such as cooking, gardening, fishing or sports
Promote early treatment and long-term standard treatment
Medications to improve dementia symptoms or slow progression
Acetylcholinesterase inhibitors: – Donepezil, Rivastigmine, and Galantamine – The FDA has approved them for mild to moderate AD, and donepezil is also approved for the treatment of severe AD.
Memantine (ebselen), a noncompetitive N-methyl-D-aspartate (NMDA) antagonist, has been approved by the FDA for use in patients with moderate to severe AD, and the drug may provide modest benefit with few side effects; therefore, it may be considered for patients with moderate to severe AD [I]. There is some evidence that meperidine may benefit patients with mild AD [III], the
neurotrophic agents, drugs that improve cerebral circulation, etc.
Cognitive function training: medication can be accompanied by training under professional supervision to further improve the patient’s cognition. Indoors, one can do simple chores with the patient, such as cooking, sweeping, drying and collecting clothes; look at old photos with the patient to recall previous events and use various gadgets to help the patient train cognitive abilities and prevent memory degradation; choose different activities according to the mild, moderate and severe degree of the patient’s condition.
Proper care: Without good care, the disease will progress faster and it will affect the efficacy of medication.
X. Care for patients with dementia
Graded care
Principles of care for patients with mild dementia
Pay attention to the patient’s diet, nutrition and daily hygiene, urge the patient to take care of his own life, participate in various social activities, contact the surrounding environment, and do not let the patient go out alone to avoid disorientation.
Principles of care for moderate patients
Moderate patients need to do simple self-care with the assistance of caregivers, help the elderly to do something at their own pace, do not blame him, encourage and comfort him appropriately, correct the elderly with patience when they make mistakes, do some simple games with the elderly, let him experience the fun of participation
Principles of Care for Severe Patients
Severe patients have lost the ability to take care of themselves. Caregivers need to take care of the elderly for eating, dressing and cleaning, etc. Patients who are bedridden for a long time should prevent bed sores from occurring, turn over and scrub regularly. Eat more fiber-rich things, help patients to take the initiative to move around and exercise gently
Home environment
Avoid changing the layout of the home as much as possible
The facilities inside the home should be easy for the elderly to move around and facilitate ventilation and lighting.
Toilets should be sit-down toilets with grab bars
The floor should be flat and dry, and the floor tiles should be non-slip with no obstructions.
Home furnishing
Room colors should be bright and peaceful, so that the room is rich in joy and a sense of warmth
furniture to avoid glass or mirrored glass furniture.
the height of the bed should be low, to facilitate the elderly up and down, with guardrails on both sides of the bed
The home environment should be safe and enclosed.
Install a signaling system to prevent the patient from wandering outside.
Food and Drink
A reasonable nutritional mix, with more light foods.
Prevent eating too little or too much.
avoiding foods that can easily cause bodily harm, such as foods that are too hot.
for patients with poor eyesight, cutlery should preferably be placed in a brighter place and cutlery should preferably be in brighter colors; patients who are offered too many types of food at one time will be overwhelmed
not eating with sharp knives and forks.
not to eat sticky food and to give solid and liquid food separately
not scolding the patient when he/she may stain his/her clothes while eating
Feeding the patient taking care to lift the bedridden person to avoid choking.
Precautions for special situations
Bring cards and bracelets when going out – with name, address, contact person and contact information, inform neighbors and janitors to keep an eye on their whereabouts, avoid living alone and using dangerous objects such as gas, prevent falls and burns, prevent inadvertent falls – patients living on upper floors Be vigilant
For those who have impulsive, injurious, self-injurious, escape and other pathological behaviors, pay attention to prevent put dangerous objects, scissors, rope, matches, rodenticide, etc. at home to collect well to avoid accidents
Avoid going out
For patients with serious special behavior or unstable condition, try to avoid their activities outside, if necessary, hospitalization
XI. What should I do if the patient is lost?
Stay calm and seek help – if the patient is lost, the caregiver should stay calm, try to look in the neighborhood, call the police as soon as possible, and provide basic information and recent color photos of the patient
Reassure the patient – When the patient is found, remember to reassure the patient and take the patient back to a familiar place
”Preventing Alzheimer’s begins with focusing on memory health.”
Brain health care is something that should be done from a young age, even from birth. A bad lifestyle is definitely detrimental. Exercise is good for the brain, stringing and chatting, keeping communication between people, developing some hobbies: singing and dancing, playing cards and chess, playing mahjong, learning computer, playing games on the computer, etc. To diligently use the brain more brain, because the brain is used into the waste, the more the better.