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Ann-Merita Golding | Dementia - The living nightmare we need to better understand (Part 2)

Published:Wednesday | September 7, 2016 | 12:00 AM
Ann-Merita Golding

In a previous article, I pointed out that dementia is not a specific disease but rather refers to a group of symptoms related to cognitive impairment which can be caused by a number of different diseases and conditions. The result is progressive memory loss and overall cognitive dysfunction. Dementia is a global problem affecting millions of people. It is expected that dementia will become more common as the population ages. It will take on increasing significance as a public-health and social issue, as more elderly persons will choose or be forced to live independent lives.

Mild Cognitive Impairment (MCI) refers to minor changes in what may be considered a person's normal ability to think or perform relatively simple tasks. These include frequent memory lapses, abnormal exercise of judgement and decision-making, difficulty in sequencing steps to complete simple tasks, as well as deficit in visual perception, speech and language abilities. Manifestations include difficulty in recalling familiar names, forgetting recent events or discussions, or where common objects were placed.

These changes may be difficult to discern at first but will become increasingly noticeable if not to the individuals themselves, to their family members and friends who spend sufficient time with them. In many cases, they do not affect the individual's ability to function in regular or routine activities, but research has shown that persons with MCI are at increased risk for developing various forms of dementia, and approximately 10-15 per cent develop Alzheimer's disease.

Many of these symptoms may also be common in an individual who has had too much to drink or may be experiencing side effects of certain medications, including prescription pain medication, etc. MCI can occur without significant memory loss. However, when it is accompanied by memory and language impairment, a person so affected is significantly more likely to develop some form of dementia within a four-year period from the onset of symptoms.




Alzheimer's disease has been categorised in three stages: mild, moderate, and severe/late stage.

In mild AD, individuals encounter difficulty in properly carrying out everyday tasks such as preparing meals, managing personal finances, using household appliances, etc. Individuals may become disoriented in unfamiliar locations such as a shopping centre. Individuals may even fail to recall recent or daily events.

In the moderate stage of AD, individuals demonstrate more functional decline, including difficulty keeping track of changes in date, time and place and challenges in basic things such as personal hygiene and dressing oneself, requiring spousal/caregiver assistance. In this stage, the ability to drive is compromised, and individuals may become a danger to themselves and others. They may also become withdrawn and non-communicative.

Individuals suffering from severe Alzheimer's disease become heavily dependent on caregivers to function and even survive. They are unable to move around on their own and may even be bedridden. Intelligible vocabulary, verbal coherence and reading and writing become significantly limited. Involuntary movements may become spasmodic and individuals are likely to become incontinent. Primitive reflexes (grasp and sucking responses, teeth grinding, etc.) may appear. These patients are vulnerable to opportunistic infections such as pneumonia or other related illnesses, e.g., stroke, heart failure, etc. especially for those predisposed for these ailments.




- Advancing age is one of the most common risk factors for developing Alzheimer's disease and other dementias, as one in every nine persons over 65 years suffers from dementia.

- Family history is also an important risk factor, as those who have immediate family members with Alzheimer's are more likely to develop the disease.

- Cardiovascular disease resulting from hypertension, high cholesterol, physical inactivity, diabetes, smoking and obesity are all associated with increased risk of developing Alzheimer's and other dementias.

- Traumatic brain injury such as brain injuries from accidents and falls poses increased risk of Alzheimer's disease and other dementias. Research has shown that even moderate head injuries double the risk of developing the disease.

- Genetic mutations have also been established as a notable risk factor for Alzheimer's disease. Particular mutations have been associated with early onset, which can develop before age 65 and as young as age 30 in some cases.

Alzheimer's disease accounts for a considerable number of dementia cases and proper care and management can be overwhelming for caregivers. It is important to seek professional evaluation at the earliest possible stage to determine the precise nature of the dementia and to tailor appropriate management. This can make a huge difference to the quality of life of both the patient and caregivers. I will suggest how this can be approached in a further article and provide further information on the other types of dementias and changes that can be expected.

- Ann-Merita Golding, MS,CCC-SLP, is a speech-language pathologist, licensed and certified by the American Speech-Language Hearing Association (ASHA). Email:;