What Do You Know about Alzheimer’s Disease? Find Out from a Geriatrician!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR TEH HOON LANG
Consultant Geriatrician
Sunway Medical Centre

21 September is World Alzheimer’s Day. We’re pleased and really appreciative of the fact that, in conjunction with this day, Dr Teh Hoon Lang has graciously shared her insight on Alzheimer’s disease with us.

IS DEMENTIA THE SAME THING AS ALZHEIMER’S DISEASE?

Dr Teh explains that:

  • Dementia is a complex brain function impairment set that interferes with daily life.
  • Alzheimer’s disease is a common type of dementia.
  • It is a progressive brain disorder characterized by the buildup of abnormal proteins in the brain.
  • This buildup will lead to a gradual decline of memory, thinking, and reasoning skills.
  • This condition will get worse over time.
An overview of Alzheimer’s disease. Click on the image to view a larger, clearer version.
  • According to some studies, over 8.5% of Malaysians aged 60 and above have dementia, with a higher prevalence among women.
  • However, note that Alzheimer’s disease and other forms of dementia can also occur to people at a younger age. They should not be considered as merely ‘old people’s disease’.
WE SHOULD BE VIGILANT & KEEP AN EYE OUT FOR EARLY SIGNS

According to Dr Teh, symptoms of dementia can be mild and hence overlooked.

“Many people may assume these symptoms as part of the normal ageing process,” she adds.

COMMON EARLY SIGNS OF DEMENTIA (OF WHICH ALZHEIMER’S DISEASE IS ONE TYPE)
  • Recent memory loss, such as being unable to recall recent events or appointments.
  • Difficulties in planning and carrying out tasks or solving problems such as following a recipe, managing their finances, or managing their own medicines.
  • Difficulty in completing familiar tasks such as cooking, driving or using appliances.
  • Confusion about time and/or place—they may lose track of the date, time, or where they are. They may also get lost in familiar places.
  • Trouble understanding visual images and spatial relationships. This can manifest as difficulties in understanding maps, following directions, judging distances, determining the size of objects, etc.
  • Problems with languages, such as difficulty finding the right words or using the wrong words during a conversation.
  • Frequently misplacing things and losing the ability to retrace steps.
  • Decreased or poor judgement. They may make poor decisions, such as giving away large sums of money or insisting on driving when they are no longer fit to drive.
  • Withdrawal from work or social activities that they used to enjoy. They may also become isolated and avoid interacting with others.
  • Changes in mood or personality such as becoming depressed, anxious, or irritable. They may also experience personality changes, such as becoming more passive or withdrawn.
CERTAIN FACTORS CAN INCREASE ONE’S RISK OF DEVELOPING ALZHEIMER’S DISEASE & OTHER FORMS OF DEMENTIA

Dr Teh shares that common risk factors include:

  • Sedentary living—not getting regular physical activity.
  • Smoking and/or excessive alcohol consumption.
  • History of head injuries.
  • Infrequent social contact and isolation. This can lead to depression, a risk factor. Thus, we, especially the elderly, are encouraged to stay socially active no matter our age.
  • Less or low levels of education in early life, as this can affect cognitive reserve—the ability of the brain to maintain our cognitive function and withstand deterioration and damage.
  • Obesity, especially during one’s mid-life.
  • High blood pressure or hypertension.
  • Diabetes, primarily type 2 diabetes.
  • Hearing impairment or individuals with hearing loss. Hearing aids may help reduce this risk.
WHY EARLY DETECTION IS CRUCIAL

Any damage to the brain is irreversible; there is no way to treat or undo the damage.

“It is important to see a doctor for an assessment as soon as possible, as early diagnosis and treatment can help to prevent or delay irreversible brain damage,” Dr Teh states.

HOW ABOUT SCREENING FOR ALZHEIMER’S DISEASE?

“According to guidelines, routine cognitive screening isn’t recommended for everyone, it’s only recommended to screen people at risk,” Dr Teh shares.

She adds, “However cognitive screening is not 100% accurate, hence, it’s crucial to educate the public about the early warning signs of dementia.”

Furthermore, some conditions may resemble dementia, such as vitamin B12 deficiency and hypothyroidism, and these can be reversed by early treatment.

INNOVATIONS OF THE PHARMACEUTICAL INDUSTRY IN DEVELOPING A TREATMENT FOR ALZHEIMER’S DISEASE

In other news, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has released a video highlighting the challenges and advances made by the pharmaceutical industry in finding means to slow the progression of Alzheimer’s disease. Have a look!

For more information, visit the IFMPA (link opens in a new tab).

Food for All: Modifying Food Texture for People With Dysphagia

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NURUL HUDA RAZALLI

FEATURED EXPERTS
AINUL SYAFIQAH MOHD AZAHARI
Nutritionist and Student of Master Clinical Nutrition
Faculty of Health Sciences
Universiti Kebangsaan Malaysia
DR NURUL HUDA RAZALLI
Dietetic Programme
Centre for Healthy Ageing and Wellness (H-CARE)
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

DYSPHAGIA: IT MEANS DIFFICULTIES IN SWALLOWING FOODS & LIQUIDS

  • Dysphagia comes from  Greek word ‘dys’, which means difficulties, and ‘phagia’, which means swallowing.
  • Medically, dysphagia is a term for swallowing difficulties. Someone with dysphagia takes more time and effort to move food or liquid from their mouth down to their stomach.
  • Episodes of dysphagia can be intermittent or progressive.
IT IS A SYMPTOM FOR MANY MEDICAL CONDITIONS
  • In adults, dysphagia is very common in adult that has a history of stroke, dementia, Alzheimer’s disease, neck cancers, and gastroesophageal reflux disease (GERD).
  • It could also be present in children with attention deficit hyperactivity disorder (ADHD), autism, Down syndrome, and cerebral palsy.
  • Dysphagia can also be a sign that there are some issues with the many nerves and muscles that are involved in swallowing activities.
YOU MAY HAVE DYSPHAGIA IF YOU EXPERIENCE THE FOLLOWING
  • Persistent drooling of saliva
  • Coughing or choking when eating or drinking
  • Bringing food back up, sometimes through the nose
  • Feeling as though food is stuck in your throat or chest
  • Being unable to chew food properly
PEOPLE WITH DYSPHAGIA FACE ISSUES THAT CAN JEOPARDIZE THEIR HEALTH & WELL-BEING

Choking and lung infection

Individuals with dysphagia are susceptible to choking. Due to difficulties in swallowing normally, consumed foods or liquids can accidentally enter the airway into the lungs. This could result in aspiration pneumonia, often known as a lung infection and can be fatal.

Poor nutrition intake
  • The prevalence of malnutrition among people with dysphagia is reported to be anywhere between 3% and 29%, which is quite a high number.
  • Malnutrition leaves people with dysphagia more vulnerable to diseases, should they not receive enough essential nutrients for optimal body function.
  • Muscle wasting, underweight, and stunting could be other issues that arise. Hence, people with dysphagia needs to be aware of any weight loss, hair loss, feeling of coldness, and fatigue as these are the early symptoms of malnutrition.
Loss of appetite and fear of mealtimes
  • People with dysphagia often lose their appetite in conjunction with their reduced swallowing ability.
  • They might develop some degree of “laziness” when it comes to drinking more often, which may lead to dehydration.
  • Because their eating experiences can be difficult, uncomfortable, and unpleasant, they may develop anxiety during mealtimes.
Inability to talk fluently
  • Dysphagia can hinder one’s ability to talk fluently and, combined with difficulties in eating, may cause the affected person to experience low self-esteem and lead to self-isolation.
  • The decrease in social engagement will give a negative impact in the person’s quality of life.
  • Thus, social support from their carer, family members, and close friends are crucial. A little extra kindness and help will give a huge impact in their life and sometimes even touch their heart.
Proper nutrition management for people with dysphagia involves providing adequate nutrients through modification of food texture and fluid consistency.

We need to also keep an eye out for symptoms of dehydration such as dry mouth or tongue, thirst, headache, and lethargy. 

Also, be alert to any unexplained weight loss, hair loss, feeling of coldness and fatigue—these could be early symptoms of malnutrition.
IF YOU ARE WORRIED THAT YOU OR SOMEONE CLOSE TO YOU HAVE DYSPHAGIA

Consult a speech language pathologist, a healthcare professional trained to diagnose dysphagia, for a proper diagnosis.

People with dysphagia can consult with dietitians for their nutritional concerns or if they want to assess their nutritional adequacy.

TIPS FOR INDIVIDUALS WITH DYSPHAGIA TO ACHIEVE GOOD NUTRITION

Understand the extent of one’s dysphagia

Discuss with the speech language pathologist and other relevant healthcare professionals on the degree of swallowing ability in the person with dysphagia.

Refer to the International Dysphagia Diet Standardization Initiative (IDDSI) Framework

This guideline has seven levels. Flow test, spoon tilt, and fork drips are used as measurement methods to determine each level.

Click to view a larger and clearer image.

Further information can be obtained from the IDDSI website (link opens in a new tab).

Modify foods into certain textures 

For more detailed information on how to modify the textures of various foods, you can refer to this page on the IDDSI website (link opens in a new tab).

  • While modifying the textures of foods into appropriate textures, take into consideration the nutritional content (carbohydrates, protein, fat, as well as vitamin and minerals). Daily meals should provide all the nutrients to improve the person’s nutritional status.
  • Always choose softer food options if texture modification is not possible. For example, choose papaya instead of apple, and ‘soften’ a dish with gravy.
  • Add special thickening powder to watery liquids. This thickening allows for easier swallowing.
Useful tips for eating
  • Have the person with dysphagia sit upright to prevent choking.
  • Have them tilt their heads to prevent liquids from going into their air passage.
  • Encourage the person to take smaller bites, and give enough time to chew the food thoroughly.
  • If small pieces of food or liquid are stuck, have them cough a little.

Dysphagia is a journey of eating experience that may switch an individual’s life 360 degree. Hence support and motivation play an important role in the management of one’s dysphagia.

References:

  1. O’Rourke, F., Vickers, K., Upton, C., & Chan, D. (2014). Swallowing and oropharyngeal dysphagia. Clinical medicine (London, England), 14(2), 196–199. https://doi.org/10.7861/clinmedicine.14-2-196
  2. Shaheen, N. A., Alqahtani, A. A., Assiri, H., Alkhodair, R., & Hussein, M. A. (2018). Public knowledge of dehydration and fluid intake practices: Variation by participants’ characteristics. BMC public health, 18(1), 1346. https://doi.org/10.1186/s12889-018-6252-5
  3. Ueshima, J., Momosaki, R., Shimizu, A., Motokawa, K., Sonoi, M., Shirai, Y., Uno, C., Kokura, Y., Shimizu, M., Nishiyama, A., Moriyama, D., Yamamoto, K., & Sakai, K. (2021). Nutritional assessment in adult patients with dysphagia: A scoping review. Nutrients, 13(3), 778. https://doi.org/10.3390/nu13030778
  4. World Health Organization. (n.d.). Fact sheets – malnutrition. https://www.who.int/news-room/fact-sheets/detail/malnutrition