Some Facts to Help You Understand Better What Dementia Is

WORDS LIM TECK CHOON


The World Health Organization reveals that about 10,000,000—that’s ten million—new cases of dementia are diagnosed every year.

In Malaysia, the Alzheimer’s Disease Foundation shares that 204,000 to 264,000 adults were diagnosed with dementia in 2020, and they expect the numbers to rise to between 637,500 and 825,000 by 2050.

DEMENTIA IS ACTUALLY A GENERAL TERM THAT COVERS CONDITIONS IN WHICH ONE EXPERIENCES SIGNIFICANT DECLINE IN COGNITIVE FUNCTION

Consultant geriatrician Dr Teh Hoon Lang explains that the decline should be significant enough to affect one’s thinking, memory, and social skills until it impedes their ability to carry out their usual day-to-day routines.

DEMENTIA IS A TERM THAT INCLUDE A NUMBER OF CONDITIONS INCLUDING
  • Alzheimer’s disease, the most common one
  • Frontotemporal dementia, a rare form that usually develops in people younger than 60
  • Lewy body dementia
  • Vascular dementia, caused by blood vessel damage that interrupts blood and oxygen flow to the brain
  • Mixed dementia, a combination of two or more types of dementia
THERE ARE MANY FACTORS THAT CAN INCREASE ONE’S RISK OF DEMENTIA

“These factors can be divided into modifiable and non-modifiable risk factors,” Dr Teh says.

Non-modifiable risk factors—things that we can’t change—include:

  • Advancing age
  • Being female
  • Certain types of dementia can be passed down from parent to child; however Dr Teh assures us that having a gene for one of these types of dementia is not a surefire guarantee that the person will develop that type of dementia

Meanwhile, modifiable risk factors include:

  • Diabetes mellitus
  • High blood pressure or hypertension
  • Obesity
  • Excessive alcohol consumption
  • Smoking
  • Depression
  • Traumatic brain injury
  • Sedentary lifestyle
  • Social isolation
  • Mid-life hearing impairment
  • Air pollution

“The more risk factors a person has, the higher their chances of getting dementia,” Dr Teh says.

TEN EARLY WARNINGS OF DEMENTIA TO WATCH OUT FOR
  • Memory loss
  • Difficulty performing familiar tasks
  • Problems with language
  • Disorientation to time and place
  • Poor or decreased judgement
  • Problems keeping track of things
  • Misplacing things
  • Changes in mood and behaviour
  • Challenges understanding visual and spatial information
  • Withdrawal from work or social activities
WHERE TO SEEK HELP IF YOU BELIEVE THAT YOUR LOVED ONE MAY HAVE DEMENTIA

It is fine to consult a general practitioner or GP, who can refer your loved one to a specialist if necessary.

A geriatrician is a specialist that can help with dementia in older persons, and other types of specialists such as neuropsychologists and psychiatrists may also step in to help.

DEMENTIA CAN’T BE CURED, BUT IT CAN BE SLOWED DOWN

Dr Teh shares that there is no cure for dementia at the moment.

However, she assures us that there are many measures or strategies to slow down the progress of the disease and provide both the affected person and their caregivers a better quality of life.

“The most important part of dementia care is to get diagnosed early and get professional advice on the management plan,” says Dr Teh. “Every person with dementia is unique and the approach should be individualized. The basic principles of care include understanding the disease pattern and the struggles or difficulty they are facing, providing a supportive environment, maximizing their strength and minimizing their loss due to cognitive decline.”

Food for All: Modifying Food Texture for People With Dysphagia

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NURUL HUDA RAZALLI

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