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What is dementia?
What is dementia and why is it best to see a doctor if you have serious memory problems?
Forgetfulness, difficulty communicating, the feeling that you are disoriented… Many people have the first signs of dementia, but are not tested for the disease. Still, it is better to do so, says Frans Verhey, professor of geriatric psychiatry at Maastricht University. If it is clear where certain complaints come from, much suffering can be prevented. “A 60-year-old patient had all kinds of complaints that her husband attributes to a burnout,” he explains. “He kept saying that she could drive herself and that she should do more. When she was diagnosed with dementia, he was able to accept that she could no longer do everything herself.” A diagnosis also provides access to the right help, treatment, support and care. It can also take away fear. Professor Marcel Olde Rikkert, clinical geriatrician at the Radboud University Medical Center (Radboudumc) in Nijmegen: “One of my patients was very afraid of being diagnosed with dementia. The intense emotions made him deteriorate even more. When I explained that he really did have Alzheimer’s disease and what we could do for him, his anxiety lessened.” If you suspect dementia, you can contact your doctor. This one asks questions like: “What day is it?” and “What is one hundred minus seven?” After that, more extensive research can be done in a hospital, for example with an MRI scan. This makes it clear what type of dementia it is.
What is dementia?
In dementia, nerve cells in the brain and/or connections between those nerve cells are broken. As a result, the brain can no longer function properly. It is a collective name for more than fifty diseases in which this happens. Some patients deteriorate quickly, others lead fairly normal lives for years. The most common form is Alzheimer’s disease. In Alzheimer’s disease accumulations of the amyloid beta protein (plaques) occur in the brain. Alzheimer’s usually starts with forgetting new information. For example, someone forgets appointments or keeps asking how your holiday was.
After Alzheimer’s, vascular dementia, Lewy body dementia and fronto-temporal dementia (FTD) are the most common. Vascular dementia is usually caused by a combination of one or more strokes (cerebral infarctions) and damage to blood vessels in the brain. A striking feature of this disease is the slower speaking, thinking and acting. Characteristic of Lewy body dementia is that the symptoms can change from hour to hour. One moment the patient may be having a good conversation with you, the next moment he or she is confused and confused. A hallmark of fronto-temporal dementia is the change in behavior and personality. For example, someone may become compulsive. The house must be clean every day at noon and the kitchen must always be first. In particular, people over 75 can get multiple forms at the same time. For example, there may be memory loss (especially Alzheimer’s) and slower thinking and talking (especially vascular dementia).
Dementia in numbers
According to estimates by Alzheimer Nederland, there are more than 270,000 people with dementia in our country. Many patients are not in the picture of doctors. GPs have registered a form of dementia in 104,000 patients. In addition, approximately 50,000 people with dementia live in a nursing home. Some 116,000 patients have no diagnosis, but they do have to contend with brains that are increasingly unable to process information. As a result of population aging and aging, the number of patients with dementia is estimated to increase to more than half a million by 2040.
Slowing Dementia
There is not yet a drug that cures dementia. However, medicines can slightly slow down the deterioration of the brain in some patients. Which drug is a good choice partly depends on the type and stage of dementia. Four drugs against dementia are available in the Netherlands: rivastigmine, galantamine, donepezil and memantine. “These drugs can keep you more alert,” says professor Frans Verhey. “The patient may not notice the effect, but without such a drug he or she might have deteriorated more quickly. The drugs work in 10 to 16 percent of patients. They do that for about a year.”
Every little bit helps
Unfortunately, these drugs can cause side effects (such as nausea, vomiting, diarrhoea, weight loss and dizziness), but whether these occur differs per patient and is unpredictable. GPs therefore do not recommend these products in their guidelines. “Discuss the option with your GP anyway”, advises Frans Verhey. “Every little bit of health gain is taken into account. If necessary, ask for it yourself, because not all general practitioners have sufficient knowledge about these drugs.”
Global Research
Scientists worldwide are discussing how to proceed with research into Alzheimer’s disease, the most common form of dementia. Continue on this road or stop? Alzheimer Nederland summarizes the discussion: “Some researchers think that a possible drug against the accumulation of proteins in the brain cannot work, because according to them that accumulation is only a by-product of Alzheimer’s disease. Others think that this clustering of proteins is a first disease process that can aggravate other disease processes. Evidence has been found for both theories. Research must show what the answer is.” Last year, Radboudumc in Nijmegen stopped drug studies into the proteins that accumulate in the brains of Alzheimer’s patients. Clinical geriatrician Marcel Olde Rikkert of Radboudumc: “The greatest chance of success comes from a combination of active ingredients, including medicines against cardiovascular diseases and drugs such as rivastigmine. There is increasing evidence that diseases of the heart and blood vessels are harmful to the functioning of the brain. The effects of such a combination drug must be investigated.”
Stay active
Over time, the brains of dementia patients continue to deteriorate. It is also important for this phase that the patient receives a diagnosis in time, say professors Verhey and Olde Rikkert. Frans Verhey of Maastricht University: “It can happen that the patient suddenly becomes restless and confused, which necessitates admission to a nursing home. Without a diagnosis, this takes much longer, because then a series of tests and forms follow. That is not pleasant in an emotionally difficult period. Getting the diagnosis is therefore also a form of planning for the future.” How can you delay the last phase as long as possible? “Stay active, because that slows down the decline and can help to prevent depression,” emphasizes Marcel Olde Rikkert of Radboudumc. “And do what suits you. For example, one of my patients had been a medical specialist. We helped him best with short philosophical conversations and writing down his life story together. Another patient, an old farmer, was helped more with a weekly ride on his tractor with co-driver. Safe on your own farmland.”
Sources):
- Plus Magazine