Dementia in the elderly is not normal because frequent forgetfulness, constant confusion, and loss of previous memories can impact behavior and daily life to the point where they cannot care for themselves. Close ones must always monitor and observe symptoms for timely care and treatment.

What is Dementia?

Dementia is a condition where brain function and the nervous system decline. It is caused by a reduction in active brain cells and loss of brain cells in various areas, leading to memory loss. It often begins with short-term memory loss followed by long-term memory impairment, thinking, decision making, planning, learning, emotional changes, social interaction, which goes beyond normal aging forgetfulness to significant memory loss affecting daily life. It is commonly found in older adults aged 65 and above. However, those with certain genetic disorders, such as Down’s Syndrome (Down’s Syndrome) , or brain conditions causing functional loss, such as stroke, nervous system infections, or brain injury from accidents, may experience dementia at a younger age as well.

What Causes Dementia?

• Neurodegeneration is commonly found in people over 65 years old, with Alzheimer’s Disease being the most common condition. Other conditions include Parkinson’s disease-related dementia and Frontotemporal Dementia.
• Stroke is found in elderly individuals with underlying conditions that affect blood vessels, such as diabetes, hypertension, high cholesterol, etc.
• Neurosurgical conditions such as cerebral hemorrhage, brain or meningeal tumors, Normal Pressure Hydrocephalus.
• Infection with viruses or bacteria in the central nervous system, such as meningitis, encephalitis.
• Vitamin B12 deficiency seen in individuals with absorption issues, such as certain diseases or medications preventing vitamin absorption, or those who have had stomach surgery, or individuals not obtaining enough vitamins from food, such as vegetarians.
• Dysfunctional systems in the body, such as thyroid dysfunction, liver failure, or chronic kidney disease.
• Exposure to toxins, certain medications, or substance abuse.
• Certain psychiatric conditions, such as Depression or Bipolar Disorder.
• Severe brain injury, such as oxygen deprivation, continuous seizures, prolonged low blood sugar, or brain injury from accidents.

How to Observe Dementia Symptoms

• Short-term memory loss
• Confusion about time and place
• Inability to learn new things, poor concentration, inability to focus on one thing for long
• Mood swings, irritability, easy anger, aggression
• Increasing communication problems, such as inability to communicate as before, misnaming objects, stuttering or stammering
• Depression, lack of enthusiasm, passiveness
• Loss of self-care abilities in various aspects, such as bathing, eating, excretion, or inability to do tasks or activities previously done, like driving, planning tasks, self-medication, or independent decision making

Stages of Dementia

Dementia is divided into 4 stages according to brain function and patient symptoms:

• Stage 1 Early-stage Dementia results in loss of ability to perform complex tasks, yet individuals can still manage basic self-care like bathing, dressing, eating, and using the restroom. Emotional issues such as depression or irritability can accompany.
• Stage 2 Mid-stage Dementia involves slight loss of basic self-care ability, understanding problems, learning deficits, and beginning loss of decision-making abilities. Occasionally, psychiatric symptoms like delusions or hallucinations may appear.
• Stage 3 Severe Dementia involves the loss of almost all cognitive abilities, inability to perform basic daily activities independently, and incontinence. Close supervision is necessary.
• Stage 4 Bedridden Dementia or Final Stage involves total dependency, inability to move, eat, or communicate, with potential complications like malnutrition, various infections, and risk of pressure sores.

Dementia Risk Factors

• Increasing age
• Certain genetic factors
• Individuals with underlying diseases increasing vascular risk such as hypertension, diabetes, hyperlipidemia, chronic liver or kidney disease
• Taking certain medications affecting brain function, such as Anticholinergic Drugs, and substance abuse
• Heavy alcohol consumption (more than 21 units per week; 1 unit = 8 grams of alcohol)
• Smoking
• Severe brain injuries
• Exposure to air pollution, especially PM 2.5
• Hearing or visual impairments
• Depression
• Physical Inactivity, such as lack of movement or exercise
• Social isolation or lack of interaction, like during Covid-19 quarantine.

How to Diagnose Dementia

• History taking and physical examination with information from the patient’s close ones
• Testing neurological function, such as memory, concentration, spatial orientation, thinking, language, and emotional states, like depression, through various tests
• Blood tests to identify causes of dementia, such as thyroid function, electrolyte levels, liver function, kidney function, vitamin levels, etc.
• Brain imaging using basic tools, such as CT Scan or MRI Scan
• Sometimes, additional specialized tests like Electroencephalogram–EEG, cerebrospinal fluid analysis, or Positron Emission Tomography–PET Scan are necessary
• Blood tests for Alzheimer’s markers, a new technology recently introduced in Thailand in the year 2567, conducted only in certain cases

How to Treat Dementia

Dementia treatment depends primarily on the cause, symptoms, and severity. Treatment is divided into:

1. Non-drug Dementia Treatment focuses on stimulating brain exercises, such as playing games, behavior adjustment, exercise, and environmental modifications, while educating caregivers or families to create proper understanding and prepare for addressing patient symptoms.
2. Drug Treatment for Dementia Patients depends mainly on the doctor. Most medications are for symptom relief and slowing brain degeneration, taken per medical advice only.
3. Surgical Treatment for Dementia Patients is considered in cases where a neurosurgical cause of dementia, as mentioned, is identified.

How to Prevent Dementia

Most dementia arises from neurodegeneration, which cannot be cured. However, maintaining consistent health care and addressing and managing certain risk factors can slow brain and disease symptom deterioration, such as:

• Maintaining diabetes, blood pressure, and cholesterol within normal ranges
• Correcting hearing impairments or abnormal vision
• Avoiding medications or substances damaging to the brain
• Brain exercises, regular physical activity, and social interaction
• Managing stress appropriately, ensuring sufficient sleep
• Avoiding smoking, alcohol, substance abuse, and brain injuries

Dementia Specialist Physicians

Dr..Chaisak Dumrikarnlert is a neurologist and a specialist in behavioral neurology and dementia at the Hospital for Brain and Bones

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Hospitals Specializing in Dementia Treatment

The Hospital for Bones and Brains is ready to find causes, care, rehabilitate, and prevent dementia with a team of brain specialists, nurses, multidisciplinary team, and state-of-the-art treatment technologies to reduce severity and help patients regain confidence in their lives.

Memory Screening Package

Memory screening package starting at 23,000 Baht

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