As Singapore confronts an ageing population, diseases associated with the ageing process are rising to the fore. In this article, we clear up certain misconceptions and impart some basic knowledge on common neurodegenerative disorders.
by Shaun Tan Yi Jie
"The scene of mortal existence closes, after a great length of time, to which, very fortunately, few of the human species arrives. The system returns to the imbecility of the first epoch of the infancy,” commented Pythagoras (6th century BC), in one of the earliest references to age-related mental deficiency.1
It is apparent that the condition of cognitive decline in aged individuals has long been a recognised affliction. To the average Singaporean, however, disorders of the brain can be mystifying, with more than 50 per cent of the general public rating themselves as low in such knowledge.2 Dementia, Alzheimer’s and Parkinson’s are familiar words that we come across every now and then in the news, but what are the differences between them?
Dementia, known as 老人痴呆症 or 失智症 in Mandarin, is the generic term used to describe a loss of cognitive function (memory, thinking, etc) and the ability to perform everyday tasks, beyond what is expected of normal ageing. It is a syndrome, not a disease. It is caused by diseases that affect the brain, such as Alzheimer’s and stroke.
Alzheimer's disease (阿滋海默症) is an irreversible degeneration of the brain that causes disruptions in memory, cognition, personality and other functions that eventually lead to death from complete brain failure. It is the most common form of dementia, accounting for 50 to 75 per cent of dementia cases.3
Parkinson’s disease (帕金森症), discovered by James Parkinson nearly a century before his counterpart Alois Alzheimer, is also a neurodegenerative disorder, but mainly impacts the motor system instead. It is diagnosed when a person exhibits two or all of these symptoms: slowed movement, muscle rigidity and tremor at rest.
Therefore, if you have Alzheimer’s, you have dementia; if you have Parkinson’s, you have impaired movement, but you may or may not get dementia. If you do, it is called Parkinson's disease dementia, which occurs in about 30 to 40 per cent of Parkinson’s cases, and can show up as late as 10 to 15 years after the initial onset of Parkinson’s. 4Part of the confusion is due to the fact that most people with Parkinson’s do experience at least some mild cognitive impairment such as slower thinking speed and clouded memory, but it is crucial to note that mild cognitive impairment does not equal dementia.
Let’s bust some myths
Poor publicity and social stigma have led to many misconceptions arising apropos such diseases. These myths stand in the way of understanding them and helping those affected.
Memory loss = dementia: Not necessarily. You may experience trouble with your memory as you age, and find that you cannot perform rational thinking as quickly as before, which is perfectly normal. However, it is not normal to struggle to remember basic things like how to make a pot of coffee or where you live. When this happens, it is best to see a doctor.
Alzheimer’s and Parkinson’s are diseases of the elderly (老人病): While these diseases are usually diagnosed in people in their 60s, there is a small but appreciable percentage of people who are afflicted early. Approximately five per cent of Alzheimer’s and 10 per cent of Parkinson’s happen before 60 years of age.5,6 On the other hand, although age is a risk factor for these diseases, ageing itself is not a direct cause; it is possible to be over 100 years old without significant cognitive deficits. As the Roman philosopher Cicero (1st century BC) observed, “senile debility…is a characteristic, not of all old men, but only those who are weak in will,” and further suggested that an active mental life could prevent or at least postpone mental failure, a suggestion that still rings true today.1
If my parents have it, I will get it too: Yes and no. Less than five per cent of people inflicted with Alzheimer’s/Parkinson’s get it due to inheritance of a specific gene.7,8 However, having relatives with the disease is thought to increase the risk when coupled with other factors such as ageing and smoking.
There is a cure: Someday, hopefully, this will come true. Currently, however, they remain incurable. Nevertheless, there are medications to help manage symptoms, slow down the progression of the disease and improve the patient’s quality of life. For example, in June 2015, the U.S. Food and Drug Administration approved the Brio Neurostimulation System for Parkinson’s.This deep brain stimulation device sends pulses through the body to reduce symptoms such as tremors. “This new device adds to the array of treatment options to help people living with Parkinson’s and essential tremor enjoy better, more productive lives,” said William Maisel, acting director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health.9 Hence, there is no reason to give up on life upon diagnosis.
They are preventable: Because the causes of both diseases are poorly understood, there are no prevention strategies available. But this does not mean that everyone will get it. WHO published its first guidelines in May this year, putting physical activity at the top of its list of recommendations for minimising risk of cognitive decline, along with a healthy diet and abstinence from smoking and alcohol. "While there is no curative treatment for dementia, the proactive management of modifiable risk factors can delay or slow onset or progression of the disease," WHO Assistant Director General Ren Minghui wrote in the report.10
Visiting a person with dementia is not worth it because they will quickly forget you were there: Dementia affects people differently. Some people might have a harder time with communication and thinking but may remember that you visited them. Research has also shown that the feelings created by the visit often last longer than the specific memory of the visit.11 In other words, long after you leave and even if the person has forgotten that you were there, the good feelings that come from sitting down together for a cup of coffee and a chat may remain.
Do’s and don’ts for caregivers
As the disease progresses, behavioural changes of the patient can be particularly taxing on the caregivers. The person may show signs of agitation, delusions, mood fluctuations and increased impulsivity. It might help to keep these tips in mind:12,13
- Do keep calm and be patient when talking to your loved one. Keep in mind that false accusations and anger at you are products of the disease, not your loved one.
- Do gently ask if you can help them out. Many patients refuse to proactively seek help in performing daily tasks that have become difficult due to fear, pride, or a desire to live as before.
- Do not say “do you remember?” This can cause anger or embarrassment.
- Do not argue or point out mistakes. If they say something that is not correct, just go with the flow of the conversation. Otherwise, it just makes them feel bad and might cause them to stop talking.
- Do not talk about them with other people as if they are not there.
- Do not speak to them like a child. Some people think that using "baby language"—speaking in a high pitch voice, using terms of endearment instead of names, and approaching the person as if they were a child—is helpful. This practice has been termed “Elderspeak”. It is patronising and has been correlated in research with an increase in challenging behaviors in the patient.14
While the elderly population in Singapore increases and cures remain elusive, it becomes even more imperative to promulgate strategies to minimise the risk of contracting these diseases. Maria C. Carrillo, chief science officer of the Alzheimer’s Association in the United States, said there was substantial evidence that there were things people could do to reduce the risks. "During the last two decades, several studies have shown a relationship between the development of cognitive impairment and dementia with…lifestyle-related risk factors, such as physical inactivity, tobacco use, unhealthy diets and harmful use of alcohol."10
It is never too early, until it is too late. Start a healthy lifestyle today.
Shaun Tan Yi Jie has recently graduated from the National University of Singapore (NUS). He will commence his PhD studies in Chemistry at NUS in August.
- 1Berchtold, N. C.; Cotman, C. W. Neurobiol. Aging 1998, 19 (3), 173–189.
- 3Burns, A.; Iliffe, S. BMJ 2009, 338 (b75).
- 4Pagonabarraga, J.; Kulisevsky, J. Neurobiol. Dis. 2012, 46 (3), 590–596.
- 5Eeden, S. K. V. D.; Tanner, C. M.; Bernstein, A. L.; Fross, R. D.; Leimpeter, A.; Bloch, D. A.; Nelson, L. M. Am. J. Epidemiol. 2003, 157 (11), 1015–1022.
- 6Zhu, X. C.; Tan, L.; Wang, H. F.; Jiang, T.; Cao, L.; Wang, C.; Wang, J.; Tan, C. C.; Meng, X. F.; Yu, J. T. Ann. Trans. Med. 2015, 3(3), 38.
- 7Bekris, L. M.; Yu, C.-E.; Bird, T. D.; Tsuang, D. W. J. Geriatr. Psychiatry Neurol. 2010, 23 (4), 213–227.
- 8Klein, C.; Westenberger, A. Cold Spring Harb. Perspect. Med. 2012, 2 (1), a008888.
- 11Guzmán-Vélez, E.; Feinstein, J. S.; Tranel, D. Cogn. Behav. Neurol. 2014, 27 (3), 117–129.
- 14Williams, K. N.; Herman, R.; Gajewski, B.; Wilson, K. Am. J. Alzheimers Dis. Other Demen. 2008, 24 (1), 11–20.