How do we recognise the symptoms of dementia and when should we seek medical help? HEMA VIJAY discusses the problem that affects the elderly with experts

It is a tricky to diagnose dementia because it manifests itself in many ways, and the early signs are often difficult to recognise. Dementia means a progressive decline in the ability to remember, to think and to reason. Dementia is not normal ageing or accelerated ageing, but a qualitative and quantitative change in the brain's function, explains veteran geriatrist, Dr. V.S. Natarajan.

Sometimes, patients do realise the onset of dementia and may be the first to know; others don't realise they have a problem and say, I am fine, my family is imagining things', elaborates Dr. V. L. Arul Selvan, consultant neurologist, Apollo Hospitals. For instance, there was an English professor who got wary about his mental state when he noticed he couldn't find the right words during lectures, while all along he had been so fluent. On the other hand, a person whose gamut of activities is limited may not display tell tale signs of dementia; but when guests come visiting, they may notice the changes.

Changed behaviour

There may be behavioural changes an irritable person may suddenly become quiet; a person choosy about food earlier may now eat whatever is put on his plate. There are those who may forget words and start speaking ungrammatically or telegraphically in broken sentences using just a few words. Some may become withdrawn, while others may forget learned processes when given a brush and paste, they may spread the paste on the handle rather than the bristles. Forgetting people, where objects had been kept, important dates, losing social inhibitions and forgetting behavioural norms are some effects of dementia.

Initially, some of these changes may seem harmless, but serious symptoms develop later. Initially, trivial things are forgotten; later, they forget important data such as their own door number, warns Dr. Lakshmi Vijaykumar, psychiatrist. One elderly man started handing out money to everyone who asked for it. He gave Rs.10,000 to an auto driver who was probably expecting Rs.500. It means he has lost his sense of judgment, explains Dr. Arul Selvan. Then, there was an elderly person who passed urine in front of everybody, without feeling embarrassed dementia has robbed him of social learned behaviour. So, be alert to changed behaviour and loss of memory in those aged 60 and above. Don't wait till the problem gets too bad.

The dementia test

Thankfully, there are simple tests available to evaluate mental function and diagnose dementia even its early stages such as the MMSE test that consists of a series of questions that takes just 10 minutes to administer. There are the very quick Clock Drawing test, the MOCA test, and the Clinical Dementia Rating tests, which are a comprehensive screening tool used for detection of dementia as well as for follow up. These tests can be performed by competent geriatrists, psychiatrists and neurologists. While doing these tests, the individual's vision, hearing, etc. have to be taken into account, as he may have good mental function but may not be able to demonstrate this because of tremors, Dr. Natarajan cautions.

A small percentage of people in the age group 60 to 70 get dementia. One-third of the population aged above 85 gets dementia. So, anyone reaching the age of 70 should take the test for dementia, regardless of the symptoms. In case of a family history of dementia or past history of head injury, dementia tests should be taken even when the individual is in his fifties. In our country, vascular dementia is common because of rampant diabetes and hypertension, and this affects younger people too, remarks Dr. Arul Selvan.

Treating the condition

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Could it be dementia?