Treating and Delaying Dementia

1. What is dementia and why should you go to the doctor with serious memory problems?

1. Forgetfulness, difficulty communicating, feeling disoriented… Many people have the first signs of dementia, but cannot be tested for the disease. Nevertheless, it is better to do so, says Frans Verhey, professor of geriatric psychiatry and affiliated with Maastricht University. If it is clear where certain complaints come from, a lot of suffering can be prevented. â € œA 60-year-old patient had all kinds of complaints that her husband knows about burnout, ”he explains. â € œHe kept saying that she could drive a car herself and that she needed to do more. When she was diagnosed with dementia, he could accept that she could no longer do everything herself. ”A diagnosis also gives access to the right help, treatment, support and care. It can also take away anxiety. Professor Marcel Olde Rikkert, clinical geriatrician at the Radboud university medical center (Radboudumc) in Nijmegen: â € œOne of my patients was very afraid of the diagnosis of 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 fears eased.â € If you suspect dementia, you can go to the doctor. This asks questions such as: “What day is it?” And “What is a hundred minus seven?” Afterwards, more extensive examination can be done in a hospital, for example with an MRI scan. This makes it clear what type of dementia it is.

2. Forgetfulness, difficulty communicating, feeling disoriented… Many people have the first signs of dementia, but cannot be tested for the disease. Yet it is better to do so, says Frans Verhey, professor of geriatric psychiatry and affiliated with Maastricht University. If it is clear where certain complaints come from, a lot of suffering can be prevented. â € œA 60-year-old patient had all kinds of complaints that her husband knows about burnout, ”he explains. â € œHe kept saying she could drive a car herself and that she needed to do more. When she was diagnosed with dementia, he could accept that she could no longer do everything herself. ”A diagnosis also gives access to the right help, treatment, support and care. It can also take away anxiety. Professor Marcel Olde Rikkert, clinical geriatrician at the Radboud university medical center (Radboudumc) in Nijmegen: â € œOne of my patients was very afraid of the diagnosis of 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 fears eased.â € If you suspect dementia, you can go to the doctor. This asks questions such as: “What day is it?” And “What is a hundred minus seven?” After that, more extensive examination 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?

1. In dementia, nerve cells in the brain and / or connections between those nerve cells break down. 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 rapidly, others lead a reasonably normal life for years. The most common form is Alzheimer's disease. In Alzheimer's disease, accumulations of the amyloid beta protein (plaques) arise in the brain. Usually, Alzheimer's starts with forgetting new information. For example, someone forgets appointments or keeps asking how your vacation 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 (strokes) and damage to blood vessels in the brain. A striking feature of this disease is slower talking, thinking and acting. A characteristic of Lewy body dementia is that the symptoms can change from hour to hour. One moment the patient may have a good conversation with you, a moment later he or she is disturbed and confused with thoughts. A hallmark of fronto-temporal dementia is the change in behavior and personality. For example, someone can become compulsive. The house must be clean every day at noon and the kitchen must always be first. People over 75, in particular, can take several forms at the same time. For example, there may be memory loss (especially Alzheimer's) and slower thinking and talking (especially vascular dementia).

2. In dementia, nerve cells in the brain and / or connections between those nerve cells are destroyed. 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 rapidly, others lead a reasonably normal life for years. The most common form is Alzheimer's disease. In Alzheimer's disease, accumulations of the amyloid beta protein (plaques) arise in the brain. Usually, Alzheimer's starts with forgetting new information. For example, someone forgets appointments or keeps asking how your vacation 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 (strokes) and damage to blood vessels in the brain. A striking feature of this disease is slower talking, thinking and acting. A characteristic of Lewy body dementia is that the symptoms can change from hour to hour. One moment the patient may have a good conversation with you, a moment later he or she is disturbed and confused with thoughts. A hallmark of fronto-temporal dementia is the change in behavior and personality. For example, someone can become compulsive. The house must be clean every day at noon and the kitchen must always be first. People over 75, in particular, can take several forms at the same time. For example, there may be memory loss (especially Alzheimer's) as well as slower thinking and talking (especially vascular dementia).

Dementia in numbers

1. 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. General practitioners have registered 104,000 patients as having some form of dementia. In addition, approximately 50,000 people with dementia live in a nursing home. Some 116,000 patients do not have a diagnosis, but they do have to contend with brains that are increasingly unable to process information. As a result of population aging and as we age, the number of patients with dementia is estimated to increase to over half a million by 2040.

2. 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. General practitioners have registered 104,000 patients as having some form of dementia. In addition, approximately 50,000 people with dementia live in a nursing home. Some 116,000 patients do not have a diagnosis, but they do have to contend with brains that are increasingly unable to process information. As a result of aging and aging, the number of patients with dementia is estimated to increase to over half a million by 2040.

Slowing down dementia

1. There is not yet a drug that cures dementia. However, medicines can slow down the deterioration of the brain in some patients. Which drug is a good choice depends in part on the type and stage of dementia. Four medicines for dementia are available in the Netherlands: rivastigmine, galantamine, donepezil and memantine. â € œThese means can keep you more alert, â € says professor Frans Verhey. â € œThe patient may not notice the effect, but without such a remedy, he or she may have deteriorated more quickly. The means work in 10 to 16 percent of the patients. They'll do that for about a year.â €

2. There is not yet a drug that cures dementia. However, medicines can slow down the deterioration of the brain in some patients. Which remedy is a good choice depends in part on the type and stage of dementia. Four medicines for dementia are available in the Netherlands: rivastigmine, galantamine, donepezil and memantine. â € œThese means can keep you more alert, â € says professor Frans Verhey. â € œThe patient may not notice the effect, but without such a remedy, he or she may have deteriorated more quickly. The drugs work in 10 to 16 percent of the patients. They'll do that for about a year.â €

Every little bit helps

1. Unfortunately, these drugs can cause side effects (such as nausea, vomiting, diarrhea, weight loss and dizziness), but their occurrence varies from patient to patient and cannot be predicted. GPs therefore do not recommend these drugs in their guideline. Â € œDiscuss the option with your doctor anywayâ €, advises Frans Verhey. â € œEvery little health gain is included. If necessary, ask for them yourself, because not all GPs have sufficient knowledge about these remedies.â €

Worldwide research

1. 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: â € œSome 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 exacerbate other disease processes. Evidence has been found for both theories. Research must reveal the answer. Last year, the Radboudumc in Nijmegen stopped drug studies into the proteins that accumulate in the brains of Alzheimer's patients. Clinical geriatrician Marcel Olde ÂRikkert of Radboudumc: â € œThe greatest chance of success is a combination of active substances, consisting of, among other things, medicines against cardiovascular diseases and agents 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.â €

Stay active

1. Over time, the brains of dementia patients continue to deteriorate. It is also important for this phase that the patient is diagnosed in time, say professors Verhey and Olde Rikkert. Frans Verhey of Maastricht University: â € œIt can happen that the patient suddenly becomes restless and confused, making admission to a nursing home necessary. Without a diagnosis, this takes much longer, because then a series of tests and forms follows. That is not pleasant in an emotionally already difficult period. Getting a diagnosis is therefore also a form of planning for the future.â € How can you postpone the final phase for as long as possible? â € œStay active, because that slows down the deterioration and can help prevent depression, â € emphasizes Marcel Olde ÂRikkert of Radboudumc. â € œAnd 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 his life story together. Another patient, an old farmer, was more helpful with a weekly ride on his tractor with co-driver. Safe on your own farmland.â €