In August 2015, the International Institute for Dementia (ADI) released a global report of dementia, estimated 9.9 million new cases of dementia by 2015, with one person suffering from dementia every 3 seconds. The world’s population of dementia in 2015 is 46.8 million, and by 2050 the number will be as high as 131.5 million. The cost of care spent on dementia is estimated at $ 818 billion in 2015, and by 2018 will exceed $ 1 trillion.
How To Treat Dementia?
According to the results of the epidemiological survey of the dementia patients commissioned by the Dementia Association of Taiwan (100 years of the Ministry of Health and Welfare) and the demographic data of the Ministry of the Interior in September 105, The number of MCI patients was 563,147 (18.45%); the number of dementia patients was 243,430 (7.98%), including 98.747 (3.24%) patients with mild dementia, 144,683 patients with mild dementia Person, accounting for 4.74%). In other words, over the age of 65 for every 13 people that have dementia, and 80 years of age over the elderly is every five individuals who have dementia.
According to this epidemiological survey results, the prevalence of dementia every five years of age were: 65 to 69 years 3.40%, 70 to 74 years 3.46%, 75 to 79 years 7.19%, 80 to 84 years 13.03%, 85 ~ 89 years 21.92%, more than 90 years old 36.88%, the greater the prevalence of the higher the higher the age, and the prevalence of every five years that the trend of doubling (Table 1).
Table 1: prevalence of dementia in the five-year-old age group
Age (years) 65 ~ 69 70 ~ 74 75 ~ 79 80 ~ 84 85 ~ 89 ≧ 90 years old
Prevalence of dementia (%) 3.40 3.46 7.19 13.03 21.92 36.88
According to the demographic data of the Ministry of the Interior of the People’s Republic of China in September 105, and the prevalence rate of dementia among the five-year-olds, 243,430 persons, were aged 65 or above in Taiwan in September, 30-64-year-old prevalence of dementia According to the International Association of dementia information for the one thousandth, estimated 30-64-year-old Taiwan dementia population of 12,658 people, plus 65 years of age or more dementia population, estimated Republic of China 105 According to the total population of Taiwan at the end of 105, the total number of people with dementia will be more than 260,000 by the end of this year (Table 2). According to the National Development Committee’s population projection, That is, one in every 100 people in Taiwan is dementia.
Taiwan’s dementia population will continue to rise
The Taiwan Dementia Association estimates the total population growth in the country based on the National Development Council’s “Population of the Republic of China (105-150)” announcement in August 105, plus the prevalence of dementia at five years. The results are as follows (Table II), the Republic of 120 years of deceased population of more than 460,000 people, then every 100 Taiwan people have two dementia; 130 years of dementia population of more than 660,000 people, 100 Taiwanese have more than three Dementia; 140 years of the deceased population of more than 810,000 people, every 100 Taiwanese have four dementia; 150 years of dementia population of more than 850,000 people, nearly every 100 Taiwanese approximately 5 dementia. The next 45 years, the average number of individuals with dementia in Taiwan increased by 36 people **; every 40 minutes *** increase the speed of growth of dementia, the Government, and the public should be prepared as soon as possible.
Republic of China 105 years 110 years 115 years 120 years 125 years 130 years 135 years 140 years 145 years 150 years
National total population 23,546 23,718 23,720 23,529 23,095 22,422 21,565 20,577 19,502 18,373
30-64 years old
Persons with dementia 12.65 12.55 12.31 11.84 11.12 10.28 9.40 8.69 8.06 7.37
65 years or older
Dementia Population 248.54 303.46 367.73 450.93 547.15 657.05 752.27 805.41 832.55 846.33
65 years or older
Dementia prevalence 8.0% 7.64% 7.54% 7.87% 8.61% 9.64% 10.34% 10.90% 11.44% 11.83%
Total population of dementia 261.19 316.00 380.04 462.77 558.27 667.33 761.67 814.09 840.62 853.70
The total population of dementia
National total population ratio 1.11% 1.33% 1.60% 1.97% 2.42% 2.98% 3.53% 3.96% 4.31% 4.65%
Source: Ministry of Health and Welfare Science and Technology Research Program “Epidemiological Survey of Dementia (Mild Cognitive Impairment, MCI) and Dementia Care Research Program”
* Table 2 is based on the National Development Council’s “Population of the Republic of China (105-150)” and prevalence of dementia.
** (853,700 people -261190 people) / 45 years / 365 days = 36.07 people / day
*** 36.07 person / day = 36.07 person / 1440 minutes = 1 person / 39.92 minutes
what is dementia
Dementia is a disease rather than a normal aging phenomenon, many families believe that the patient is old Fan epilepsy, old stubborn, that people are old, so ignore the importance of medical treatment, but in fact, he has been sick, it should be To be treated.
Dementia is not a single disease, but a combination of symptoms (Symptoms), it is not only the symptoms of memory loss, but also affect other cognitive function, including language skills, sense of space, computing power, Judgment, abstract thinking, attention and other aspects of functional degradation, and may appear interference behavior, personality changes, delusions or hallucinations and other symptoms, the severity of these symptoms sufficient to affect their interpersonal relationships and workability.
The difference between dementia and normal aging
★ may suddenly forget something but afterward will think of it.
★ If the memory test, may not be able to remember the items in the trial entirely.
★ For yourself said, done, completely forgotten.
★ can not remember the items in the memory test, or even completely ignore that they have done the test.
Source: Qiu Mingzhang, Tang Liyu, dementia care guide, 2009, the original water culture.
(C) There are several categories of dementia
In the classification of dementia, broadly divided into two categories: degenerative, vascular, but patients sometimes there are two or more causes, the most common are Alzheimer’s disease, and vascular dementia co-exist (Also known as hybrid).
- Degenerative dementia
Most patients are of this type, of which the following three most common
In this case,
1906 by the German Dr. Alois Alzheimer found, hence the name is the most common dementia.
Early symptoms of the most prominent memory loss, the time, place and people identify problems, more than two cognitive dysfunction, is a progressive degeneration and irreversible; for neurodegenerative diseases, the brain nerve cell damage, The Doctor through the computer tomography and magnetic resonance judgments, mainly because of Alzheimer’s disease early to violate the hippocampus back to the primary post-natal anatomy can be found in abnormal senile plaques and nerve fibers entangled, the former US President Leiden that suffer from this disease. The clinical course of about 8-10 years.
In this case,
(2) frontotemporal lobe dementia (Frontotemporal lobe degeneration)
Brain disorders to the frontal lobe and temporal lobe mainly characterized by early personality changes and behavioral loss of control, there is often irrational behavior; or new language barriers, such as expression difficulties, naming problems and other progressive degradation phenomena. The average real hair age after 50 years old.
(3) Dementia with Lewy Bodies:
For the second most common degenerative dementia, characterized by the addition of cognitive dysfunction, may be accompanied by early in the body stiffness, trembling, walking instability, repeated unexplained fall. Also, there will be more visible symptoms of the spirit, such as sharp as the auditory or auditory hallucinations, mood swings or suspicious delusions and other symptoms occur, the average real age of 70 years of old.
(4) there are other such as Huntington’s disease (Huntington’s Disease), etc. caused by dementia.
Is due to stroke or chronic cerebrovascular disease, resulting in reduced blood circulation in the brain, resulting in brain cell death caused by mental retardation, is the second largest cause of dementia. Have vascular dementia after a stroke, small vascular dementia. Approximately 5% of patients with stroke suffer from dementia and have a 5% chance of experiencing dementia if they survive. Its characteristic is a sudden deterioration of cognitive function; there are ups and downs, was ladder-like degradation, the early action often slow, slow response, gait instability and mental symptoms.
In this case,
- Common clinical features:
- Emotional and personality changes (depression)
- Urinary incontinence
- False bulbar paralysis (dysphagia, dysarthria, emotional incontinence)
- Walking obstacles (slip falls)
- Other factors leading to dementia
Some dementia is caused by a particular reason, after treatment may have the opportunity to recover, this type of dementia causes are:
- Malnutrition: such as the lack of vitamin B12, folic acid, and other nutrients.
- Intracranial lesions: such as normal pressure water brain disease, brain tumors, brain trauma.
- Metabolic abnormalities: such as hypothyroidism, electrolyte imbalance and so on.
- Central nervous system infections: such as syphilis, AIDS and so on.
- Poisoning: because of drugs, alcohol and so on.
- The course of dementia
Dementia is a progressive degeneration of the disease, mild symptoms from mild to moderate, severe, terminal symptoms, disease degradation is not necessarily the time, there are individual differences. Understand the disease course and symptoms can help patients and their families to prepare in advance to cope with the illness caused by changes in life.
The course of dementia can be divided into mild knowledge disorder, mild (early), moderate (medium), severe (late).
Mild Cognitive Impairment (Mild Cognitive Impairment) for the standard aging to dementia symptoms began to appear between; there is a transition area. MCI in the clinical each year about 10% -15% will develop into dementia, faced with more complex tasks or social environment, there will be problems, but simple daily life has no effect.
The following list of possible behavioral symptoms for the development of the course of dementia.
- Project initial stage
- Medium term
Symptoms are mild and are often overlooked and delayed. Life skills continue to decline, the handling of daily life things become more complicated. Almost entirely dependent on others to take care of.
- Always forget what to put.
- Often looking for something.
- Forget the appointment with someone else.
- Forget what others have told him.
- Compare can not remember what happened recently.
- Now it’s a few years and a few days. 1. Forget about things that have happened, such as whether you have eaten or have a shower.
- Repeat the same question.
- To identify people, understanding the environment and the distinction between time and more difficult.
- Long-term and recent memory loss, becoming increasingly dangerous. 1. forget the familiar side of people, things, things, and even some long-term memory.
- Memory loss, do not remember the important things in life.
- May not even know who they are.
Mistakenly mistaken only in the wrong lighting of light rain, the night was prone to misidentification. 1. Time and space disorder, can not tell the morning and evening and season.
- Mistakenly believe that their family or spouse is someone else disguise, so want to take care of his wife or family.
- That the current environment is not their home, often clamoring, “I want to go back.”
- The disappearance of reality, such as the TV play in the mistaken for true, or even to attack the TV.
- See the mirror, reflective objects, windows in their reflection, will be mistaken for others, and dialogue
Emotional change Emotions are larger than before, for example: can not find what you want and want to get angry. With the left
Some may have excited behavior, cranky, suddenly angry, crying and so on. 1. You may get angry because you can not express or understand the meaning.
- Severe emotional expression.
Personality 1. become hesitant, difficult to make a decision on the matter.
- Become suspicious, suspicious.
- Become timid, introverted.
- Become eccentric, irritable, angry temper. With the left, but because of the understanding of things and language, emotional control more vulnerable to anger, frustrated. Often with family or caregiver conflict. Become more dependent, cognitive; memory function continues to degrade, personality expression is not visible.
Verbal expression 1. Oral expression difficulties, speech as before smooth.
- Can not remember what to say or can not remember the name of an object. 1. Speaking words become less; the content is poor.
- Speech expression incoherent, lack of logic.
- Slowly lose reading and language skills. 1. Do not speak or repeat only a fixed sentence.
- Language skills decline, speech can not understand or irrelevant, can not cope with others.
Lost in the infrequent places will be lost.
- Take the public transportation will be the wrong station. 1. In the vicinity of home or common areas will be lost.
- Do not know the direction, can not go out on their ride, easy to get lost. Almost no longer able to go out on their own.
Paranoia 1. suspected spouse infidelity.
- Worry will be abandoned by family members.
- Be persecuted and think that the neighbors will hurt him or steal his things. With the left, in addition to the higher frequency, the more easily lead to delusions of secondary language and physical violence. Can not express / any such reaction
Visual hallucinations 1. To see someone in the room, may be familiar, have died or family members do not know. Sometimes see insects, snakes and other people feel unpleasant things. See the room was a person who may be familiar with, have died or family members do not know the people or children. Sometimes see insects, snakes and other people feel unpleasant things. Can cause secondary delusions. Can not express / any such reaction
Roaming or restless 1. restless, keep walking.
- Want to leave home to go outside. With the left, but the higher the severity. Conflict when prone to conflict. Limb dysfunction, prone to accidents.
Inappropriate behavior 1. Repeat the action, such as consistently putting things into the cabinet and out and so on.
Repeat the same question many times. 1. Luna Zang things, some useless stuff, and even hide the rubbish, or put off your shoes into the quilts and so on.
- It may be enraged by the verbal content or an inappropriate response from a caregiver, resulting in verbal intimidation, or even violence.
- Lack of judgment and understanding, inappropriate behavior in public places. Completely dependent on others to take care of, no response to the appropriate action.
Sleep disorders day and night upside down at night to walk or engage in other activities day and night reversed, may not sleep all night, daytime sleepiness. Diurnal rhythm disorder, daytime sleep times longer. Often nap, sleep ability and ability to regain consciousness.
We reduce mobility 1. We do not love to go out.
(2) Lack of interest in previous activities. Can not go out smoothly to reach the destination, even at home began to find the toilet, his bedroom. 1. Hard to walk.
- Need to rely on wheelchair lines, and even bedridden.
- Can not stand, stand.
Diet problems 1. After eating also said to eat.
- Diet may require assistance from others. 1. Can not prepare meals, need others to help.
- Diet is not healthy: repeat the situation to be more serious food. 1. can not eat their own.
- Refuse diet.
- Dysphagia may occur.
Life disorders 1. For the compound life functions of the obstacles, such as money management error, decreased cooking capacity.
(2) The ability to use objects declined. For example, often the wrong phone.
- Judgment and ability to work gradually decreased. 1. It ‘s hard to cook alone, clean, shop and so on.
- Lose the ability to use conventional equipment, such as washing machines, air conditioners, remote control and so on. Completely unable to live independently, loss of self-care ability.
Clothing and personal hygiene problems in the choice of clothes are hesitant. 1. Personal hygiene treatment deterioration, such as the toilet, bath and other needs of others to help.
- Can not properly dress or handle clothing, such as cold weather, wearing only a short-sleeved, dirty clothes, such as when to wear clean clothes.
- Occasional incontinence may begin. 1. incontinence.
- the dress can not take care of themselves.
Source: Qiu Mingzhang, Tang Liyu, dementia care guide, 2009, the original water culture.
(E) early symptoms
Each patient’s first symptoms and their work in the past and social functions are closely related, with individuality. To increase the physician and the public awareness of early symptoms of dementia and alertness to increase the chance of early diagnosis of dementia, the United States dementia Association proposed dementia ten warning for your reference, if found at home elders When the following 10 signs appear, it is recommended that you immediately seek a professional neurologist or psychiatrist to perform a complete examination and diagnosis, depending on the results to determine the direction of treatment, may delay the deterioration of some symptoms, do not That this is the inevitable phenomenon of aging and delay the appropriate treatment time.
Note: The following indications to Alzheimer’s disease, for example, different types of dementia symptoms appear slightly different, it is recommended that you discuss with the physician.
(1) memory loss affects life:
In this case,
Most people occasionally forget the meeting time, a friend phone, but after a while or after reminders will think of it again. But dementia patients remember the frequency is higher, and even after reminding can not think of the event. Therefore, patients may also often repeat questions, repeat shopping, or even repeated medication. People with dementia tend to forget what’s happening shortly, and even important dates or events are ignored.
(2) to plan things or to solve the problem:
In this case,
There are times when the average person may break even, but it can be difficult for a dementia patient to plan, execute a plan, or deal with numbers. For example, there is a problem with cooking a recipe based on a familiar recipe or dealing with monthly bills. They are less attentive and need more time to deal with things they used to be familiar with.
(3) can not do the original familiar with the affairs
In this case,
Dementia patients are often familiar with the issues of the original often forget or omission of the established steps, but can not be completed, such as mathematics teacher for the addition and subtraction error often, English teachers do not know “book” is what young drivers to drive the uncle is now often open The wrong way, the number of bank notes banknotes difficult, senior chefs cooking away flavor and so on.
(4) confusion of time and place:
In this case,
Usually, people will forget today is the number, in the unfamiliar places may get lost. But patients with dementia will not know the date, day or night, do not know where they are or how to come here, and even lost in their home and can not find the direction of home.
(5) Difficulty Understand the relationship between visual images and space:
In this case,
Most people may be due to cataracts and visual impairment, but patients with dementia may be reading, judging the distance, will determine the color or contrast will be difficult. A person with dementia may mistakenly recognize another person in the mirror and feel that there are other individuals in the room.
(6) verbal expression or writing difficulties:
In this case,
Most people occasionally can not think of a word, but the chances of dementia can not remember more often, or even use other words to replace the simple words, such as: “messenger (postman)
(G) dementia how to treat
Currently, there is no way to stop or restore brain cells that have been damaged by drugs that target dementia but may improve symptoms or delay the progress of the disease. Therapies are divided into drug and non-pharmacological treatments, Can improve the quality of life of patients, reduce the burden on caregivers, and delayed the patient was sent to the nursing center time.
First, drug treatment
In this case,
Alzheimer ‘s disease
In the treatment of Alzheimer’s drugs are cholinergic inhibitors and NMDA receptor antagonists, hoping to slow down the rate of deterioration of mental function in patients with other drugs, including antipsychotics, antidepressants, etc., for improvement Patients with psychiatric symptoms.
Health insurance can be paid for those who are eligible.
- Choline Inhibitors: Ai Yi Yan (Aricept, Donepezil), Yi Si can (Exelon, rivastigmine), Lee Yi Ling (Reminyl, galantamine). Possible side effects are nausea, diarrhea, anorexia, headache, vomiting and so on.
- NMDA receptor antagonists: memory will be good (Ebixa, memantine), Wise (Witten, memantine). Moderate to severe Alzheimer’s disease is more effective.
- Antipsychotics: When the patient has hallucinations, delusions, attacks, hostility and non-cooperation and other symptoms, can be given antipsychotic drugs, such as Silo (Seroquel, Quetiapine), Risperidone (Risperdal, Risperidone). Possible side effects include drowsiness, constipation, decreased blood pressure, tremors, the stiffness of the body or limbs, and so on.
- Antidepressants: patients with depression, irritability, sleep disorders can be used to treat antidepressants, such as Prozac (Prozac, fluoxetine), Carrefour (Zoloft, sertraline), US Shu Shu (Mesyrel, trazodone) Wait. Possible side effects: a headache, nausea, dizziness, poor balance and so on.
Temporal and tmedicinesemporal lobe dementia
There are still no drugs to treat or prevent, but for their mental and behavioral symptoms can be used antidepressant or anti-anxiety drugs and other drugs to treat.
Lewy body dementia
At present, only symptomatic treatment is available, and drugs are used to control Parkinson’s symptoms and psychiatric symptoms. However, anti-Parkinson drugs can improve the action of good shake and other obstacles, but may increase the psychiatric symptoms; antipsychotics can improve the patient’s mental symptoms, but at the same time may be more severe action disorders.
Vascular dementia treatment focuses on reducing the risk of further damage to the brain, that is to prevent the occurrence of stroke. Mainly for vascular risk factors for control, such as hypertension, diabetes, hyperlipidemia treatment and antithrombotic therapy.
Other factors leading to dementia
Can find a reversible cause, for the purpose of therapy. For example vitamin B12 deficiency, hypothyroidism and so on.
Second, non-drug treatment
In this case,
In addition to medical care, through the adjustment of the environment (familiar, stable, safe), the activities of the arrangements, communication methods, cognitive training, nostalgia, light, massage, music therapy, aromatherapy, pets Treatment, art therapy and other non-drug care techniques, but also improve the mental and psychological symptoms of dementia patients.
Here are a few simple treatments:
Through a group of ways, by the past things and memories of the experience and increase patient language expression, interpersonal interaction, improve the emotional purpose, and then delay the treatment of a disease model. Recalling and sharing personal life experiences can encourage and support people with dementia through group nostalgic processes and help the mentally disabled to think back, discuss and share their past experiences and experiences to increase their confidence, self-esteem, Thereby reducing the melancholy mood, relieve symptoms.
The use of music as a medium to improve their mood, promote language communication and then delay the disease of a treatment model. Design music activities to provide incentives and events, by simple musical instruments, lyrics explain methods to provide patients with positive stimuli, delay the degradation of the disease.
The use of teaching materials and painting, collage, sculpture and other methods of interaction with dementia, to provide a wealth of sensory stimulation and self-expression opportunities; through dementia statement to share their work to promote dementia language expression and sense of achievement; in the production process , Mutual assistance among members to form a real interpersonal interaction, to enhance interpersonal satisfaction, to participate in activities to increase motivation and thus slow down the degradation.
The use of auxiliary teaching aids, daily life appliances or other self-made equipment, posters, design cognitive activities to help dementia by moving the brain, slows down the degradation of cognitive function. The process often with a combination of sensory stimulation, reality-oriented activities. Cognitive impairment is the main symptom of dementia, and cognitive training hopes that even under the influence of disease, the elders can still re-arrange their daily activities to establish the habit of participating in activities to maintain the maximum possible independent function and face the adjustment loss Intellectual problems brought about by the troubled.