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Health

Dementia

  • Introduction
  • Healthy Living
    • 放聲歌唱有益身心健康
      • Chief Editor sharing her not-so-successful story of losing weight
        • Points to note when choosing body check-up plan
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                  • 禦寒穿衣有妙法
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                  • Swimming for the Green-aged
                    • "OKAY HEALTHCARE"
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                          • Common Health Problems
                            • Government Subsidised Chinese Medicine Services
                              • Heatstroke
                                • Swallowing difficulty
                                  • Dementia
                                    • BC360 eSport
                                  • Stroke
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                                  • Parkinson’s Diseases
                                    • How to sleep well?
                                      • Gout
                                        • Cancer
                                          • 癌症藥物援助計劃
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                                          • Bone and Joint Care
                                            • Muscle loss
                                            • Taking care of your knees
                                            • Preventing Falls and What to do after a Fall
                                            • Pain
                                          • Eye Care
                                            • Other health problems
                                              • 肌肉流失
                                              • How to improve constipation
                                              • Green-age people are prone to having Shingles
                                              • Testosterone Replacement Therapy: Is It Good or Bad?
                                              • 夜尿困擾
                                              • Incontinence
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                                            • 感到焦慮時怎麼辦?
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                                                • 積極面對「疫」境
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                                                                        As we become older, our memory will naturally deteriorate, but will every elderly person suffer from dementia? No, that may not be the case. In fact, dementia is a cognitive disorder, a brain disease caused by brain atrophy and hypofunction. Patients with dementia not only become more and more forgetful but may also have problem with reasoning, communicating, learning, calculating and making decisions alongside changes in their personalities and behaviours. Therefore, it is advisable to undertake an examination early and seek appropriate treatment which will help delay the pace of brain degeneration. 
                                                                         
                                                                        5 common types of cognitive disorders:
                                                                         
                                                                        Alzheimer’s Disease 


                                                                        Alzheimer's disease is the most common type of cognitive disorder, accounting for 50% to 75% of all cases. The causes of this degenerative disease are not known and there is no cure of this disease at present. The patient's decline is gradual. As brain cells die, abnormal substances emerge in the body and become "plaques", generating disruptive signals to the brain and upsetting the connections in-between brain cells. The death of brain cells causes certain degree of malfunctioning in the body, such as memory failure, taking longer time to complete a usual task, loss of focus in speech and a tendency to repeat messages, etc.  When the condition has deteriorated during the late stage, the patient may be bedridden for a long period of time and require special care.
                                                                         

                                                                         
                                                                        Vascular Dementia


                                                                        Vascular Dementia is the second most common type of cognitive disorder. This is caused by a series of strokes or by vascular disease, resulting in accumulative damages to the brain.  In most cases, the degradation is step-by-step, i.e. with greater degeneration following each stroke.  Vascular dementia is most common in co-existing with other forms of dementia, due to multiple strokes or blockage in the cerebral blood flow.  Multiple strokes can damage some parts of the brain which control specific functions, and the symptoms of cognitive impairment may occur if the part which is responsible for decision-making is damaged.  So far, problems over artery circulation in the brain can only be controlled by medication.
                                                                         

                                                                         
                                                                        Frontotemporal Dementia


                                                                        Frontotemporal Dementia accounts for less than 10% among cases of dementia. The damage is in the brain’s frontal lobes (the areas behind the forehead) or its temporal lobes (the regions behind the ears).  Those who have this problem start to see symptoms at the age of 40 to 60+.  Degeneration in personality, behaviour (loss of control mainly) and in speech comes earlier and more serious before degeneration in the memory begins to show.  The cause of the disease is still unknown, but in some cases it may be caused by family heredity.
                                                                         

                                                                         
                                                                        Dementia With Lewy Bodies


                                                                        Some patients with this type of dementia have developed some small spherical tissue, called Lewy bodies, in their brains.  It is generally believed that this will lead to death of brain cells. Patients can easily get delusion, become extremely confused, have a fall and encounter Parkinson type of tremors.  Their conditions can fluctuate greatly from day to day, as opposed to the progressive deterioration in the case of Alzheimer's disease.
                                                                         

                                                                         
                                                                        Huntington’s Disease


                                                                        Huntington's disease is an inherited disorder.  The deterioration of the brain functions affects one’s ability to think and move.  The problem usually starts at the age of 30 to 50. characterized by a decline in the mental abilities and physical abilities such as irregular and involuntary jerky movement of the limbs and face.  In most cases, patients with Huntinton’s disease show symptoms of cognitive disorder, such as personality changes, memory failure, speech disorder, weak judgment and psychological problems.
                                                                         



                                                                        Common symptoms of cognitive impairment
                                                                         
                                                                        Early stage
                                                                        • Loss of short-term memory
                                                                        • Changing emotions or behaviours
                                                                        • Weakening of judgment
                                                                        • Difficulty to learn new things and follow complicated instructions
                                                                        • Difficulty in expressing or understanding abstract things, such as describing physical discomfort, personal feeling, etc.
                                                                        • Need to be constantly reminded but can still manage daily routines
                                                                         
                                                                        Moderate Stage
                                                                        • Confusing early memory and reality
                                                                        • Occasional disjointed expression
                                                                        • Behavioral and personality changes and occasional emotional instability
                                                                        • Need to be helped in daily self-care
                                                                         
                                                                        Late Stage
                                                                        • Memory impairment; forgetting familiar people and things
                                                                        • Decline in physical activity and mental condition
                                                                        • Unable to communicate effectively
                                                                        • Unable to handle daily life
                                                                        • Long-term care is required
                                                                        • Biological clock confusion


                                                                        Prevention:
                                                                        1. To avoid suffering from cerebrovascular disease, should prevent and control diabetes, hypertension, heart disease and stroke

                                                                        2. To establish a healthy lifestyle:
                                                                        • Choose foods which are low in sugar, salt and oil, high in vitamins and protein foods, and maintain a balanced diet
                                                                        • Have regular exercise
                                                                        • Avoid smoking and heavy consumption of alcohol
                                                                        1. To maintain a remarkable life
                                                                        • Broaden social life, connect with people and share with family and friends
                                                                        • Develop healthy hobbies and personal interests to stimulate brain functioning
                                                                        1. To undertake examination early and seek help

                                                                        2. To maintain a cheerful mind, and adopt an appreciative and thanksgiving attitude to life

                                                                        3. To use the brain more often and have the courage to accept new things

                                                                        4. Do more brain exercise to prevent brain decline 
                                                                         
                                                                        Dealing with emotional and  behavioral problems
                                                                         
                                                                        About 90% of patients with Alzheimer's disease have behavioral problems, and these "non-functional behaviors" are divided into psychological and physiological aspects.  The former includes depression, anxiety, delusion, hallucinations, while the latter includes attacks, excitement, insomnia, screaming and wandering.  Causes of these behavioral problems include:
                                                                        1. The patients may be under pressure when they have difficulty to cope with the task/work in front of them;

                                                                        2. They may become frustrated when they interpreted messages incorrectly;

                                                                        3. Such behaviours may be caused by other potential diseases.
                                                                        These behaviours may take place without warning, causing concern to both the patients and the carers. However, carers may be able to find ways to prevent or address the causes of such behaviours by, for example, recording each instance and what happened before and the time at which such instance took place. Bear in mind that each patient is an individual and he or she may react differently to the same situation.

                                                                         
                                                                        Emotional problems
                                                                        1. Reduce the pressure on the patient from the external environment
                                                                        • Provide a quiet, stress-free environment and simple instructions familiar to the patient for avoiding emotional problems
                                                                        • Approach the patient with ease and in a slow pace, so as to avoid imposing the carer’s own stress and anxiety on the patient.
                                                                        • As the patient may not recognize everyone, do try to mention your name and relationship with him/her at the time of contact.
                                                                        • Keep eye contact and proper physical touch with the patient. Address the patient by a name familiar to him/her.
                                                                        1. Adjust the environment
                                                                        • Be aware of circumstances which may give rise to emotional problems and prevent such problems from re-occurring as far as possible. Carers may use a log to record such instances for monitoring.
                                                                        • Make the best use of the environment to address emotional problems, such as by taking them out for a walk in a safe place when they wish to move around.
                                                                        • Build a well-structured, comfortable, personalized and user-friendly environment for the patient.
                                                                        • Simplify the layout and decoration as far as possible and use bright colours.
                                                                        • Avoid changing the living environment, such as moving to a new place, as it may worsen the patient’s emotional problems.
                                                                        1. Distracting attention
                                                                        • When the patients’emotion is unstable, pacify them with comforting words, and then distract their attention to relieve the tension. Be generous with praises for positive change of behaviours and signs of cooperation.
                                                                        • If the patient is in a safe environment, the carer may temporarily not to deal with the patient’s anger, retreat for a while or ask someone else to take over.
                                                                        • Allow the patients to do things that they really enjoy and chat with them on these subjects. Be always ready to come up with praises and encouragement.
                                                                        1. Tips
                                                                        • Do not argue with persons with dementia, especially when they are depressed or upset as they are incapable of remaining rational.
                                                                        • Stay calm and refrain from expressing negative emotions
                                                                         
                                                                        Behavioral problems 
                                                                        1. Causes for aggressive behaviours
                                                                        • Defensive behaviours: When patients are in an environment where they need to be helped or when their independence and privacy are infringed, such as taking a bath or going to the toilet, they feel insulted and frustrated and so may react with anger.
                                                                        • Incapability: They feel frustrated when they fail to manage or complete certain tasks.
                                                                        • Feeling misunderstood and embarrassed about what is happening: They may accuse others for stealing their belongings because they cannot find the objects or they are unwilling to admit that they have forgotten where they have put those things.
                                                                        • Fear: If persons with dementia cannot recognize where they are or the persons they live with, they will be shocked with fear. They may convince themselves that they are in another place (such as a friend's home) or the people around them are strangers. Apart from that, any sudden sound or anyone coming from behind can cause them to react with hostility.
                                                                        • When something unusual happens, such as the visiting of a large group of people, or the presence of disturbing sound or activities, they will have difficulty to adjust and would not know how to cope with the situation.
                                                                        • When the patients are bored, frustrated, frightful or when they are suffering from certain illness and pain, especially when they have difficulty communicating with others through words, they may express themselves through anger, attacks and emotional outbursts.
                                                                        • When they are being stopped form doing something, they may feel fearful and angry.
                                                                        1. Handling aggressive behaviours
                                                                        • Sometimes a patient becomes aggressive and may use more violent language to hurt people. At this time, the carer should stay calm and do not show sign of fear. Try to understand that although the attack appears to be directed at you, it is not a deliberate personal attack.
                                                                        • When the patient is in a good mood, it is good to arrange for him or her to participate in some constructive activities within his or her capability. Watch out for any change in the patient’s emotions, which is an effective preventive measure.
                                                                        • While the activities arranged for the patient should be within his or her capability, do not expect too much from the patient. If the patient becomes inpatient for not being able to do well, adjust the level of difficulty of the activity and give every encouragement for even the slightest achievement.
                                                                        • Let the patients complete some tasks which they can do by themselves, even if it may take a long time. This is an encouragement for them to complete a task independently.
                                                                        • Enjoy some refreshments together with the patient especially something he really likes. That will help distract his attention. Sometimes, the carer could be the reason for his emotional outburst and the carer should stay away for a while until he calms down.
                                                                        • The patient's temper may be caused by physical discomfort like inflammation in some parts of the body. If there is such a possibility, must consult the doctor.
                                                                        • If aggressive behaviours occur and are becoming frequent, should consult a doctor as control by drug may be required and the patient should be put under close observation.
                                                                        1. Prevention of unattended home exits
                                                                        • A lock may be installed at the front door which can be opened on both sides. The carer must remember to keep the key at all times.
                                                                        • The lock can be installed at location which the patient would not expect.
                                                                        • A doorbell or sensor can be installed at the main gate, which produces a sound when the door is opened. This will alert the carer that patient has gone out.
                                                                        • Make sure that the design of the garden or terrace is safe and make it a "secured zone" for the patient to walk around.
                                                                        • Allow the neighbours and security staff know that there is family member with dementia and ask them to inform the family if he or she goes out alone.
                                                                        1. Handling patients accustomed to nighttime unattended home exits
                                                                        • Provide a tranquil and restful environment for a good sleep.
                                                                        • Increase the patient's daytime activities to make him tired and sleepy at bedtime.
                                                                        • Let the patient drink a glass of warm milk or listen to some soft music before bedtime so as to make him fall asleep easily.
                                                                        • If the patient wakes up at night, let him know that he is safe and where he is. For example, put some objects familiar to him in the bedroom and install a small night light to make the room adequately lit to reduce fear.
                                                                         
                                                                        Tips for communicating with persons with dementia
                                                                        • Keep your voice soft while speaking, but make sure the patient can hear you well.
                                                                        • Words are not the only means of communication. Should also focus more on nonverbal communication modes, such as body contact, speaking tone. When the patient shows signs of not understanding what is said, the carer can use body language to assist.
                                                                        • Be always ready to listen actively and be empathetic in understanding the emotions and feelings of the patient.
                                                                        • Speak slowly, keep the sentences short and concise, only talk about one thing at a time. Also, can talk about things that the patient can remember more easily, or things that he encounters every day, such as date, weather, etc.
                                                                        • Ensure that the patient is not subject to noise disturbances from radio, television, etc.
                                                                        • Provide the patient with appropriate eyeglasses, hearing aids and other aids when needed.
                                                                        • When talking to a patient, do not change the environment frequently. This will help reinforce the patient's trust in you.
                                                                        • Allow the patient sufficient time to understand what is said and to make a response.
                                                                        • Try to use different expressions to convey your message if needed.
                                                                        • During the conversation, enable the patient to know where he is, what is happening around him, who he is, etc. to enhance his sense of security.
                                                                        • Always refer to names familiar to the patient, such as “your son Siu Ming” instead of just “your son”.
                                                                        • Focus more on the expression of feelings rather than the content of conversation.
                                                                        • When the patient repeatedly ask the same question, do answer him tactfully and avoid making impatient responses such as "you have asked the same question many times", etc. A carer should repeat the answer patiently and provide other prompts, such as writing the answer on paper, in front of the patient.
                                                                         

                                                                        Relevant websites and articles
                                                                        • Common Health Problems-Department of Health Elderly Health Service - Dementia
                                                                        • Hospital Authority Smart Patient: Chronic Diseases – Dementia
                                                                        • 港島東醫院聯網: 長者常見疾病 - 認知障礙症 (Chinese version only)
                                                                        • Psychogeriatric Service of Kwai Chung Hospital
                                                                        • 渣打香港150週年慈善基金長者智晴坊 (認知障礙症長者服務)
                                                                        • 賽馬會耆青藝坊
                                                                        • 認知障礙症長者易走失 「樂回家」服務提供適時支援 (Chinese version only)
                                                                          長者 – 社聯頻道    2016/06/23
                                                                        • 老有所醫:改善健忘 從心脾肝腎着手(Chinese version only)
                                                                        • 老有所醫:日間室內光線不足 亂生理時鐘無覺好瞓(Chinese version only)
                                                                        • 老有所醫:適量社交 穩定三高 預防認知障礙(Chinese version only)
                                                                        • 關於認知障礙症(前稱腦退化) - 你不可不知道的八件事 (Chinese version only)
                                                                        • NHS Choices: Dementia (English version only)



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                                                                        《腦友.陪著您走》計劃 - 網劇《尋》足本版 (Chinese only)

                                                                        《腦友.陪著您走》計劃主題曲MV - 記得唔記得 (Chinese only)

                                                                        Tips for Carers

                                                                        進食困難長者有選擇(Chinese only)

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                                                                        Our forum is a platform for you to share different interests and life experience with others of similar age or background. To become a member, please fill in the following form for registration and click the "Register New Membership" button. The information you send to us will be protected by law. Upon successful registration, you will be directed to a new page showing "Registration Succeed", and you can logon immediately.

                                                                        Please contact us if there are any questions.

                                                                        For first time logon, please register below:


                                                                        Please create your own username and password to logon the forum:


                                                                        In order to better incorporate your needs and expectation, you are most welcome to provide the information below, but is optional only.