Dementia syndromes - how to recognise and where to seek help? Episode 43

Monika Rachtan:
Hi, I'm Monika Rachtan and welcome to another episode of 'Patient First'. I am 30 years old and I never thought that dementia diseases could affect me. However, it turns out that even 30% people in their 80s have symptoms of such diseases. The important thing is that they also affect younger people. Today, I will talk to Prof Urszula Fiszer, a specialist in neurology, about this topic.

Ursula Fiszer:
Good morning, Madam Editor.

Monika Rachtan:
Professor, I mentioned 'dementing diseases' and 'dementia syndromes'. Could you explain to our listeners what these conditions are?

Ursula Fiszer:
Thank you for the invitation. Dementia syndromes are an extremely important topic. They are diseases of civilisation, where dementia manifests itself in reduced intellectual function and behavioural disorders. They can be a symptom of many brain diseases, such as Alzheimer's disease, which is the most common disease of civilisation today, or cerebrovascular diseases.

Monika Rachtan:
But this dementia syndrome is not just a concept, is it? It determines the sick person's behaviour, introducing visible and acute problems for him or her.

Ursula Fiszer:
Correct. The symptoms at the beginning can be very subtle, like torsional memory impairment. The patient may not remember activities performed recently, despite excellent long-term memory. This is compounded by speech difficulties and other minor symptoms. Unfortunately, over time the symptoms increase, causing greater difficulties in functioning.

Monika Rachtan:
What can we do to pick up on these subtle changes, e.g. in a loved one who is starting to show such symptoms?

Ursula Fiszer:
Problems, like not remembering pointing days or difficulty naming objects, are important. Changes in behaviour, such as constantly looking for objects in the house, are also a signal. Any change in behaviour should be noted, as it may indicate the beginnings of dementia.


Monika Rachtan:
Irritability can be a symptom of many diseases. A recent guest on the programme mentioned that she had hypothyroidism.

Ursula Fiszer:
Your editor raises a very important point. In the case of such symptoms, the patient should be carefully examined. A detailed history of the patient's difficulties, information from the environment, a physical examination and a neurological examination are important. We should also think about systemic diseases by performing basic tests such as a morphology, thyroid hormone tests, glucose levels, as well as specialised neuroimaging tests such as a CT scan or MRI. These symptoms can indicate dangerous diseases, such as a brain tumour, so early diagnosis and proper differentiation are key.

Ursula Fiszer:
Degenerative diseases often have no effective causal treatment, but we can treat other, very similar diseases effectively.

Monika Rachtan:
The professor mentioned an ideal world where the patient has access to extensive diagnostics. What about the reality, where the healthcare system has its limitations?

Ursula Fiszer:
Thank you for your compliments. Indeed, healthcare has its imperfections. In the first instance, a patient with worrying symptoms should go to their primary care physician. If relatives cannot accompany, it is worthwhile for them to write down the symptoms they are observing and give them to the patient. It helps a lot if the patient brings such a list to the doctor. Simple tests can initially assess the patient's cognitive function.

Monika Rachtan:
What do these tests consist of?

Ursula Fiszer:
These are psychological tests in which the patient performs written, drawing tasks and we assess their intellectual functions in points. A full psychological examination can only be carried out by a psychologist. Diagnosis and assessment of neurological conditions require detailed investigations, including basic blood tests and assessment of cognitive function. The patient should then go to a neurologist for a more thorough examination, which may reveal non-pyramidal symptoms, such as discrete tremor or rigidity, indicative of specific conditions. Neuroimaging studies, which vary in availability across the country, are also important.


Monika Rachtan:
Is it true that there is now a wait of over 100 days for a description of an MRI or CT scan?

Ursula Fiszer:
Well, the information on this varies. At our centre, we can have an MRI description even within half an hour. A lot depends on the place where the examination is performed. I suggest asking the radiologists for details. Personally, I do not encounter any problems in obtaining descriptions of these examinations.

Monika Rachtan:
I have heard of problems with staff shortages in the health service.

Ursula Fiszer:
Yes, these problems do not only affect radiology, but to a lesser extent. Greater difficulties arise in other specialties. Health care in Poland is indeed facing difficulties.

Monika Rachtan:
If a patient has visited a primary care physician and initial tests indicate a problem, what next?

Ursula Fiszer:
Accurate diagnosis is important, as some symptoms may be due to treatable conditions, such as syphilis or endocrine disorders. Degenerative diseases, such as Alzheimer's disease, have no causal treatment, but there is symptomatic therapy to slow down the disease process. Modern therapies are being introduced, such as intravenously administered antibodies, although this treatment is still being investigated. It is also important for patients to be provided with appropriate management indications.

Monika Rachtan:
How should such a patient proceed?

Ursula Fiszer:
Lifestyle changes are key. Prevention of neurological diseases from a young age is important. Education and higher education can delay the progression of intellectual disorders. In middle age, it is important to take care of health, treat hypertension, cardiovascular disorders and pay attention to obesity and a proper diet to avoid vascular atherosclerosis, which affects the development of degenerative diseases.

Monika Rachtan:
Professor, I return to the subject of younger people, which you mentioned, in the context of education. We recently had Professor Adam Antczak as a guest who spoke about how RSV flu can cause brain damage in children, which affects their functioning at school. Could this affect the incidence of dementia?

Ursula Fiszer:
The effect of infections, including viral infections, on the acceleration of dementia syndromes has long been known. Infections can be a direct cause of dementia or influence inflammatory processes in degenerative diseases. These diseases involve the death of neurons damaged by pathological proteins. Inflammatory processes and even bacterial flora influence this.

Monika Rachtan:
So abnormal bacterial flora can also promote disease?

Ursula Fiszer:
Yes, abnormal flora can promote inflammatory processes in the brain.

Monika Rachtan:
Can you, Professor, explain what the neurons are responsible for?

Ursula Fiszer:
Neurons, or nerve cells, are responsible for all our functions - intellectual and motor. Without them, we are unable to function.

Monika Rachtan:
Coming back to obesity, which can also contribute to dementia syndrome?

Ursula Fiszer:
Obesity, often associated with diabetes, can influence degenerative brain diseases. There are theories that Alzheimer's disease, for example, is 'type 3 diabetes', which involves the brain's resistance to insulin and accelerates degenerative processes.

Monika Rachtan:
What about addictions, like alcohol or tobacco?

Ursula Fiszer:
Alcohol and tobacco certainly have an impact, with tobacco especially in older age. In addition to avoiding these substances, physical and intellectual activity and good nutrition are important in prevention.

Monika Rachtan:
How do we get society active, especially older people who are leaving the labour force and becoming 'couch potatoes'?

Ursula Fiszer:
Activities they enjoyed before should be suggested, and time spent being active and social should be encouraged. A life spent on the sofa with a remote control is the worst choice, quickly leading to dependence on the environment and a worsening of dysfunction.

Monika Rachtan:
Professor, do you think that systemic solutions are needed to activate seniors? We have communities organising various activities, but no one will force seniors to participate. Should there be solutions, such as jobs for seniors for two hours a day for which they receive a token payment? I was in a restaurant where an elderly gentleman with a 'Master of Hospitality' badge was working and he greeted us with a smile. It made him happy.

Ursula Fiszer:
Your editor reminded me of the situation in Tokyo. There, I also met an elderly person in a restaurant who was taking care of the guests. The owner, who was about 100 years old, noticed that I did not like to eat with chopsticks and brought me European cutlery. This was remarkable to me and shows how important it is to involve senior citizens.

Monika Rachtan:
So maybe we don't need systemic change, but rather more awareness and a willingness to care for seniors. By giving them attention, they can also take care of us.

Ursula Fiszer:
It is a question of social awareness. It is important that we keep active and socialise from a young age. Having hobbies is important, and in middle age we should pay attention to the symptoms of depression, which can be confused with dementia syndrome.

Monika Rachtan:
What are the symptoms of depression?

Ursula Fiszer:
Symptoms include lowered mood, apathy, slowing down and impaired intellectual function. Depression can be treated and is often confused with dementia syndrome.

Monika Rachtan:
How to encourage seniors to treat their depression?

Ursula Fiszer:
This is difficult when the patient does not want help. You can offer to see a doctor at home and convince them that treatment can improve their condition. Patient organisations can also help by offering support and information.

Monika Rachtan:
What can the younger generation do to help seniors with depression?

Ursula Fiszer:
Encouragement and collaboration with patient organisations can be key. Conversation and support are important and can motivate seniors to take up treatment and be active.

Monika Rachtan:
Our programme partner is the Institute for Patient Rights and Health Education, which actively supports patients and works with patient organisations. The Institute's website provides information on how to help and use patient organisations.

Ursula Fiszer:
Treatment of depression improves the patient's mood, normalises sleep and activity. Sleep is very important for the prevention of dementia syndromes. To ensure proper sleep, a dark environment, avoidance of screens before bedtime and relaxation are important.

Monika Rachtan:
What should proper sleep look like at different ages?

Ursula Fiszer:
Sleep should be continuous, without periods of awakening. A dark environment, avoidance of screens and relaxation before bed are important.

Monika Rachtan:
Can depression co-exist with dementia syndrome?

Ursula Fiszer:
Yes, it is a difficult diagnostic situation, but specialists can distinguish this and use antidepressants.

Monika Rachtan:
What are the pharmacological treatments for dementia diseases?

Ursula Fiszer:
Cholinesterase inhibitors are used in Alzheimer's disease. Transdermal systems are also available. It is important to use drugs appropriate to the type of disease and neurotransmitter. In advanced stages, drugs acting on the excitatory receptor are also used. Modern therapies, such as monoclonal antibodies, are used with caution.

Monika Rachtan:
What preventive measures are most effective?

Ursula Fiszer:
Prevention, i.e. a healthy diet, physical and mental activity, is now more effective than treatment of degenerative diseases. Prevention and building intellectual reserve are key.

Monika Rachtan:
Although we convey a lot of difficult information and concepts today, you should not be afraid to do so. If you don't understand something, ask. This is a very important topic and it is crucial that we start taking care of ourselves now, when we are younger and do not yet have disease symptoms, instead of waiting for the need for treatment.

Ursula Fiszer:
The most important thing is to take care from an early age, to pay attention to small changes in the behaviour of loved ones that may indicate dementia syndromes, and to provide care and support to older people with such problems. This is a very difficult situation for them and their carers.

Monika Rachtan:
I remind you that many older people may not have a diagnosis and may be lonely. We should be understanding and patient with seniors who may have difficulties with daily activities.

Ursula Fiszer:
Humanising medicine means treating the patient as a human being, not just as an object of study. Despite technological advances, the patient should always come first.