Dementia: Signs, Symptoms, and When to Seek Help

Q: Dementia: Signs, Symptoms, and When to Seek Help

Hello, A-Dai： Two years ago, Grandpa suffered a stroke that caused brain damage and degeneration, and he is currently showing signs of dementia. <br>It would be advisable to take Grandpa to a neurologist for a detailed evaluation to determine if there are medications available to

Is there dementia or not?

Hello, Dr.
Liang.
My grandfather is 80 years old and has diabetes and heart failure.
Two years ago, one morning after his exercise, he returned home to eat breakfast and fell asleep while eating.
The family thought it was due to high blood sugar since he had forgotten to take his insulin for several days.
They assumed that administering insulin would resolve the issue and did not take him to the hospital.
As a result, my grandfather showed unusual behavior and seemed confused about taking his insulin.
The family believed that once his blood sugar normalized, he would return to normal.
However, in the afternoon, while chatting with him, they noticed he was answering questions incorrectly and even struggled to name fruits.
When they consulted the hospital's health education staff, they were told it might be due to his blood sugar dropping, so they delayed seeking medical attention for another three days.
As the family became increasingly concerned about his condition, they decided to take him to the emergency room, where the doctor diagnosed him with a stroke.
At that time, my grandfather had lost some memory.
He stayed in the hospital for five days and was discharged without any specific medication, continuing his usual medication (Bokey).
On the day before discharge, he was given three capsules of a medication called Baoshantong and was instructed to take all three at once.
Upon discharge, these three capsules were not covered by health insurance.

I would like to ask the doctor: 1.
Why are these three capsules of Baoshantong not covered by insurance? 2.
Does my grandfather have dementia? Should he see a doctor? He has lost some memory due to the stroke, but the medical staff did not provide any recommendations or treatment before his discharge.
Currently, my grandfather's cognitive abilities seem normal; he understands family conversations and is aware of recent family events (like who bought a car, who traveled, who is getting married).
However, he forgets what he just ate and claims he hasn't eaten anything.
He can distinguish between day and night but does not know what day of the week it is and shows no interest in finding out.
Every morning, family members have to wake him up; he has never woken up on his own.
He also does not take the initiative to bathe and lacks motivation for anything, just sitting all day.
He only goes out for a walk when prompted and watches TV only when it is turned on for him.
The only thing he shows interest in is traveling (he becomes motivated when he hears about trips).
Does my grandfather have dementia? If his current condition indicates dementia, will the doctor prescribe medication? Will medication help his condition? Due to his diabetes and heart failure, he takes a total of 11 pills daily, so the family is considering that if there is no medication for dementia, it may not be necessary to see a specialist (which would hurt my grandfather's pride).
3.
After the stroke, my grandfather's chewing has become very slow; he takes small bites and takes a long time to eat even a small amount of food.
Is there any way to improve this? (I once asked a dentist, but the dentist just replied that eating slowly is not an issue.) However, it pains me to see my grandfather eat so slowly.

A-Dai, 30~39 year old female. Ask Date: 2022/12/12

Dr. Liang Yinpan reply Geriatrics

Hello, A-Dai: Two years ago, Grandpa suffered a stroke that caused brain damage and degeneration, and he is currently showing signs of dementia.
It would be advisable to take Grandpa to a neurologist for a detailed evaluation to determine if there are medications available to slow down brain degeneration and whether oral rehabilitation could improve his swallowing function.
As for why the medications for the stroke are out-of-pocket, you would need to consult the attending physician at that time, as I am not familiar with the entire condition and treatment process from back then, and I apologize for not being able to answer that.
I wish for Grandpa's condition to improve soon.
Best regards, Liang Yin-Pan, Geriatrics Department, Changhua Hospital, December 13, 2022.

Reply Date: 2022/12/12

More Info

Understanding dementia, especially in elderly patients with comorbidities like diabetes and heart failure, is crucial for ensuring their well-being and quality of life. Your grandfather's situation raises several important points regarding the signs and symptoms of dementia, the implications of his medical history, and when to seek help.

Signs and Symptoms of Dementia
Dementia is characterized by a decline in cognitive function that affects daily living. Common signs include:
1. Memory Loss: Difficulty remembering recent events, such as forgetting meals or appointments, as you've observed with your grandfather.

2. Language Problems: Struggling to find words or follow conversations, which may explain why he has difficulty naming fruits or answering questions appropriately.

3. Disorientation: Confusion about time, place, or people. Your grandfather's inability to remember the day of the week is a concerning sign.

4. Changes in Mood and Behavior: Apathy or lack of interest in activities he once enjoyed, such as not wanting to engage in conversations or activities unless they are related to travel.

5. Difficulty with Daily Tasks: Challenges in performing familiar tasks, which may manifest in his slow eating habits and reluctance to initiate activities like bathing or exercising.

When to Seek Help
Given your grandfather's history of a stroke and the cognitive changes you've described, it is advisable to seek a comprehensive evaluation from a healthcare professional specializing in geriatric medicine or neurology. This evaluation can help determine whether he is experiencing dementia, mild cognitive impairment, or other cognitive disorders.

1. Cognitive Assessment: A formal cognitive assessment can help identify the extent of his cognitive decline and differentiate between normal aging, mild cognitive impairment, and dementia.

2. Neurological Evaluation: Since he has a history of stroke, a neurologist can assess any residual effects and recommend appropriate interventions.

3. Medication Review: Given his multiple medications for diabetes and heart failure, a review by a geriatrician or pharmacist can ensure that his medications are optimized and not contributing to cognitive issues.

Addressing Your Questions
1. Why Are Certain Medications Not Covered by Insurance?: The coverage for specific medications, such as the ones prescribed for stroke prevention, can vary based on insurance policies and the specific circumstances of the patient's health condition. It’s best to consult with the healthcare provider or the insurance company for clarification.

2. Does Your Grandfather Have Dementia?: While he exhibits some signs of cognitive decline, a definitive diagnosis can only be made through a thorough evaluation. His ability to understand conversations and recognize family members is a positive sign, but the memory issues and lack of initiative are concerning.

3. Will Medication Help?: If diagnosed with dementia, medications such as cholinesterase inhibitors may be prescribed to help manage symptoms. However, the effectiveness can vary, and the decision to start medication should consider his overall health and preferences.

4. Improving Eating Habits: Slow chewing and eating can be improved through occupational therapy, which focuses on strategies to enhance daily living skills. Encouraging small, manageable bites and creating a relaxed eating environment can also help. If there are concerns about swallowing or chewing, a speech therapist can provide specific exercises and strategies.

Conclusion
Your grandfather's situation is complex, and addressing his cognitive and physical health requires a multidisciplinary approach. Engaging with healthcare professionals who specialize in geriatric care can provide the necessary support and interventions to improve his quality of life. It’s essential to advocate for his health and well-being, ensuring he receives the appropriate evaluations and treatments. Remember, early intervention can make a significant difference in managing dementia and enhancing the quality of life for both your grandfather and your family.

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