Is It Dementia Or Are You Growing Old? World Alzheimer's Day 2021

[Music] [Music] [Music] [Music] good afternoon everybody my name is dr priya raghavan i'm a consultant psychiatrist working at kadabam's hospital in bangalore i welcome you all to this afternoon's live webinar on dementia i would like to speak to you today on the occasion of world alzheimer's day 2021 the theme for this year is no dementia as in get to know k-n-o-w dementia the reason uh why this topic has come about for this year is simply to promote awareness of dementia get to know what constitutes dementia what doesn't just so you're able to access treatment and get adequate support for your patients and families put together so we can all join in the fight against dementia so there's quite a topic quite a few topics that we need to cover today and i will be going in the following order first i'm going to be speaking to you about um why we need to speak about dementia what are the different conditions that mimic dementia dementia itself its diagnosis treatment and finally a little bit about healthy aging and probably aging gracefully and i will then conclude with my summary of points for you all so i will be speaking to you in my capacity as a specialist in old age psychiatry having worked as a consultant in the united kingdom and also currently working as a consultant here in bangalore which also means i have the experience of working across two nations but also across two different health systems and why do we need to even speak about elderly people today so if we have to try and understand this we need to know that we are living now in a changing world where um people are living for much longer there's increased longevity for the last few decades um given to advancements in scientific medical and technological fields this essentially means that a lot of other conditions which we did not know about in the past are now coming to the fore one of the most important among them would be various dementias alongside increased longevity we are also living in a world looking at changing health needs which means changing physical needs so the longer you live then that basically means people are getting older living for longer they get having a lot of physical health um conditions like restricted mobility could be due to arthritis or it could be various pains it could be frailty when they are getting just weaker falling difficulty moving various infections etc it also then leads to various changing mental health needs because undoubtedly if there's a physical health need that does impact on the mental health of individuals this means elderly people are bound to have various mental health conditions like depression stress of course dementias we are also living in a world where our societal structures are changing as an example i think our country was a country which lived within the joint family system this is now increasingly disintegrating as we are all living in nuclear families um this is also because of the shift um in or you know a shift in migration wherein youngsters wish from villages and towns wish to come to cities and youngsters in the cities wish to move abroad this essentially means a lot of our elderly

population are actually left within their own homes and villages and in cities not necessarily to fend for themselves but certainly on a day-to-day basis this does pose some practical challenges so within this context of um change uh we are seeing we are witnessing people with a lot of memory problems and when it comes to memory issues we have different sets of people there'll be a i have seen in clinical practice a set of people who are particularly not worried about their memory at all you know despite the fact that there are obvious glaring memory issues patients and families are not worried as they simply attributed to normal aging we also have another set of people who get very worried at the prospect of slight memory problems and they start to worry that they have dementia and they get all tests done so um i think it's important to set facts straight today and we need to know uh what is normal aging what is an abnormal process so before we actually start about start talking about these conditions i want to draw your attention to this term called cognition cognition is essentially a term that encompasses various characteristics like memory language thinking reasoning judgment making decisions implementing decisions solving problems etc etc all these things what we call the higher brain function uh put together constitute what's called cognition and we are going to be using the term cognitive decline quite a fair bit today and this is why i wanted you to know what cognition actually means so um when you come across um elderly people for example it could be your dad uncle aunt or your next door neighbor at home uh having the odds slip in their memory um you know it doesn't necessarily mean they have dementia because growing old [Music] as we all grow old we are bound to forget a little bit so as we grow older our body systems do start to slow down brain is no exception to it so the aging brain will show some normal changes like a little bit of stretching a little bit of thinning and as a result of these structural changes to the brain there may be occasional lapses in memory you may find that your dad or your granddad or your aunt is not able to multitask as well as they used to before but they are still very much with it they are still very sharp and they can still do all the tasks that they were able to do before except that they need that extra bit of time because the brain has slowed down a little bit it needs time to process things but it's all very much there so cognitively they're very much intact just that they have slowed down a little bit this is what we call normal aging this does not mean you have dementia it's very much a natural process and it's nothing to worry about and how do we maintain this or how do we ensure that we are reducing the risks for developing dementia as something i'm going to be speaking about at the very end so given that this is normally aging then i would like to draw your attention to the other end of the spectrum which is dementia and when i say other end of the spectrum here i mean it's an illness it's a disease of the brain so what exactly does dementia mean the term dementia essentially refers to a disease of the brain it is chronic in nature in the sense it is long standing and it also is a degenerative condition which means it gets worse with time so

essentially dementia is a chronic neurodegenerative disorder that occurs because of underlying diseased processes in the brain whereas normal aging is perfectly a part of aging and is not a disease and it's very important to differentiate these two conditions because treatment is necessary for dementia whereas treatment is nowhere required for normal aging so um when we are talking about the disease brain then we have um many questions coming out for example people ask us are dementia and alzheimer's the same uh and i would say the dementia simply refers to a cluster of symptoms it is what we call a syndrome so the disease brain comes out with a cluster of symptoms called dementia and under the banner of dementia we have several subtypes the most common subtype is alzheimer's i'll come back to that in a minute before that i want to talk about some symptoms of dementia because this is what many people will need to actually watch out for the most common symptom of dementia as you all know is lapses in the memory and when we say memory it usually starts off with short-term memory and eventually with time invades the long-term memory and i want to draw your attention to this because many families when i ask them casually in the clinic how is you know your mom's or dad's memory they say oh it's absolutely fine they remembered everything from way back but of course they don't remember anything um you know that's happened recently and i'd like to say that that is something that needs explored because it could be a dementia or it could be part of normal aging but something that requires work up so one of the hallmarks of dementia is um short term it starts off with lapses in the short term memory and as the dementia progresses invades the long term memory uh so you may find that your near and dear one forgets things frequently it could be forgetting days days appointments where they put the keys did they take the tablets did they not take the tablets taking the tablet forgetting it and then taking them again is actually a particular risk that we see and we need to reduce so memory lapses will manifest in this particular fashion um as a mem as the you know as the dementia deteriorates there are many people who cannot maybe recognize their own son or daughter because in their mind they are back in time they have traveled back in time they are in a very different time zone because as i said um the short-term memory is the one that gets erased first and as the dementia progresses it invades other aspects of the memory so if your 85 year old mom

cannot recognize their 50 year old daughter is standing in front of them it is mainly because they in their mind in the 85 year old mom's mind the daughter is still about 15 years old or 20 years old and it is that daughter that they can recognize because they are in a very different time zone so one of the hallmarks as i said is memory problems there are other things other symptoms of dementia are like language difficulties you may find that a person with dementia is not able to take part in a conversation because they are not following the thread of the conversation they may start to say something and they may stop abruptly probably because they have lost track or because they're not able to get the right words out or simply because they don't understand what is being spoken anymore so language difficulties could be in two different ways um as in spoken language they may struggle to find the words or they may struggle to understand what is being spoken some of the other symptoms of um you know dementia include difficulties in recognition it could be recognition of objects things people places faces anything and i just gave you an example of mum not being able to recognize their own daughter it is a combination of memory lapse and also difficulty in recognition i remember one of my patients who did not know where to put the bread instead of putting it in the bread basket she ended up putting it in the tea kettle because she could not recognize that that was a tea kettle and and not a bread basket we also find patients who actually pee in the kitchen sink and not in the toilet because they are not able to recognize anymore that that's a kitten sink and they are not allowed to do so some of the other symptoms of dementia could be um difficulty with spatial orientation so you may find that you know your granddad who has been living in the house for the last 40 years does not know where the toilet is anymore you may find that the same grandfather goes down the street and cannot recognize the family the familiar roots and he may get lost i mean how many times have we seen um you know patient families coming in saying oh my dad or my granddad so and so was lost and some stranger thankfully got them back home in an auto that's because they have lost their sense of spatial direction so these are all some symptoms of dementia but we call it as a dementia only when the cognitive decline which i spoke to you about is also accompanied by functional decline what i mean by that is when there are lapses in memory language thinking reasoning judgment recognition and etc when these actually um impact their day-to-day functioning like they can't go to the shops anymore or they're not able to buy vegetables anymore they're forgetting lists or they're losing track of money they don't know how much money they have anymore in the bank or they don't know who came and went and you know what kind of bill they have made etc if they do not have knowledge of these things anymore so there is a cognitive decline alongside a functional decline for at least a period of minimum 6 months then we call it as a dementia so these are all some of the clinical features that i would like you to perhaps make note of before you start panicking that your near and dear one has a dementia and of course if you're in doubt you're always welcome to come and see us so that leads us on to the next question uh so what causes dementia uh to be uh to be perfectly honest we don't exactly know that one thing that causes dementia there is explosive amount of research that is happening in um this particular area and now we have all we have come up with a set of risk factors all pitted up one against the other that will increase the chances of anyone developing the condition so the first and foremost this uh the single biggest risk factor for uh dementia is age and this is what we call as a non-modifiable risk factor because we cannot help the fact that people grow older so the older you get the higher your chances of getting a dementing illness but that alone as i said is not enough for someone to get a dementia there are some other factors that we can work on to reduce your chances of dementia and what are they some of the other factors are what we call vascular risk factors vascular essentially refers to anything any factor that interferes with the blood flow in your body so it could be things like high blood pressure diabetes obesity heart attacks previous strokes smoking alcohol kidney damage as a result of diabetes or hypertension all these factors put together are classed under vascular risk factors because these things will affect the blood flow to any organ in the body by affecting the tubes that carry blood the tubes what we call our trees they get affected by all these risk factors so that the tubes become very hard inflexible it incl increases blood pressure they get clots inside they get cholesterol deposits inside etc etc and these culminate in stroke if it happens in the brain it culminates in heart attack if it happens in the heart and if it happens in the leg it's what we call peripheral vascular disease etc etc so all these risk factors that cause heart disease also cause dementia they also cause brain disease so the simple thing is if we are able to address all of these risk factors then your risk of developing dementia actually comes down yes there are some other non-modifiable risk factors like genetics and we can't do much about that again uh however um you know dementia is occurring within the family amounts to almost uh one percent or even less so i don't think we should worry about that too much when dementia does not run in families it's it's a very very small percentage of course um what it also means there are some genetic factors that increase your risk but you don't invariably get it so what i mean by this is um somebody has cancer in the family if dad has cancer in the family it does not necessarily mean the sun will invariably get it it does mean however that his chance of developing that particular type of cancer is a bit higher compared to the rest of the normal population same with dementia if mom or dad or a sibling in the family has dementia then you as a son daughter or the other sibling have a slightly higher risk but not invariably so so these are all some risk factors of dementia that we need to be aware of and what happens as a result or you know as a result of these risk factors we spoke about the clinical symptoms but what is it that actually happens in the brain that causes these symptoms uh lots of things and as i said there's a lot of investigation there's a lot of research that goes on into these processes as an example if i have to say what happens in alzheimer's disease is um [Music] the disease process for alzheimer's actually starts decades earlier than the clinical symptoms so it is fair to say that alzheimer's disease changes in the brain start as early as 40 plus years when you're at the age of 40 plus but the symptoms develop decades later and do not get disheartened by that because i said there are lots of other things that can be done to reduce the risk of dementia and not everybody who has alzheimer's disease changes in the brain go on to develop clinical symptoms so what happens in alzheimer's disease is that um okay the brain is made up of i'm gonna i'm gonna digress a little bit the brain is made up of billions of neurons neurons are what we call you know nerves basically nerves so each nerve you can um imagine a nerve as having a head and a tail um so the two put together are called neurons see the the tail portion of the nerves um again there's billions of them and they all kind of um talk to the other nerves with these tails being connected so one tail gets connected to another tail um at a junction and what happens at these junction is that there's a release of chemical from this nerve to the other nerve right so what happens in dementia is there are changes that occur at this microscopic level at the cellular level at every single level so you have structural changes in the brain as in when you imagine you know billions of nerves in your brain the nerves are kind of kept connected to each other by an in by the intervening tissue now in that tissue if you you know there are what we call abnormal beta amyloid deposits or plaques they are protein deposits that are found in between these nerves that actually damage the nerves that damage that chemical process what i told you the chemical you know connection between the nerves is damaged by way of these plaques and inside the nerve heads what i spoke about itself there is um accumulation of abnormal proteins called tau tau tau proteins and plaques

these are some of the basic changes that actually occurs in alzheimer's disease brains uh and these changes are so profound that the um that the chemical talking that the chemical messengers that that um the way they uh kind of talk to each other is all affected uh so this is just an example of what happens in alzheimer's disease if you look at other diseases like vascular dementia um you know the blood flow as i said to the brain is not as good as it should be and that can cause memory problems so to my earlier question do dementia and alzheimer's mean the same dementia is a group of symptoms it's a syndrome and under dementia you have several subtypes alzheimer's dementia is the most common type of dementia about 70 percent of people have alzheimer's disease the next common would be your vascular dementia and as i've already said it's a blood flow to the brain that is affected that causes memory problems this is what we call vascular dementia some other types of dementia would be lewy body dementia parkinson's disease dementia lewy body and parkinson's disease dementia occur more or less in the same continuum of conditions so some people may develop parkinson's disease first and then go on to develop a dementia and some people may develop louis body dementia first and then go on to develop parkinson's symptoms leave this to the experts but what i'm just trying to tell you is there are different types of dementia and the reason we have different types of dementia is because it has some implications for treatment some of the other types of dementias you may wish to know about are what we call frontal temporal dementias occurs in much younger people and they are the more difficult um more challenging sort of dementias because the issues there would also be much more complex um so with these um different kinds of dementias what do you you know just in case you're getting overwhelmed when you're thinking what do we do next um so this is where it's very important to investigate the condition do a proper dementia workup and then arrive at a diagnosis and when i say arrive at a diagnosis we spoke a bit about normal aging i spoke about dementia it's not just these two conditions that walk into your clinic there are many many other conditions that mimic these you know mimic dementias for example mild cognitive impairment so as the name suggests there is a cognitive decline here there is cognitive impairment which is mild and it's not severe enough to be classed as a dementia and it is certainly not mild enough to be classed as normal aging so mci is a category which we come across quite frequently that is a gray zone between normal aging and dementia why is it important because some types of mci are actually you know because of an underlying alzheimer's disease process and these mcis can go on to develop dementia and then there are other mcis which do not go on to develop dementia they just stay there the reason they stay there is because of some of the underlying conditions that cause mild cognitive impairment when i say mci the way it presents is yes your grandfather may be repeating things forget uh repeating things uh sorry forgetting things repeatedly he may not know where he put his keys and he may not exactly remember if he took tablets or not but he will eventually get that he may land up asking you questions repeatedly but despite all of these lapses in memory lapses in language he's still able to function reasonably normally so if you have cognitive decline but no functional decline then we call it as mild cognitive impairment if there is cognitive decline accompanied by functional decline we call it dementia if there's no cognitive decline just a little bit of slowing and absolutely no functional decline it is just normal aging so it's quite important to differentiate these because you know as i said already dementia can be treated we will need to keep an eye for mci to see if it progresses to dementia some of the other causes of mci would be things like some vitamin deficiencies particularly in vegetarians where you know vitamin b12 which is commonly derived from meat if it is deficient or you know an undetected thyroid disorder overactive thyroid under active thyroid that is not treated can present a bit like dementia or mild cognitive impairment so if you do the work up the bloods and all the investigations detect these issues address them you may find that the mild cognitive impairment returns to normal depending on the underlying cause of course and some mild cognitive impairment will stay where they where it is for example if there's vascular damage to the brain you're about forgetful but it's still not translated into functional decline then you would call it as mci because of vascular causes and then of course mci progresses to alzheimer's dementia if it's because of an alzheimer's process the conversion rate from mci to dementia is about 15 per year 10 to 15 per year that means 10 to 15 percent of cases with mci will go on to develop dementia that year so it's important to actually keep an eye on all these different conditions and how do we do it so i will give you an example of what we do at kadapam so you have an idea of what to expect as i said it's very important to tease these conditions out to see is it dementia is it mci is it normal aging is it something else like a depressive illness because depressive illness also is a risk factor for dementia another condition called delidium which essentially again refers to a set of symptoms wherein there is um a sudden onset of confusion sudden onset of memory problems sudden disorientation don't know where they are what they are doing but all in the context of physical illness is called a delirium so um delirium dementia depression these all kind of go together in the elderly population so when anyone presents with confusion memory problems low mood etcetera it's very important to tease out the different causes and see what is it that they have is it delirium is it dementia is it depression is it normally aging is it mci what is it because the treatment is very different if it's a delidium it would be a bit silly to um treat them for depression um so for example let's say if the sudden onset confusion uh is because of low sodium it's because of very high sugars and you end up treating them for depression um then they're not going to get better if any they're going to get much worse similarly if someone has a depressive illness and you treat them for dementia the depression is not going to get better it's going to get worse so it's very important to tease these things out and see what condition they actually have before we treat them so how do we actually go about addressing these symptoms um you know let's say you have a concern you're not sure if it's a delirium dementia is it just normal eating or could they be depressed what do we do about it so it's very important as i said to first diagnose dementia and diagnosing dementia essentially means ruling out the other conditions like depression delirium etc and then diagnosing dementia and coming up with the treatment for the same how do we do it so the way we do it in kadabams and in fact worldwide what happens is that we'd first like to meet the patient

gather all the information as much as possible from the patient and very importantly from the family because once somebody has a diagnosis of dementia it's very important to work with the families because they are the ones who are providing care and they will also need a lot of support because there is a significant amount of care and burden involved as well so what we do at kadabam's in our memory clinic is that we see the patient first at the first assessment we gather information from them and also speak to the families see what the concerns of the families are and we'd like to know a timeline of events you know having spoken to the patient and the families we try and understand try and piece together what is it that has happened when did the problem start what is the nature of decline etc we'd like to know more about your physical health medication all the risks we spoke about it could be forgetting to turn off the cooker it could be you know going out of the house not coming back because you don't know the way etc so we gather all information as much as possible in the first appointment and then we would need to do a basic set of investigations in most people as i said to rule out the other conditions so if someone's a diabetic if someone has had recent surgery etc there may be a lot of things that's going on in the bloods that we need to know about there could be simple infections so we would ask for a blood screen we would need to do other basic investigations like an ecg and also a brain scan the brain scan is done mainly to see what's happening in the brain is there any vascular damage what is the extent of it what's the size of the brain particularly the areas that's responsible for the memory etc and so we have clarity around what is happening so we put then in the second appointment we put all of these things together we gather all you know your blood reports your brain scan reports information from the patient from the families and also do memory tests what we call cognitive testing um you know depending on how much the person is able to do we may have to do a series of tests to identify exactly what is the level of um you know cognitive problems that this person is facing what's the severity of it so we have it on paper use that as a baseline and based on this we can then arrive at a diagnosis if it is a dementia we will tell you what it is and we will also speak to you about what the diagnosis entails and how is this condition going to progress because now coming to treatments there is no real cure for dementia as you know there's a lot of research happening in this area but we haven't found a cure as yet so medications are available and what do these treatments do they essentially slow down the progress to some extent and so they provide a stability of life and a better quality of life and tablets and medication also help in managing some of the other symptoms of dementia as i said like if there's a language difficulty or if there's too much agitation etc these tablets the anti-dementia tablets might help in addressing some of these issues so alongside anti-dementia tablets we also you know many times find the need to prescribe other psychiatric medication as and when the condition progresses because men most people with dementia go on to have you know what's called bpsd behavioral psychological symptoms of dementia wherein you know they are shouting screaming in distress they may have hallucinations some low moods etc so we may find the need to use psychiatric medication to address some of those symptoms as well so when you look at treatments for dementia yes we have pharmacological that is medication treatment we have a lot of tree talking treatments useful talking treatments for example reorientation therapy wherein you're you know reorienting them bringing back to where they are telling them the day date month year these are simple things you could do at home validation therapy is um an interesting thing because sometimes if you're telling you know telling the person in front of you telling your dad uh daddy today um today is not uh you know december 20th it is not uh 2021 and your dad's insisting no this is 1955 and getting very angry wound up there's no point in going in arguing with him you may eventually learn with time and with our help and with our support that it is sometimes best to leave things the way they are and not argue with the person and explain to them when they are calmer in the sense you're providing validation for your dad's thoughts there's other things like cognitive stimulation therapy this is a particular type of talking therapy that can actually even be done by families and carers and can be very useful in stimulating cognition for the person with dementia and it also allows you a chance to actually know much more about your mom and dad than you actually knew so it's going back a bit in time and you know doing various things that they enjoyed or they perhaps remember about and so it stimulates their memory then there are um so there are talking treatments that can be done of medication that can be given and of course not to mention um the you know the practical aspects of caring for someone with dementia this is something our social workers and our organizations will help you with it may be providing tips about offering practical support for example if you find that your dad is struggling to take a shower because it's way too slippery then we may ask you to install you know handrails bath rails you may need banisters in your house just so they don't fall off while going up the stairs and it could be um you know other simple

practical things like maybe even installing a clock in every room nice and bright so they know exactly what the time is and don't get up at two in the morning and wander into the kitchen thinking it's seven o'clock in the morning for tea and biscuits so there are lots of these practical things that we can do as well and we will help you with all of these we also give you plenty of information following a diagnosis of dementia about the diagnosis what to expect as time would go on just so you are prepared and wherever possible we will offer practical help as well we'll also tell you about resources and help that is available in the area where you're living so you're much more prepared to deal with the condition and most importantly you know we professionals are able to comment on capacity because mental capacity is something that deteriorates with time and this is why for people with dementia and this is why it's vitally important that we diagnose the condition catch it early so we can make arrangements for example um you know if there are many families who do come in very late um they realize much later in the course of the illness that this doesn't sound like normally aging there's something else happening here we tell them it's dementia and everything but it may be too late for them to put their affairs in order and how many families have we seen brothers sisters at loggerheads because of property issues because of care issues they're not because they haven't accepted the diagnosis themselves and these things take time so it's much better if early diagnosis is given so that all these arrangements can be put in place so what i would like to tell you is there's plenty on offer there are things that we can do although that although there is no cure and we will be helping you uh every step of the way here at karabam's so finally before um you know i'd like to call it a day i'd like to give you a few tips about how to age healthily because not everybody is going to develop dementia most of us are going to go through normal aging so i'd like to tell a little bit about how we actually do that so the most important thing i spoke to you about was the vascular risk factor so that is very closely linked to lifestyle changes as i already said all factors that affect the heart also affect the brain they reduce the chance of dementia so addressing your lifestyle reduces your risk of dementia by one-third and that's a significant number so it's very important to actually um exercise regularly so it's never too late to start so if you're not exercising try and do as much as you can you know it you may be 40 you may be 50 you may be 60 you may be 70 or even 80 do whatever you can even if it is just sitting in your place and wriggling your legs if you're too if you're 18 you're not able to do things so the general recommendation however um is that you get about 150 minutes of moderate intensity exercise per week that's about 20 to 22 minutes per day it can be done and this could be like um you know cycling brisk walking dancing etc um the other thing uh to do uh i mean yoga uh will also help the other thing to do would be um you know linkedin exercise is also diet having a good diet a good balanced diet and i'm not suggesting that you have a balanced diet every single meal of your day because it's really not possible but um try and ensure that you eat at least five portions of fruits and vegetables so it could be four fruits and one vegetable or it could be three fruits and two vegetables etc five portions of vegetables on most days you would need to cut down on starch and carbohydrates not more than a third of the energy should come from starchy foods and when you're eating starchy foods try and eat whole foods like you know whole wheat etc cut down fat needless to say and there's a lot of controversy about saturated fat it's health you know the bad benefit of saturated fats i think it's reasonable to say um foods containing saturated fats like coconut oil palm oil are reasonably good as long as they are had in moderation certainly the saturated fats trans fats coming from deep fried food you know processed foods like your burgers pizzas hot dogs etc you would need to cut down on them try to eat it all in moderation as much as possible the other thing would be proteins yes increase your intake of proteins on a daily basis wherever possible also get it from all the dals pulses your beans etc cut down on red meat because it also contains a lot of fatty food uh go for lean meat like chicken uh fish again it's supposed to be uh you know very good the omega fatty acids in there these all cut down the risk of your dementia good diet exercise also your weight you need to watch your weight so your weight whether you're at your ideal body weight will depend on your age your height your genetics and also um your ethnicity so you know there's plenty of websites on google just google your uh ideal uh your bmi and you will need to do some exercise to get to that bmi the other thing to actually watch out for would be alcohol so if you're drinking too much please cut down if you all that's the general advice for most people but if you already have liver damage then there's absolutely no alcohol for you and when i say cut down what you're generally allowed is about 14 units of alcohol per week for both men and women previously it was 21 units for men and the guidelines have now been revised because 21 is way too harmful so 14 units for men and women how to calculate units etc is a different story altogether we'll cover it another day but essentially even about you know about half a bottle of whiskey half a bottle of rum that's about 360 mls would amount to somewhere around 14 units so you need to drink a bit less than that and if you're drinking 14 units in a week ensure that you're spreading it out over three or four days and not drinking all the 14 units in one go because again that's very toxic to the brain and puts you at risk for various dementias especially alcohol-related dementia so we've spoken a bit about alcohol your weight your diet we also need to speak about smoking please stop smoking we know the ill effects of smoking and i won't go into it much today other than this there are other things that we need to do in order to lead a healthy life and age healthily what are they some of the things i would like to speak to out with the lifestyle changes are coping with change very important to cope with change learn to cope with change because there are many things that can actually you know go wrong as we grow older this could be loss it could be loss of a partner loss of son daughter it could be loss of a job it could be retirement it could be children getting married moving away from home it could be any of these things or being diagnosed with a physical illness but it's very important that we learn how to cope with this not get bogged down by the negatives in our life but it's very important to acknowledge and unders and focus learn to focus on what's actually going good and that will give us an impetus to try and see how much of it we can fix when things are actually going wrong and if you're not able to fix it then how do we actually accept it so for example if you've lost a loved one we're not going to be able to fix it but with time we will eventually learn how to accept their death and there will be of course a grieving period but that is again um you know considered totally normal so it's very important to cope with change accept what's going on and if there's something that we are upset about i think it's important we learn to express those feelings so if you're not able to talk it out with your near and dear one write it down so that it becomes much more clear makes sense just so we are able to address those issues very important to learn from mistakes who doesn't do mistakes apart from coping with change it's also important to find new uh find meaning and joy in whatever we do so instead of sitting getting upset thinking that you know son is married he's not paying attention to me anymore i think it's very important uh for us to actually go

and learn something new find a little bit of enthusiasm it could be learning a new language it could be learning computers or in fact trying to find out how you can actually integrate with your son's new family so uh you may also wish to you know do some voluntary work at your local place where you live it could be at the street you could do a organization to keep your place neat and tidy in your road or it could be maybe volunteering at the local temple if you want to spend time with nature by all means go and do it so you need it's important to try and find new meaning in your life so you're also able to cope with change the third important thing is to stay socially connected and i cannot stress the importance of this because isolation um you know lack of social connection these are all connected these are all linked to depressive illnesses and they in turn are linked to dementia so stay connected if it's not possible to go out now because of the pandemic which is totally understandable it poses its own threats then there's plenty of other ways to socialize it could be online it could be through skype video calls you will know all of these things better than me it's also important to maybe make connections with the younger generation it could be from your family it could be with your neighbors because they can also prove to be very useful helpful a lot of things to learn from the younger generation as well like technological advancements etc and they may learn a lot of things in turn from you so as i said important to stay connected meet your friends family if you can't go invite them over and i think that those things will have a positive effect on your mood and the other important thing is any physical health issues please get them addressed the number of ways you can do it so uh in those days we used to have this concept of family physicians or our gps it uh may not be such a bad idea going back to that now because right now we are all bogged down on going to different specialists so you go to the neurologist which is very important if you have a neurological problem we go to cardiologists if there's a cardiac issue again very important and we uh you know we we cannot neglect these aspects of life but also somewhere in in our thirst to see different specialists we have lost the continuity of care in my view and nobody so your neurologist is not going to know what's going what's happening from the cardiac side and cardiologist doesn't know what's happening with the neurological side and we need somebody who's going to tie all these things together and in my view it is a gp so i think we perhaps have to think about making that connection with the gp so the gp knows what exactly is happening in each specialty with this patient so we can take you know a decisive call on things it's much easier to do it that way see of course by all means see specialists if needed take your medication regularly if you're struggling with medication ask your son daughter family or anyone who's going to be able to help out to sort out medication in those doset boxes which we get so it's easier to take medication for you seek timely help so with all of these things i think at the individual level you know i have no doubt in saying that you will be aging healthily and you'll also be aging gracefully so as a summary i would like to finish by saying yes it's very important to know about all the different conditions alongside dementia please come and see us we will help you out you know in teasing out the different conditions providing the right care do not panic and irrespective of the diagnosis it's very important to actually work on your lifestyle and all of the other things that i just spoke about so we can actually age gracefully and also join us in the fight against dementia thank you [Music] you