Cognitive health and mental health 

Cognitive health refers to the ability to think clearly, learn and remember while mental health refers to our psychological and emotional well-being. Although these definitions differ from one another, cognitive and mental health are closely related to each other as seen by the link between dementia and depression. About 21% of people who have ongoing depressive symptoms develop dementia as well while 40% of people with dementia experience symptoms of depression and may even develop major depressive disorder.

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Dementia

Severity of Dementia

Dementia is an ongoing worldwide problem with 1 person being affected by it every 3 seconds and the decline in cognitive health actually begins much earlier than the diagnosis of dementia which highlights the need to address it immediately after it has been detected. Not only do the effects of dementia have an early onset, they are extremely consequential. Quality of life is compromised as individuals lose their autonomy overtime. The costs incurred to battle dementia and care for people with dementia is higher than most chronic illnesses such as diabete, hence it is a major concern on both individual and national level. 

 

Symptoms & Progression

Having dementia is not just about being forgetful as that could just be associated with normal aging. There exists several other symptoms that might point to the possibility of dementia:

  • Impairment of cognitive functions like attention deficit, reduced ability to make decisions or reason as well as language issues and decline in visual-spatial perception which might lead to falling easily.
  • Further down the line, daily living gets affected and activities such as bathing, feeding, dressing and moving from place to place becomes much more challenging.
  • In the late stages of dementia, more extreme forms of impairment occur such as aphasia where the individual loses the ability to understand language or even speak; agnosia where the individual loses the ability to recognize even common objects like toilet bowls and dysphagia which refers to difficulties in swallowing. 

 

Pathway for diagnosis of Dementia

In the early phases of dementia, signs of dementia usually go undetected until the symptoms become more severe. The diagnostics process for dementia can be time-consuming as the process is not as straightforward as assumed. During this process, cognitive health of the patient declines even further. Although one might assume that the situation improves once the diagnosis of dementia is confirmed, the opposite usually happens as the concern for the patient becomes heightened and along with that comes the restriction of freedom and loss of autonomy. Some patients are restricted from leaving the house, others require someone to accompany them all the time. Many are terminated from their job. A passive lifestyle is created where the patient doesn’t go out and engage much with other people, resulting in the development of depression. The worsening of mental health leads to further loss of motivation and disengagement from life. This perpetuates the decline in cognitive health resulting in a vicious cycle of cognitive impairment and mental health deterioration. 

 

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What can be done?

Maintain Vascular Health

This pertains to maintaining low blood pressure, low blood sugar and low cholesterol levels as high levels in these aspects can lead to strokes which ultimately brings about the onset of dementia symptoms. 

 

Vascular health can be maintained in 4 ways:

 

  • Being physically active
  • Eating healthily
  • Avoiding smoking and drinking less alcohol
  • Aiming for sleep quality

 

Exercise the Mind

This involves using certain parts of the brains or abilities and to keep them actively engaged such that we don’t lose them due to deteriorating cognitive health. 

 

Exercising the mind can be done in 4 ways:

 

  • Learning something new such as a new language or hobby 
  • Playing strategy games which can be done with your loved ones
  • Creating a purposeful schedule to plan for things to look forward to so that motivation remains high 
  • Breaking convention by doing things differently from how you normally would such as eating with your non-dominant hand or taking a new route home

 

Maintain Social Connection

People with dementia are typically socially isolated which highlights the need for having such social connections with people to communicate and check in with on a regular basis.

 

Maintaining social connection can be done in 4 ways:

 

  • Check-in with old friends to revisit past, shared experiences together
  • Meet new people of different ages/profiles such as a new neighbor as this exercises the brain to find ways to maintain and create conversations with someone new
  • Have meaningful conversations that goes beyond small talks and delves into talks of passion and interests
  • Engaging in discussion provides an avenue for mental exercise where you are not just passively receiving information but also processing what you have seen and expressing it to other people in engaging conversations

 

Get checked & diagnosed early

Minimizing the effects of dementia can be also done through early detection of it. Once there are signs of dementia that have surfaced, have a formal diagnostic assessment soonest. Typically, the people closest such as family, friends and colleagues are the early spotters. They might recognize signs before the individual himself or herself does which should prompt immediate checking for the individual. 

 

Early diagnosis allows for early intervention, engagement and services to be provided and also allows ample time for future planning of important decisions like how much finances are required, the arrangements for future living etc. 

 

Providing care for people with dementia

Focus on the person & abilities

Instead of just seeing the person as being stubborn or forgetful and emphasizing on their conditions, we should focus on them as a person instead. Just like everybody else, they have the same key psychological needs of being occupied, having meaningful attachment with others, having a sense of identity and inclusion as well as emotional and physical comfort. We should do what we can to meet those needs of the individual.

 

Advocate for active engagement

By actively engaging with the individual with dementia, it helps them to exercise and stimulate different faculties of their brain which slows down the deterioration of cognitive health. 

 

Focus on relationship building

If the individual does not want to engage in an activity with you that you had painstakingly organized such as building a puzzle together and instead wants to just sit down and talk with you, do not get frustrated at them because the most important thing is the connection with the individual and the relationship between the 2 of you and not the activity. 

 

Aim to create pleasant experiences

Tying in together with the previous point, more than having to do a puzzle that is not exciting or enjoyable for the individual, what matters is creating happy and positive emotions that will benefit the individual greatly. 

 

Conclusion

People with dementia may forget your name but they never forget how you made them feel. The environment that we create for them and ultimately the feelings that we invoke within them is the most important aspect to consider when providing for people with dementia and we should never lose sight of this goal in the midst of caring for them. 

 

I am an LGBT affirming therapist based in Singapore. I completed my Master’s Degree in Counselling Psychology the Netherlands. During my training, I was exposed to vulnerable groups in the community including victims of humans trafficking as well as children exposed to abuse and family conflicts. Subsequently, I have been working with adults and families affected by dementia, working with caregivers as well as senior clients in the past few years. I am a member of the British Psychological Society and Association of Psychotherapists and Counsellors Singapore.    

Dian

Counselling Psychologist

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