– By Dr. Dung Ngo

Dementia is a general term that refers to the progressive decline in cognitive function due to damage or disease in the brain. Thus, dementia is a brain disorder that affects various aspects of a person’s cognitive skills including memory, attention, language, visual spatial ability and executive skills (e.g., problem solving, planning and decision making). Symptoms of dementia can be classified as either reversible or irreversible depending upon the cause of the disease. Therefore, early detection of these symptoms is crucial to effective treatment and prognosis.

There are many different forms of dementia commonly found among older people. The most common is Dementia of Alzheimer’s Type (AD). Researchers estimated that there are approximately 4.5 million people in the United States suffer from AD. The disease usually occurs after the age of 60 and the risk increases significantly as one lives longer. For example, about 5% of people between the ages of 65-75 are at risk for developing AD. The risk, however, increases to about 50% among those who are 85 years of age and older. Although AD may be found among younger age groups, it is much less common. There are slightly more women with AD than men. However, the prevalence rates may be confounded by the fact that women generally live longer than men. Consequently, women are more susceptible to having AD. Although researchers are not quite sure what causes AD, they have determined that there is no one single factor, but several factors are associated with AD. In addition to age, scientists believe that family history of AD, genetic (e.g., apolipoprotein E) and degeneration of nerve cells in the brain (plaques and tangles) are other factors attributed to the cause of AD.

Alzheimer’s disease is an insidious disease. It begins slowly and continues to degenerate with time to affect the patient’s cognitive function, personality, motor skills and behavior. Early symptoms of AD may be mild general forgetfulness such as misplacing things and trouble remembering recent events, conversations, or names of familiar people or objects. These changes may be bothersome; yet, they do not cause much distress to the patients or their family members. Thus, these mild difficulties are often mistaken with normal aging process and cause a delay in diagnosis and treatment. As the disease progresses, memory and other cognitive problems begin to interfere with the person’s ability to carry out activities of daily living, including performing self-care needs. Eventually, the person with AD will become debilitated and unable to live independently. The course of the disease varied from one patient to another. Generally, AD patients live from 8-10 years after they are diagnosed; however, some people may live with the disease for as many as 20 years.

It is important to note that progressive cognitive decline is not a normal part of the aging process. Therefore, early, accurate diagnosis of AD is crucial in helping patients and their families plan for the future, as well as to improve patient’s care and reduce caregivers’ stress. Furthermore, early detection of the disease will also offer the best chance to treat the symptoms of the disease in the early stage. There is no absolute way to diagnose AD when the person is still living. The only definitive way to diagnose AD is to do an autopsy. However, at specialized clinics, doctors can diagnose AD correctly up to 90% by performing various medical tests, collecting family history, taking picture of the brain (neuroimaging) and conducting neuropsychological assessment. Currently, there is no cure for AD. However, a number of FDA approved drugs (e.g., Aricept, Exelon, Reminyl, and Namenda) have been found to help improve memory functioning and slow down the progression of the disease. Scientists across the U.S. and around the world are working tirelessly to understand more about AD each day.

The Baylor College of Medicine is working on developing and validating a neuropsychological battery for dementia among Vietnamese Americans. The goal of this project is to improve the understanding, awareness and accurate diagnosis of dementia, as well as to open access to treatment for Alzheimer’s disease, amongst Vietnamese Americans. The standardized battery in Vietnamese language will be essential for diagnosticians across the country and will be useful in community education for increasing understanding about the assessment and symptoms of dementia. It will also provide Vietnamese Americans with improved access to appropriate health care resources. The project will provide a benchmark for cross-cultural clinical practice and study of various forms of brain disorders within the Vietnamese American community in the near future.

Epidemiological data on dementia and other neurological diseases is seriously lacking for Asian Americans, despite there is evidence to believe that Asian Americans should have rates of dementia that are similar to Caucasians (Cummings & Lin, 2000). The paucity of data on dementia can largely be attributed to the absence of culturally and linguistically sensitive instruments to diagnose cognitive disorders among this population. There are undoubtedly additional issues regarding cultural beliefs in help-seeking behavior that reduce health-care utilization (Ngo, 2004).

Given the availability and continued development of newer treatments for Alzheimer’s disease, the importance of accurate and early diagnosis is crucial. That is particularly true in patient populations who, because of cultural limitations in current assessment techniques, cannot be properly assessed with regard to whether they have dementia or with regard to determining the type of dementia present. For instance, there are currently more than 1.2 million Vietnamese Americans, with the majority born and educated in Vietnam who do not speak English fluently. Approximately 10% of this population are over the age of 60 and therefore are at risk for developing dementia. Currently, no cognitive assessment instruments are available for use with Vietnamese Americans; moreover, the normative data available for use in Caucasian and other Asian American populations are not culturally applicable to the Vietnamese. As such, the need for culturally sensitive neuropsychological instruments with appropriate normative data is imperative.