Dementia

Dementia

Overview of dementia



Dementia takes its roots from Latin, where ‘de’ means ‘apart’ and ‘mentis’ means ‘mind’. Dementia is the disease of the brain causing loss of cognitive functions (reasoning, memory and other mental abilities) due to trauma or normal ageing.

Dementia is not normal with aging. It can occur both in elderly and young people due to the underlying medical conditions. This decline ultimately impairs the capacity to carry out everyday activities such as driving, household chores and personal care.

In addition, they experience decline in intellectual functioning like,

  • Use of language and numbers
  • Awareness of what is going on around them
  • Judgment and the ability to reason
  • Solving problems
  • Think abstractly. 

Dementia is of two types:

  • ReversibleThis type of dementia can be cured partially or completely if treated early.
  • Irreversible—This type is incurable and the patient is completely dependent on others.

Occurance of disease in different groups: Approximately, 17–25 million people are affected with dementia globally. It primarily affects the elderly people. The onset of dementia usually occurs during the middle adult life. In some people, the symptoms are seen earlier, but may not be recognized.

The frequency of people suffering from Alzheimer’s disease (e.g., irreversible type of dementia) increases with age and it is estimated that the occurrences is1

  • 0.5% per year in people aged from 65 to 69 years
  • 1% per year from 70 to 74 years
  • 2% per year from 75 to 79 years
  • 3% per year from 80 to 84 years
  • 8% per year in people over 85 years.

Studies estimated that 26% of women and 21% of men over the age of 85 years are affected with some form of dementia. Of them, approximately 50% have Alzheimer’s disease.2

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Signs and Symptoms of Dementia

Short-term memory loss is the first sign of dementia. Symptoms are dependent upon the areas of the brain affected. The signs and symptoms can be based on cognitive function and behavioral changes.

The signs and symptoms of cognitive functions are as follows:1

  • Decision-making—Unable to make any decision.
  • Poor judgment—Unable to react in emergencies.
  • Misplacing things—Increased disorientation and confusion, even in familiar surroundings.
  • Impairment of movements—Difficulty in walking and other movements such as swallowing, which increases the risk of malnutrition and choking.
  • Verbal communication—Unable to remember simple words and substitute some irrelevant words in their speech. This makes it difficult for the listener to understand.
  • Abnormal moods—This includes anxiety and depression.
  • Complete loss of memory—unable to recognize even close relatives and friends.

Signs and symptoms of behavioral changes include:

  • Unable to eat, dress and toileting.
  • Avoids and abandons hobbies and interests.
  • Unable to perform routine activities.
  • Lack of emotional control and inappropriate responses.          
     

Early signs of dementia

Causes of Dementia

Dementia has many causes. It is difficult to determine the exact cause. Hence, a clear diagnosis is very important for treating this condition.

Some of the causes are as follows.4

  • Degenerative diseases like Alzheimer’s disease, Parkinson’s disease, Huntington’s disease and Creutzfeldt-Jakob disease.
  • Vascular dementia caused due to atherosclerosis, which is a condition that harms the blood vessels supplying the brain.
  • Some conditions like hypothyroidism, vitamin B12 deficiency, folate deficiency, syphilis of the nervous system, subdural hematoma (a blood clot round the brain, usually following a blow to the head), hypercalcemia (abnormally high calcium levels), undiagnosed diabetes and brain tumors or infections produce dementia can cause dementia. These can be reversed with treatment.
  • Medicines like tranquilizers, sleeping pills, antidepressants can cause dementia like symptoms.

 

Risk Factors for Dementia

The following are some of the risk factors contributing to this condition.5

  • Age—As age advances, possible chances of getting affected with dementia is more.
  • Genetics—Genes play an important role in passing the disorder to the offspring.
  • Smoking and Alcohol Intake—People who smoke and consume alcohol are at the highest risk for atherosclerosis, which is an underlying cause for dementia.
  • Plasma Homocysteine—Presence of higher levels of homocysteine in the blood increases the risk of vascular dementia and Alzheimer’s disease.
  • Down Syndrome—People with down syndrome develop plaques and neurofibrillary tangles increasing the risk.

 

Diagnosis of Dementia

Early diagnosis helps to prevent the condition from deteriorating. The following are the steps involved in the diagnosis of dementia.

  • Medical History—A detailed family history is gathered from family, friends and colleagues. This helps to gather more information about signs and symptoms, general health, diet, nutrition and alcohol intake.
  • Basic Medical Tests—This includes tests like blood tests, thyroid and liver function tests, glucose tests etc., which are conducted to rule out other diseases associated with it. Apart from this, detection of other disease conditions like diabetes, kidney disease, liver disease, thyroid abnormalities, problems with the heart, lung or blood vessels, which cause memory loss, confusion and symptoms related to dementia is necessary.
  • Neurological Examination—This is done to assess proper functioning of the nervous system. This involves tests for reflexes, coordination and balance, muscle tone and strength, eye movement, speech and sensation.
  • Mini-Mental State Examination (MMSE) —This involves a questionnaire about day-to-day routine activities to access the mental function.
  • Brain Imaging—Brain scans like structural imaging, functional imaging Electroencephalograms (EEGs), single photon-emission computed tomography (SPECT) are done to identify the changes in brain structure and function.
  • Psychiatric evaluation—Is necessary to find out the nature of the disorder such as depression or any other psychiatric disorder.

 

Treatment of Dementia

Appropriate treatment is given to cure reversible dementia depending on the severity of the condition and may include antibiotics or a surgery to remove the tumor or clot in the brain. Although irreversible dementia cannot be cured, medications are given to control the symptoms. Treatment involves the following.

Pharmacotherapy

The following drugs are used:

  • Cholinesterase Inhibitors—Cholinesterase inhibitors are drugs that block the activity of an enzyme in the brain called cholinesterase. The drugs that come under this class are Tacrine, Donepezil, Rivastigmine, Galantamine or Galanthamine.
  • Antidepressants or Anxiolytics—Antidepressants are a group of drugs used to alleviate depression. Anxiolytics are drugs that are used to treat anxiety and depression. The drugs coming under this group are Fluoxetine, Sertraline, Paroxetine and Citalopram.
  • Antipsychotics—Antipsychotics are a group of drugs used to treat psychosis. Haloperidol, Risperidone, Quetiapine, Olanzapine, Ziprasidone are the drugs under this class.1

  • AnticonvulsantsThese are also called antiepileptic drugs and are used in the prevention of occurrence of epileptic seizures. Valproic acid, Carbamazepine Gabapentin, Lamotrigine.
  • Over-the-counter (OTC) drugs—The available OTC drugs for dementia are Diphenhydramine and nonsteroidal antiinflammatory drugs (NSAIDs) like Aspirin, Naproxen, or Ibuprofen.


Alternate Treatment


A range of therapies, vitamin supplements and herbal remedies are available. Following are some them.

Reminiscence Therapy—This involves discussing about the past events in groups and helping them to recall using photos or familiar objects.
Reality Orientation—Helping the patient to remember where he or she is and letting them know what is going around them.


Vitamin and Other Supplements—VitaminB12 and folic acid, lower the levels of an amino acid in the blood that is usually high in Alzheimer’s patients. Zinc can improve memory, which lacks in elderly people. Some studies suggest that L-arginine, an amino acid increase the blood flow in the brain helping vascular dementia. Alpha-linolenic acid (ALA), borage oil and evening primrose oil containing essential fatty acids may help to reduce the risk of Alzheimer’s disease. A diet including less animal fats and more fish is helpful.


Herbal Remedies—Herbs are usually safe and help to strengthen and tone the body’s systems. It is always safe to talk with a physician and taking his opinion.

The following are some herbs used to help this condition.2

  • Ginkgo (Ginkgo biloba) is helpful in treating early Alzheimer’s disease and other forms of dementia
  • Huperzine A (Huperzia serrata) helps to recover memory in both vascular and Alzheimer’s dementia.
  • Hawthorn (Crataegus monogyna) , is a tonic which helps in blood circulation.
  • Siberian ginseng (Eleutherococcus senticosus) and American ginseng (Panax quinquefolium) increase stamina and improve cerebral circulation.
  • Lemon balm (Melissa officinalis), helps to recover cognitive function in mild Alzeimer’s dementia.
     


Prevention of Dementia

As there is no cure for dementia, the best method to prevent it, is leading an active life with healthy practices.8

Healthy practices include:

  • Avoiding alcohol, smoking and drug abuse.
  • Healthy diet with low in saturated animal fat.
  • Using seat belts when driving.
  • Wearing helmets when riding motor cycles.
  • Wearing protective headgear when playing contact sports. 

 

Living with Dementia

Caring for a person with dementia is very hard, as the condition deteriorates over a period of time. A person may experience emotions like loneliness, anger or frustration and guilt. Family and friends can offer much support to the affected person.

Apart from this, emotional support and practical support is obtained from occupational therapists, voluntary organizations, social services and other support groups. Some hospitals and residential homes offer short-term care for people with dementia.

Living with dementia

Stages of dementia

Written by: Healthplus24 team
Date last updated: September 30, 2012