Dementia

Dementia is a group of symptoms that affect memory, thinking and social ability.

This interferes with a person's daily activities. Alzheimer's disease is the most common cause of progressive dementia.

Certain types of dementia can be reversed when the causative factor is treated, while others are progressive.

Dementia cannot be termed as one single disease in itself, it is mostly a general term for describing various symptoms such as impairment in thinking, memory and communication. Dementia is most likely said to occur as one ages, but it cannot be termed as a normal part of aging. In a recent census, it has been reported that an estimated 6 million people who are above the age of 65 years in the United States are living with the Alzheimer’s disease. Alzheimer’s disease is said to account for almost 70 to 80 percent of all the cases of dementia.

Types of Dementia

Dementias are of several types and they include:

• Dementia with Lewy bodies: This is often a neurodegenerative condition which is mostly linked to the unusual amounts of a protein called alpha-synuclein being deposited in the brain.
• Alzheimer’s: This is often characterized by plaques which occur between the dying cells present in the brain as well as the tangles present within the cells. Both of these are due to abnormal amounts of protein. In a person suffering from Alzheimer’s, the brain tissue has progressively just fewer nerve cells and connections and the size of the brain tends to shrink.
• Parkinson’s disease: This is a long-term progressive disorder that usually affects the motor system and is characterized by loss of cells in a specific region of the brain. But those suffering from Parkinson’s can also tend to develop dementia-related symptoms.
• Mixed dementia: This is often referred to as a diagnosis of two or three different types of dementia happening at the same time. For example, an individual can show both vascular dementia and Alzheimer’s disease at the same time.
• Huntington’s disease: This type of dementia is often characterized by certain types of uncontrolled movements along with dementia.

Below are certain types of other disorders which can also lead to dementia-related symptoms:

• Down syndrome: This is more likely to increase the likelihood of early onset of Alzheimer’s.
• Frontotemporal dementia: Also known as Pick’s disease, this refers to various rare disorders that mainly affect the frontal and temporal lobes of the brain, thus affecting personality, behavior and language.
• Posterior cortical atrophy: This disorder is said to resemble changes mostly seen in Alzheimer’s disease, but in various parts of the brain.
• Normal pressure hydrocephalus: When there is excess of cerebrospinal fluid which tends to get accumulated in the brain, then it leads to normal pressure hydrocephalus.

The symptoms of dementia vary depending on the part of the brain that is affected and can be divided into cognitive and psychological changes.

Cognitive changes include

• Memory loss
• Difficulty communicating or finishing words
• Difficulty reasoning or solving problems
• Trouble with planning and organizing
• Poor coordination and motor function
• Confusion and disorientation

Psychological changes include

• Personality changes
• Depression
• Anxiety
• Paranoia
• Agitation
• Hallucinations

One of the early symptoms of dementia would include trouble with the memory. These changes are often subtle and it tends to involve short term memory issues. An elderly person can very well remember any events which had taken place some couple of years back, but a person suffering from dementia would find it difficult to remember what they had for breakfast. At times, such individuals forget where they had left a particular item; they tend to forget what they were supposed to do or why they had entered the room.

Those individuals tend to struggle while communicating their thoughts. It would be very difficult for a normal individual to have a conversation with an individual who is suffering from dementia. Depression is also one of those typical symptoms occurring in people suffering from dementia. They also have mood changes which they themselves do not understand wherein there is a sudden shift in their personality. For example, at one moment they can be shy and the next moment, they would be outgoing.

Dementia is caused by the damage of nerve cells in the brain. Dementias can be grouped according to the affected area or whether they worsen with time (progressive dementias).

Dementia is said to be caused by the death of the brain cells and also because of the neurodegenerative disease called the progressive brain cell death. This is mostly said to happen over time and is often associated with most of the dementias. However, there is still no clarity on whether dementia leads to death of brain cells or brain cell death leads to dementia.

Other dementias which are caused by vitamins or deficiencies of certain vitamins can be improved with treatment.

Progressive dementias that can't be reversed include:

• Alzheimer's disease
• Vascular dementia
• Lewy body dementia
• Frontotemporal dementia
• Mixed dementia

Other disorders that can be linked to dementia include:

• Traumatic brain injury
• Creutzfeldt-Jakob disease
• Parkinson's disease

Dementia is said to be caused by a stroke, brain tumor, head injury or any other major cause.

• Vascular dementia - This is often called as multi-infarct dementia. It occurs because of the death of the brain cells which can be caused due to cerebrovascular diseases such as stroke. This would mostly lead to preventing the normal flow of blood, thereby preventing oxygen from reaching the brain cells.
• Injury - There is a direct linkage of post-traumatic dementia with the death of brain cells which can be caused due to injury. There are certain types of traumatic brain injuries mostly the repetitive ones, for example, the one received by sports players. They have been often linked with certain kinds of dementias which appear in the later part of their life. There are very few evidences or proofs to prove that a single brain injury can raise the likelihood or turn out to be the cause of degenerative dementia such as Alzheimer’s disease.

Dementia is also said to be caused due to the following:

• HIV infection - It is uncertain on how the virus tends to damage the brain cells, but one thing is sure that it will definitely happen.
• Reversible factors - There are certain dementias which can surely be treated by reversing the effects of the underlying causes. It would include medication interactions, abnormalities in thyroid, depression and deficiencies of vitamin.

Tests that can be used for the diagnosis of dementia:

• Cognitive and psychological tests in which doctors measure the thinking skills such as
  • memory,
  • orientation,
  • reasoning and judgement,
  • language skills
  • attention.

• Neurological evaluation in which doctors evaluate
  • memory,
  • laguage,
  • visual perception,
  • attention,
  • problem-solving,
  • movement,
  • senses,
  • balance,
  • reflexes
  • and other areas.

• Brain scans like MRI, CT and PET scans can be used check for evidence for stroke, bleeding or tumors.

• Lab tests to check for physical problems that can affect brain function, such as vitamin B-12 deficiency and hypothyroidism.

• Psychiatric evaluation to check for any other underlying mental problems.

There is also a second part of the test which is to probe someone who is close to the patient and it would include six different questions so as to find out whether the patient has:

• Found it difficult to manage medications or money.
• Been struggling for finding the right words or tends to use the inappropriate words.
• Been needing more help when it comes to travelling or transport.
• Been finding it difficult to remember any recent events or conversations.

If these tests do confirm the memory loss, then standard type of investigations are often recommended which would include brain CT scan along with routine blood tests. By carrying out clinical tests, it would rule out or identify any kind of treatable causes of memory loss and would also help to narrow down the potential causes, for example Alzheimer’s disease.

There is also a Mini-Mental State Examination or the MMSE which is a type of cognitive test and it helps in measuring:

• Ability of recalling words
• Language abilities
• Orientation to space and time
• Visuospatial skills
• Calculation as well as attention

The MMSE is said to help in diagnosis dementia caused due to Alzheimer’s disease and it also helps in rating the severity, whether the treatment with drugs is required or not.

There is no treatment for dementia and medications are usually used for managing its symptoms.

Medications that can be used include:

• Cholinesterase inhibitors including donepezil (Aricept), rivastagmine (Exelon) and galantamine (Razadyne). These drugs increase the levels of a nuerotransmitter that is involved in memeory and judgement. Side effects of these drugs may include
  • nausea,
  • vomiting
  • diarrhea.

• Memantine, which helps regulate glutamte, a neurotransmitter, that is involved in brain functions like learning and memory. Sometimes memantine can be given along with cholinesterase inhibitors.

• Non-drug therapies that can be used to treat dementia include making environmental and occupational changes to help the person with dementia to find it easier to focus and function.

Alternative remedies for dementia that can be helpful include dietary supplements, herbal remedies and therapies.

Other therapies include:

• Taking small doses of vitamin E
• Eating fish omega-3 fatty acids
• Ginkgo
• Music therapy
• Art therapy
• Pet therapy
• Massage therapy

Risk factors that can increase the chances of developing dementia include:

• Being older than 65
• Having a family history of dementia
• Having Down's syndrome
• Having mild cognitive impairment
• Heavy alcoho use
• Depression
• Diabetes
• Sleep apnea
• High blood pressure or high cholesterol

Complications of dementia may include:

• Inadequate nutrition
• Pneumonia
• Inability to perform self-care tasks
• Increased risk of injury
• Death                                                                          

There are certain risk factors which are often associated with dementia, but the biggest of them is the age factor. Few of the other risk factors would include:

• Alcohol abuse
• Diabetes
• Very high levels of bad cholesterol present in the body
• Smoking
• Atherosclerosis which is a cardiovascular disease that is said to be caused due to the narrowing of the arteries.
• Mild cognitive impairment which not always, but in certain cases can lead to dementia.
• If the blood levels of one of the amino acids, homocysteine, are above average.