Dementia

Dementia is defined as a group of symptoms that affect a person’s memory, thinking and social abilities. Dementia isn’t one specific disease; it is a broad term for loss of thinking ability severe enough to interfere with a person’s daily life. Multiple diseases can cause dementia, Alzheimer’s being the most common.

What are the symptoms of Dementia?

Common symptoms of dementia are divided into cognitive and psychological:

Cognitive changes

• Memory loss, usually noticed by someone else.
• Short-term memory problems, such as forgetting where you put something or asking the same question again and again
• Communication problems or difficulty in finding the correct word.
• Trouble remembering visual and spatial things, such as getting lost on the usual route while driving.
• Problems with reasoning or
• Difficultly in problem-solving.
• Trouble performing complex tasks.
• Trouble with planning and organizing.
• Poor coordination and control of movements.
• Confusion and disorientation.

Psychological changes

• Personality changes.
• Depression.
• Anxiety.
• Agitation.
• Inappropriate behavior.
• Being suspicious, known as paranoia.
• Seeing things that aren’t there, known as hallucinations.

What are the causes and risk factors of Dementia?

Caused by damage to or loss of nerve cells, dementia occurs when the brain cells are unable to communicate, making it hard for someone to think and feel, and resulting in behavioral changes and connections in the brain. Dementias are classified according based on the their progression or reversal.

Progressive dementias

Dementias that worsen over time are known as progressive dementias and these include the following:

• Alzheimer’s disease – most common cause of dementia.
• Vascular dementia – dementia is caused by damage to blood vessels supplying blood to the brain
• Lewy body dementia – formation of balloonlike clumps of protein in brains of these people. Common symptoms include acting out dreams in sleep and seeing things that aren’t there (visual hallucinations).
• Frontotemporal dementia – breakdown of nerve cells and their connections in the frontal and temporal lobes of the brain
• Mixed dementia – more than 1 type of dementia (Alzheimer’s, vascular, Lewy body).

Other disorders linked to dementia

Huntington’s disease – genetic change that causes certain nerve cells in the brain and spinal cord to waste away.

Traumatic brain injury (TBI) – most often caused by repetitive head trauma which mostly occurs in boxers, football players or soldiers.

Creutzfeldt-Jakob disease – A disease that may be passed from parent, Creutzfeldt-Jakob disease might be due to deposits of infectious proteins called prions. Symptoms of this fatal condition usually appear after age 60.

Parkinson’s disease – Many people with Parkinson’s disease eventually develop dementia symptoms, which is known as Parkinson’s disease dementia.

Reversable Dementia-like conditions

• Infections and immune disorders
• Metabolic or endocrine problems.
• Low levels of certain nutrients
• Medicine side effects.
• Normal-pressure hydrocephalus.

Risk factors for Dementia

• Age
• Family history of dementia
• Illnesses including Diabetes, Down syndrome, multiple sclerosis, heart disease, and sleep apnea
• Depression
• Lifestyle factors, such as smoking, heavy alcohol use, poor diet, and lack of exercise
• Brain injury from certain accidents
• Stroke
• Infection of the brain (for example, meningitis and syphilis)
• Hearing loss
• Sleep problems and disorders, including insomnia or dependence on sleep medications.
• Pollutants in your environment
• Cognitive reserve, which is your brain’s ability to handle diseases and comes from doing mentally stimulating work.
• Drinking large amounts of alcohol
• Cardiovascular risk factors such as obesity, high blood pressure, high cholesterol, and the buildup of fats in the artery walls (atherosclerosis)

How is Dementia diagnosed?

To diagnose the cause of dementia requires the skill of recognition of the pattern of loss of skills and function of a doctor. Recently, biomarkers are used for accurate diagnosis of Alzheimer’s disease. Number of tests help pinpoint the problem of dementia, not one single test.

Some tests your doctor may order include:

• Blood and urine tests – to check for vitamin B-12 in the body or for an underactive thyroid gland
• Chest X-ray
• PET, MRI, or CT scans to show your brain activity
• Electroencephalogram (EEG)
• Spinal fluid analysis

Cognitive and neuropsychological tests – To evaluate the following:

• Attention
• Orientation
• Memory
• Judgment
• Language, motor, and spatial skills and function
• Overall mental health, as conditions such as major depression and schizophrenia can cause similar symptoms as dementia

What are the treatment options for Dementia?

Most types of dementia cannot be cured, but treatment focuses on managing symptoms, especially the emotional and behavioural symptoms.

• Dementia medications:

Following medicines temporarily help in improving symptoms:

Cholinesterase inhibitors: Medicines work by boosting levels of a chemical messenger involved in memory and judgment. Cholinesterase inhibitors slows or delays symptoms from getting worse.

Memantine: Decreases the activity of a neurotransmitter involved in memory formation. Like cholinesterase inhibitors, this medicine doesn’t work for everyone.

Other drugs that mild AD –  Aducanumab-avwa (Aduhelm) and lecanemab-irmb (Leqembi).

Antidepressants and antipsychotics may also be prescribed to help with emotional and behavioral symptoms.

• Therapies:
  Occupational therapy – teaches patients and their loved ones behaviour while preparing for when dementia progresses. This also includes establishing routines for memory training, physical exercise programs.
  Changes to the environment – Reducing clutter and noise to make life easier for someone with dementia to improve focus and function. Hiding unsafe objects such as knives and car keys may be required and monitoring systems that alerts a caregiver if the person with dementia wanders.
  Simpler tasks –  Breaking tasks into easier steps and focusing on success, not failure is important part of therapy in dementia as the presence of routine help reduce confusion in people with dementia.
  Other therapies that help in relaxation and may help in reducing aggression are-

• Music therapy
• Watching videos of family members.
• Pet therapy, which can include visits from dogs or other animals
• Aromatherapy
• Massage therapy.
• Art therapy, which involves creating art, without focusing on the outcome.

Can Dementia be prevented?

There is not conclusive evidence, but following things may help in preventing or managing dementia:

• Keep an active mind – Mentally stimulating activities like spend time reading, solving puzzles and playing word games.
• Be physically and socially active – 150 minutes of exercise a week should be a must.
• Quit smoking – Some studies have shown that smoking in middle age and beyond might increase the risk of dementia and blood vessel conditions. Quitting smoking might reduce the risk and improve health.
• Get enough vitamins – such as vitamin D or daily B-complex vitamin and vitamin C
• Manage cardiovascular risk factors such as high blood pressure, high cholesterol, obesity and diabetes.
• Maintain a healthy diet.
• Get good-quality sleep. 
• Treat hearing problems – People with hearing loss have a greater chance of developing problems with thinking, known as cognitive decline.

References:

1. Dementia. Mayo Clinic. May 2024. https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019
2. Dementia WebMD. May 2024. https://www.webmd.com/alzheimers/types-dementia