Dementia

DEMENTIA

What is dementia?

Dementia is a collective term that is used for chronic brain conditions and diseases that impact memory, language, ability to think, ability to solve problems and simple day-to-day activities performance. Dementia is common in very elderly people, thus young people generally are not affected with dementia.


Damage to the brain cells is the main cause of dementia. The damage interferes with the ability of the brain cells to communicate with one another. When communication between a particular region of brain cells is affected, the person’s thinking, communication abilities, motor abilities, or behavior gets affected.


Poor blood supply, abnormal protein accumulation and degenerative changes in the brain may also be key factors that can cause dementia.


Memory loss is a common symptom of dementia. However, only memory loss doesn’t indicate that a person has dementia. People with dementia have serious problems with two or more brain functions such as memory loss and language.


Being diagnosed with dementia can be a life-changing and challenging situation for the patient and pertient’s caretakers. Dementia is a progressive condition and can worsen with time. Currently available treatments are helpful to slow the progression of the disease, but they can’t entirely stop dementia.


Types of dementia

Different regions of the brain are responsible for different functions. Thus, the damage of brain cells in particular regions of the brain can cause different types of dementia. However, there are only a few which are common and others are very rare. The most common types are:


Alzheimer’s Disease:   This is the most common form of dementia which accounts for 60-80% of all dementia cases. Alzheimer's disease is a degenerative neurological disorder that causes the brain to shrink and brain cells to die. During the development of Alzheimer's disease, nerve cells in areas of the brain that control language, reasoning, sensory processing, and conscious thought die due to plaque deposition. Alzheimer's is commonly seen at the elder age while the chances of developing the disease increase with age. Alzheimer's disease causes problems with memory, thinking and behavior. People with Alzheimer's begin to have problems recognising family and friends, learning new things. They also find it difficult to carry out everyday tasks. They might suffer from insomnia. In the more severe stages of Alzheimer's disease, the brain completely shrinks and people become increasingly dependent on others.


Dementia with Lewy bodies (DLB):   This is the second most common type of progressive dementia. This neurodegenerative condition occurs due to the abnormal build-up of protein deposits (Lewy bodies) in the nerve cells in the brain. It affects how the brain processes any information. The most common symptoms are memory loss, difficulty in alertness and attention, tremors, hallucinations (seeing objects or people that are not present), rigid muscles and slow / uncoordinated movement etc.


Vascular Dementia:   This condition occurs when vessels that supply blood to the brain become damaged or blocked or narrowed. Thus blood and oxygen supply to the brain are reduced or cut off and this may result in strokes. Vascular dementia worsens with every episode of stroke. Long-term damage on brain blood vessels due to aging, high blood pressure, diabetes, lupus erythematosus and brain hemorrhage may also lead to vascular dementia. Vascular dementia can lead to less focus and slower thinking etc.


Parkinson's disease:   This is neurological movement disorder and primarily caused by low and falling dopamine levels. The cells in the area of the brain called the substantia nigra produce the chemical called dopamine. Dopamine has a very important function in the body. It acts like a messenger that tells your brain when you want to move a particular part of your body. Thus when the cells producing dopamine are damaged or begin to die, Parkinson's disease occurs. The cause of the death of the cells is not known. Common symptoms are tremor, uncontrollable movements and difficulty in writing etc.


Frontotemporal dementia:   Frontotemporal dementia occurs when the frontal (the front side of the brain) and temporal ( the right side of the brain) lobes of the brain are affected. The frontal and temporal lobes of the brain are associated with behavior and language of the person. Thus this disorder affects a person's personality, behavior and understanding as well as speaking of language.


Mixed dementia:   This condition occurs when the person is affected with symptoms of two or more types of dementia together. For example, a person may show both Alzheimer’s disease and Frontotemporal dementia at the same time. Generally people older than 80 may get affected by multiple types of dementia at a given time.


Huntington's disease (HD):   This is an inherited brain disorder in which cells specifically in the caudate and the putamen areas of the brain die. Thus a person’s emotions and cognitive abilities are affected.


Causes of dementia

There can be several causes for dementia occurrence, but the most common cause is the degeneration of neurons (brain cells). The most common conditions that can cause dementia are:


   Alzheimer’s disease

   Parkinson’s disease

   Huntington’s disease

   Lewy body disease

   Creutzfeldt-Jakob disease

   Multiple sclerosis disease which attacks the immune system and damages the protective covering of the nerves resulting a disturbance in the communication between the brain and the body

   Meningitis which inflames the brain and the membranes of the spinal cord

   Subdural hematomas where blood clots forms under the outer brain covering

   Hydrocephalus (fluid build-up in the brain)

   Hypothyroidism (low level of thyroid hormones)

   Hypoglycemia (low blood sugar)

   HIV / AIDS associated neurocognitive disorders

   Depression

   Metabolic disorders like vitamin B-12 deficiency

   Stroke

   Brain tumor

   Trauma or injury to the brain caused due to an accident or fall

   Excessive use of alcohol or drugs

   Side effects of medication


Symptoms of dementia

Symptoms of dementia are mostly related to the types. Symptoms can range from mild to severe depending upon the types. Mainly these symptoms are related to memory loss and mental tasks. They are as follows:


   Progressive memory loss which may start with simple forgetfulness and gradually increase to severe where the person can’t remember own name, name of family members, address etc

   Difficulty in performing basic day to day tasks such as cleaning, wearing clothes, eating, etc

   Difficulty in establishing new memories and learning new things

   Difficulty in language speaking, writing or remembering even simple words

   Difficulty in judgment and decision making

   Difficulty in solving problems and reasoning

   Difficulty in solving complex or mental problems

   Difficulty in planning and organization

   Difficulty in communicating and coordination

   Difficulty in spatial and visual abilities

   Losing sense of place or time

   Losing interest in everything

   Being repetitive by asking or telling the same thing again and again

   Confusion

   Disorientation

   Sudden mood swings

   Overall personality change

   Anxiety

   Depression

   Inappropriate behavior

   Paranoia

   Hallucinations

   Being disorientated


How is dementia diagnosed?

Doctors usually diagnose dementia by knowing about a person's symptoms, medical and family history as well as by doing a physical examination. A single test can’t confirm the diagnosis of dementia so doctors advise several tests to diagnose the exact problem. These tests include:


Laboratory tests:

Blood tests:   Blood tests are helpful to detect a vitamin B12 deficiency or thyroid disorders that can decrease mental functioning.

Spinal fluid test:   Spinal fluid test is helpful to examine inflammation, infection, or markers of certain degenerative disorders.


Psychiatric evaluation:

Psychiatric evaluation is helpful to determine if the patient is suffering from depression or any other mental health condition that may be responsible for causing dementia.


Neurological evaluation:

Neurological evaluation is helpful to evaluate the memory, language skills, attention, judgment, problem-solving ability, math and reasoning, balance and muscular coordination, visual perception, senses and reflexes of the patient.


Brain scans:

Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) scan:   These scans are helpful to check if there are any signs that show evidence of stroke, bleeding, tumor or hydrocephalus.

Positron Emission Tomography (PET) scans:   These scans are helpful to determine the brain activity patterns and to check for amyloid or tau protein deposition in the brain. The presence of these proteins indicates the presence of Alzheimer’s disease.


Treatment of dementia

There are no definitive treatments for dementia yet. However various forms of treatments can be applied based on the dementia symptoms. For irreversible dementia, symptoms can be reduced by medications, therapies, diet and lifestyle changes.


Medications:  


Cholinesterase inhibitors:   Increase the levels of chemical messengers that help in memory and judgment.

   Donepezil   ( Aricept )

   Galantamine ER   ( Razadyne ER )


Nerve-protecting medicine:   Nourishes the nerve cells, protects them from damage, and improves their survival.

   Citicoline


NMDA receptor antagonist:   Decrease the activity of glutamate and control the symptoms.

   Memantine   ( Namenda )


Anxiolytics:   Ease anxiety or restlessness.

   Lorazepam   ( Ativan )


Antipsychotic medicines:   Control feelings and behaviors such as aggression, agitation, delusions, or hallucinations.

   Aripiprazole   ( Abilify )

   Haloperidol

   Olanzapine   ( Zyprexa )

   Risperidone   ( Risperdal )


Ibuprofen:   This cyclooxygenase (COX) inhibitor relieves pain, decreases inflammation, and reduces fever. It decreases the production of nitric oxide (NO), protects neurons against glutamate toxicity, and decreases the production of proinflammatory cytokines thereby controlling the symptoms of dementia.


Statins:   This class of drugs helps to reduce small blockages in blood vessels that carry blood to the brain.


Therapies:  

   Cognitive stimulation therapy focuses on group activities and exercises designed to improve memory and problem-solving skills.

   Occupational therapists teach how to manage the behavior of a dementia patient and how to prevent accidents and keep the house safe.

   Soothing music listening helps the patient to relax.

   Aroma and massage help the patient to relax.

   Spending time with pets helps to improve the moods and behaviors of dementia patients.


Lifestyle management:   Patient or his/her caregivers can take the following steps to reduce symptoms as well as risks related to dementia:

   Visit your doctor regularly and talk about any changes in symptoms or new symptoms.

   Take your prescribed medications regularly.

   Create daily routines, keep tasks simple and break tasks in easy steps.

   Speak clear and simple with a dementia patient, it will help the patient to stay calm and understand things properly.

   Reducing noise helps a dementia patient to concentrate and work more efficiently.

   Keep familiar surroundings and routines so patients don’t have confusion and agitation.

   Keep safe surroundings so patient’s can’t be hurt or get lost.

   Maintain your overall health by doing exercise and meditation.

   Exercise regularly to lose obesity and to stay fit and active.

   Walk with friends or family members to stay engaged socially.


Diet:  

   Take foods that are rich in vitamins and minerals.

   Avoid excessive smoking and alcohol consumption.


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