What is Dementia?
Dementia is a disorder or damage of nerve cells in the brain affecting mental abilities that include memory, thinking skills, social inabilities, mood swings, changes in behaviour which is very disruptive to day-to-day activities and hugely impacts quality of life. Alzheimer’s disease and memory loss are generally associated with dementia, but these are not the only forms of dementia. There are a number of conditions which someone with dementia experiences and dementia can take various different forms. It generally develops in people that are over 65 years old as it is an age-related condition.
What are the symptoms of dementia?
Dementia is set of signs and symptoms which vary greatly from case-to-case but generally include the following categories:
- Cognitive symptoms: these include a deterioration in memory, reasoning skills, identity confusion, difficulty performing everyday tasks, language, coordination, planning and communication.
- Psychological symptoms: Hallucination, agitation, depression, sleep disorder, delusions.
- Behavioural symptoms: Mood swings, anxiety, repetitive behaviour, nervous “ticks”, changes in sleep pattern or appetite, irritability, a quick temper, aggression.
- Physical symptoms: muscular movements, weakness or weight loss often as a result of aforementioned changes in appetite and sleep patterns.
What are the risk factors for developing dementia?
The disease is caused by degeneration in the cerebral cortex area of the brain that controls memory and other mental functions. It damages the brain cells and this leads to cognitive impairments. There are many diseases and conditions that are common in people under 65 years of age and can lead to dementia or dementia which include:
- Brain injuries: Traumatic head injuries that can be caused by falls, concussions or accidents at any point in life can lead to dementia at an older age.
- Infections of the brain: Infections that impact the central nervous system like Meningitis, Encephalitis, HIV and Creutzfeldt – Jakob disease.
- Heart and lung problems: Chronic heart and lung diseases influence the risk of developing dementia as these diseases starves brain cells by restricting the supply of oxygen to the brain, thereby affecting its normal function and leading to death of brain cells, eventually manifesting in dementia.
- Hormone disorder: disorders of the hormone secreting and hormone-regulating organs such as the thyroid gland.
- Metabolic disorders: Hormonal disorders, heavy metal exposure, thyroid problems, hypoglycemia, liver cirrhosis or kidney failure that disrupts the chemical balance in the blood.
Reversible causes of dementia
When the disease is caused by trauma or any degenerative diseases it is irreversible but in some cases it can be reversible when the cause of disease is a nutritional deficiency or the use of any particular drugs or abuse of alcohol. While the cause of the symptoms may be treatable in some cases, it is not guaranteed that it will be reversed if the underlying cause it addressed. Some of the causes of reversible dementia include the following:
- Nutritional deficiencies: Vitamin B-1, B-6, B- 12 deficiency
- Metabolic problems: Thyroid dysfunction, Depression
- Normal pressure hydrocephalus: This is a condition in which excess cerebrospinal fluid builds up in the cavities in the brain that are meant to contain fluid. This excess fluid build-up increases the pressure on brain tissue.
- Anticholinergic medications: This refers to a broad class of drugs that are used to treat a variety of conditions such as Parkinson’s Disease as well as Chronic Obstructive Pulmonary Disease and gastrointestinal disorders. Using these drugs for prolonged periods of time can cause toxicity to build up in the brain, ultimately manifesting in dementia.
- Alcohol-induced cognitive impairment, long-time alcohol or illegal drug use
- HIV-associated neurocognitive disorders (HAND)
Irreversible causes of dementia
Alzheimer’s disease is the most common irreversible cause of dementia and is caused due to abnormal deposits of protein or “plaque” that progressively damages the internal structure of the brain.
Degenerative neurological disorders which include Frontotemporal dementia ( Pick’s disease ), Lewy bodies, Parkinson’s and Huntington’s disease.
Vascular disorders that affect blood circulation causing multiple strokes in the brain.
What are the different types of dementia?
It mostly occurs after 65 years of age and is caused by reduced oxygen supply to the brain due to blockage of blood vessels depriving vital oxygen and nutrients to the brain. This leads to problems with memory, language, concentration, planning, judgment and personality changes.
Many people with vascular dementia live for a number of years but usually for no more than five years after the symptoms begin. Although it is not curable, if diagnosed at an early stage, it may be possible to slow down the progression.
Multifactorial or mixed dementia:
It represents more than one type of dementia and most commonly combines Alzheimer’s disease and vascular dementia together. Life expectancy is around 10 years after being diagnosed with mixed dementia. It is most common in people over 75 years of age.
It causes decline in memory, disorientation, problems with reasoning and communication. It is not curable but the patient’s quality of life can be improved through regular therapy including behavioral, cognitive stimulation, reminiscence therapy or cognitive rehabilitation therapy
Lewy Body dementia:
This is a common type of progressive dementia which involves tiny protein (alpha-synuclein) deposits called Lewy bodies which develop in nerve cells affecting chemicals in the brain (such as neurotransmitters) and leading to problems with memory, thinking, behaviour and movement.
It may cause hallucinations, disturbed sleep patterns, mood swings and depression. Lifespan after diagnosis is typically 5 to 12 years.
It is not curable but management of symptoms through modifications of lifestyle and environment, regular exercises, avoiding daytime naps, music therapy, aroma therapy or massage therapy can also help the person to live well.
Frontotemporal dementia (including Pick’s disease):
Frontotemporal dementia is a group of conditions affecting the frontal and temporal (side) lobes of the brain leading causing a loss of empathy, a loss of short-term memory and difficulties with processing language.
Mild cognitive impairment (MCI):
This is not really a form of dementia but, instead, an intermediate stage between the cognitive declines that results from aging and dementia.
People with Mild cognitive Impairment are most likely to develop dementia but this is not always the case because MCI can also be caused by depression, certain types of medications or any other physical problems which do not result in dementia.
Who gets dementia?
People with over 65 years of age are at increased risk of developing dementia but this can affect younger people and is difficult to recognize at an early stage; very rarely, it is seen in people between 20 to 30 years of age (often referred to as “early onset”) with symptoms becoming more pronounced with age.
It is usually diagnosed between 45 to 65 years of age. Frontotemporal dementia has genetic roots and can run in families.
How can we diagnose dementia?
Early detection of the disease is crucial as it can be treated in some cases and progression of the disease can be slowed or even prevented. Dementia can be diagnosed based on the following:
This includes physical examinations, testing blood or other fluid levels, assessments about the beginning of the symptom development, family history and the patient’s past and current medication regime.
Cognitive and Neuropsychological:
To assess the memory, cognitive functions and other mental abilities to check the functioning of the brain, the doctor can request brain scans using Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) technologies to check brain activity.
Is there any cure for the dementia?
There is no cure for the disease (unless it is due to the reversible causes alluded to above) and treatment for dementia focuses on slowing down the progression of the disease.
Age is the biggest risk factor of developing dementia. Life expectancy is about 8 to 10 years after the diagnosis.
In order to protect the brain, a person should quit smoking, eat and maintain healthy diet, maintain blood pressure, blood glucose, cholesterol, life style modifications, engage in mental stimulating activities and exercise regularly. Cardiovascular exercise increase flow of oxygen to the brain and improves mood, behavior and mental functions.