Dementia

When we think about dementia, we think of a set of symptoms that include memory loss, difficulties with thinking, problem-solving or language. These signs start on a small scale, but they become more severe in time. What is more, when a person is suffering from dementia, he or she may experience changes in their mood or behavior.

Dementia appears as a consequence of the brain damage. There are several diseases that can cause the brain damage, such as Alzheimer’s disease or a series of strokes. Even though the Alzheimer’s disease is the most common disease that causes dementia, it is not the only one. There are other symptoms that someone might experience and this depends on the part of the brain that is damaged.

Symptoms of Dementia

While the symptoms of dementia vary, the most commonly affected areas include visual-spatial, language, memory, attention and problem-solving. Usually, the majority of dementia types are slow and progressive. When the person notices the symptoms of dementia, the process has already started in their brain for a long time. What is more, it is possible that a person would face two types of dementia at the same time.

However, the following psychological and behavioral problems affect people who have dementia:

  • Balance problems
  • Tremor
  • Speech and language difficulty
  • Trouble eating or swallowing
  • Memory distortions (believing that a memory has already happened when it has not, thinking an old memory is a new one, combining two memories, or confusing the people in a memory)
  • Wandering or restlessness
  • Perception and visual problems
  • Behavioral and psychological symptoms of dementia (BPSD) almost always occur in all types of dementia. BPSDs may manifest as:
  • Agitation
  • Depression
  • Anxiety
  • Abnormal motor behavior
  • Elated mood
  • Irritability
  • Apathy
  • Disinhibition and impulsivity
  • Delusions (often believing people are stealing from them) or hallucinations
  • Changes in sleep or appetite.

When dementia is at its early stages, all the above signs and symptoms may be very subtle. The early stage of dementia is called mild cognitive impairment (MCI). Usually, 70% of the people who were diagnosed with MCI, progress to dementia at some point. When a person develops MCI, this means that the changes have been happening in his or her brain for a long time already. However, the symptoms are just beginning to show.

In the early stage of dementia, the person begins to show symptoms noticeable to the people around them. In addition, the symptoms begin to interfere with daily activities. For instance, the person may begin to have difficulty with more complicated chores and tasks around the house. At this stage, the person can still take care of him or herself. It may happen though that he or she may forget simple things like taking the pills or doing laundry. Fortunately, reminders have been invented to help people do the stuff they forget about.

The symptoms of early dementia usually include memory difficulty, but can also include some word-finding problems (anomia) and problems with planning and organizational skills (executive function). Moreover, other signs might be getting lost in new places, repeating things, personality changes, social withdrawal and difficulties at work.

As dementia progresses, the symptoms experienced in the early stages of dementia generally worsen. Once dementia reaches its middle stage, the affected persons cannot function outside their own home. These persons should not be left alone. They are still able to do simple chores around the house, but this is pretty much it.  

Once dementia is beginning to be severe, the affected person needs assistance with most of their personal care. He or she needs permanent supervision to ensure that they do not hurt themselves or get lost. If left unsupervised, a person with late-stage dementia may wander or fall, may not recognize common dangers around them such as a hot stove.

Causes of Dementia

Depending on the part of the brain that is affected, dementia will affect the people differently. There are different types of dementia that have various causes.

Progressive dementias

These are some types of dementia that progress and they are not reversible:

  • Alzheimer’s disease. It usually appears in people age 65 and older and it is the most common cause of dementia. There are still not clear causes for Alzheimer diseases. However, plaques and tangles are often found in the brains of the people who suffer from this disease.
  • Vascular dementia is the second most common type of dementia. It occurs as a result of damage to the vessels that supply blood to your brain. Blood vessel problems can be caused by stroke or other blood vessel conditions.
  • Lewy body dementia. Lewy bodies are abnormal clumps of protein. They have been found in the brains of people suffering from Lewy body dementia, Alzheimer’s disease, and Parkinson’s disease.
  • Frontotemporal dementia. This is a group of diseases characterized by the breakdown of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior, and language. The causes are still not known.
  • Mixed dementia. Autopsy studies of the brains of people 80 and older who had dementia indicate that many had a combination of Alzheimer’s disease, vascular dementia, and Lewy body dementia. However, the studies are still ongoing trying to determine how having mixed dementia will affect the symptoms and treatments.

Other disorders linked to dementia

  • Huntington’s disease which is caused by a genetic mutation. Its signs and symptoms include a severe decline in thinking skills. These symptoms usually appear around age 30 or 40.
  • Traumatic brain injury caused by repetitive head trauma, such as experienced by boxers, football players or soldiers. Depending on the part of the brain that was injured, it can lead to dementia. However, the symptoms might not appear until years after the trauma.
  • Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without known risk factors. This condition might be due to an abnormal form of a protein. Creutzfeldt-Jakob disease can be inherited or caused by exposure to diseased brain or nervous system tissue. The symptoms of this disease appear around the age of 60.
  • Parkinson’s disease. Many people with Parkinson’s disease eventually develop dementia symptoms.

Dementia-like conditions that can be reversed

  • Infections and immune disorders. Dementia-like symptoms can result from fever or other side effects of your body’s attempt to fight off an infection. Conditions such as multiple sclerosis that result from the body’s immune system attacking nerve cells also can cause dementia.
  • Metabolic problems and endocrine abnormalities. For example, people with thyroid problems, low blood sugar (hypoglycemia), too little or too much sodium or calcium, or an impaired ability to absorb vitamin B-12 can develop dementia-like symptoms.
  • Nutritional deficiencies. Not drinking enough liquids (dehydration); not getting enough vitamin B-1, B-6 and B-12 in your diet can cause dementia-like symptoms.
  • Reactions to medications.
  • Poisoning. Exposure to heavy metals, such as lead, and other poisons, such as pesticides, as well as alcohol abuse or recreational drug use can lead to symptoms of dementia.
  • Anoxia can occur due to severe asthma, heart attack, carbon monoxide poisoning or other causes.
  • Normal-pressure hydrocephalus is caused by enlarged ventricles in the brain. It can cause walking problems, urinary difficulty, and memory loss.

Risk Factors

There are several risk factors that can lead to dementia. Some of them can be changed, while others are irreversible.

Risk factors that can’t be changed

  • Age. The risk rises as you age, especially after age 65. However, dementia isn’t a normal part of aging, and dementia can occur in younger people.
  • Family history. Having a family history of dementia puts you at greater risk of developing the condition.
  • Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer’s disease.
  • Mild cognitive impairment. This involves difficulties with memory but without loss of daily function. It puts people at higher risk of dementia.

Risk factors you can change

  • Heavy alcohol use.
  • Cardiovascular risk factors.
  • Depression. Although not yet well-understood, late-life depression might indicate the development of dementia.
  • Diabetes. If you have diabetes, you might have an increased risk of dementia, especially if it’s poorly controlled.
  • Smoking.
  • Sleep apnea.

Diagnosis and Treatment

Once the above signs and symptoms start to appear, it is very important to see the doctor. It might be that some of the problems can be treated, so this is why it is mandatory to have a proper assessment. It is very important to find the right cause and so get the right treatment.

Dementia is usually diagnosed by a specialist doctor such as:

  • a psychiatrist – a mental health specialist
  • a geriatrician – a doctor specializing in the physical health of older people
  • a neurologist – someone who concentrates on diseases of the nervous system.

However, dementia cannot be determined by one single test. The diagnosis will be established following a combination of different things:

  • the patient’s ‘history’ – the doctor talking to the person and someone who knows them well about how their problems developed and how they are now affecting their daily life
  • physical examination and tests (for example, blood tests) to exclude other possible causes of the person’s symptoms
  • tests of mental abilities (for example, memory, thinking)
  • a scan of the brain, if this is needed to make the diagnosis.

Unfortunately, Most types of dementia can’t be cured. However, the symptoms can be managed with several therapies and medications.

Medications

  • Cholinesterase inhibitors including donepezil, rivastigmine, and galantamine — work by boosting levels of a chemical messenger involved in memory and judgment. There are also side effects and they include nausea, vomiting, and diarrhea.
  • Memantine works by regulating the activity of glutamate. In some cases, memantine is prescribed with a cholinesterase inhibitor. Dizziness is a common side effect.
  • Other medications efficient in treating depression, sleep disturbances or agitation.

Therapies

  • Occupational therapy is very effective in preventing accidents, such as falls; manage behavior, and prepare you for the dementia progression.
  • Modifying the environment. Reducing clutter and noise can make it easier for someone with dementia to focus and function.
  • Modifying tasks. Break tasks into easier steps and focus on success, not the failure.

Alternative medicine

  • Vitamin E. Evidence for taking vitamin E to slow Alzheimer disease is soft. Doctors warn against taking large doses of vitamin E because it may have a higher risk of mortality, especially in people with heart disease.
  • Omega-3 fatty acids. There is some evidence that eating fish three times a week might lower your risk of dementia. However, more research is needed.
  • Ginkgo. Although ginkgo is considered safe, study results have been inconsistent in determining whether ginkgo helps people with dementia.

Other therapies

  • Music therapy, which involves listening to soothing music
  • Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia
  • Aromatherapy, which uses fragrant plant oils
  • Massage therapy
  • Art therapy, which involves creating art, focusing on the process rather than the outcome.

References:

http://www.alz.org/what-is-dementia.asp

https://en.wikipedia.org/wiki/Dementia

http://www.healthline.com/health/dementia/early-warning-signs#symptoms2

http://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/treatment/txc-20198533

https://www.alzheimers.org.uk/info/20007/types_of_dementia/1/what_is_dementia/7

 

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