Dementia

Overview of dementia

As one ages, it is possible to experience some degree of decline in mental agility and memory retention. However, in some cases, the individual experiences a sharp decline in mental abilities and this becomes severe enough to interfere with their normal functioning, occupation and personal relationships.

What Is Dementia?

Contrary to lay perception, dementia is not a specific disease or illness per se. Rather, the term is meant to be used to describe a set of symptoms related to decline in mental function as a result of damage to nervous tissue. These symptoms may be observed in individuals suffering from a variety of disorders such as Alzheimer’s disease and Parkinson’s disease.

Typically, dementia affects the brain. A person who develops dementia may no longer be able to think as clearly as they used to be able to do. They may not be able to identify or recognise familiar faces or places. The ability to communicate is often impaired. They will need help to execute simple, everyday tasks including self-care and household chores. In fact, even their behaviour and personalities can change quite a bit. This can be extremely disconcerting to family members and friends.

Unfortunately, it is not possible to repair the damage already sustained by the brain. In other words, dementia cannot be cured. But treatment can certainly help to slow it down or offer relief from certain kinds of symptoms.

Why Do Some People Develop Dementia?

There are quite a few different diseases and medical problems that can lead to dementia. The common factor that they all share is damage to the nervous tissue of the brain. Progressive cell death in the brain can arise as a result of injury, cardiovascular disease, infectious diseases, endocrine problems, or genetic disorders. A few of its causes and risk factors are actually modifiable and entirely avoidable. Substance abuse and HIV infection are good examples.

A more comprehensive list of recognised causes for dementia appears below:

• Brain tumour.
• Stroke.
• Brain injury.
• Hydrocephalus.
• Meningitis.
• Down’s syndrome.
• Alzheimer’s disease.
• Parkinson’s disease.
• Huntington’s disease.
• Multiple sclerosis.
• Thyroid problems.
• Prolonged substance abuse.
• HIV.
• Creutzfeldt-Jakob disease.
• Posterior cortical atrophy.

What Are The Signs Of Dementia?

Unfortunately, dementia often goes unnoticed in its earlier stages. The patient may show some slight signs of confusion, or memory disturbances but these may be put down to stress, ageing or any number of other factors. It is only when more symptoms begin to surface and when they become more intense and noticeable that the family may begin to suspect a serious problem.

Here are some signs to look for:

• Forgetfulness.
• Decline in ability to reason and think clearly.
• Difficulty with planning tasks.
• Declining ability to communicate effectively.
• Difficulty in managing routine tasks.
• Mental confusion.
• Irritability.
• Social withdrawal.
• Anxiety.
• Restlessness.
• Repeating oneself over and over.
• Compulsive behaviours.
• Mood changes.
• Loss of motivation.

What Are The Different Forms Of Dementia?

As we have seen, dementia is more accurately described as a syndrome rather than a disease. A syndrome is a particular collection of symptoms that may be associated with a variety of diseases. Hence, dementia can manifest in a number of different forms. For instance, it may manifest in the form of Alzheimer’s disease, Lewy body dementia or vascular dementia.

Let’s take a look at these in brief:

• Alzheimer’s disease: This disease leads to a dramatic and noticeable shrinkage in the size of the brain. As more and more brain tissue is lost, crucial areas such as the hippocampus shrivel up and the fluid-filled spaces in the brain called ventricles expand in size. These changes can take place gradually and over a period of several years or even a few decades. Typically, this produces memory loss and difficulties with speech and reasoning. It is not as yet clear why exactly such changes take place, although scientists believe that they may be attributed to a combination of heredity and environmental factors.
• Lewy body dementia: This form is characterized by abnormal deposits that affect the functioning of neurons in the brain. It is a progressive condition that affects reasoning and memory, causing behavioral changes and even sleep disturbances. This can take two forms, namely, Parkinson’s disease and dementia with Lewy bodies.
• Frontotemporal dementia: This is less common than the two types discussed above. It is typically characterized by more behavioral and emotional changes as compared to the other types. Cognitive impairment is present but not as markedly as in the other types. Hence, the patient’s behavior is characterized by a decline in their ability to empathize and a tendency towards depression. They are more likely to indulge in socially inappropriate behaviors.
• Vascular dementia: This type is so named because it is associated with vascular events like strokes. The brain damage that results from a severe stroke can leave the patient with a form of dementia. The exact nature of symptoms depends on the specific area of the brain that has been affected by the stroke but, in general, patients lose the ability to think clearly, retain memories and form a reasoned judgment.
• Mixed dementia: Often, patients present with characteristics of more than one specific form of dementia. This is known as mixed dementia. It can complicate the process of diagnosis.

What Are Some Complications One Should Be Aware Of?

Receiving a diagnosis of dementia can be very hard to accept and cope with. The fact that this disease impairs brain functioning and in a progressive manner means that the patient must reconcile themselves to losing their memories, normal functioning and even close relationships. This can bring an intense form of identity crisis and some patients with dementia are prone to developing anxiety and depression.

As their cognitive abilities weaken, patients become more and more dependent on carers for basic needs. Their forgetfulness puts them in danger of getting lost, injured or harmed. The strain on their relationships increases. Overall, dementia can lead to a marked decline in the patient’s quality of life on the physical, mental and emotional levels. This disease also shortens life expectancy.

How Is Dementia Diagnosed?

The general combination of symptoms may broadly indicate dementia, but the most important part of diagnosis is to discover the extent of the condition and the underlying reason for it. In order to find out whether or not a patient is suffering from dementia, the doctor will typically administer cognitive dementia tests, which take the form of simple questionnaires. The patient will be asked basic questions about their age, the time at the present moment, their present location, their home address etc. Subsequent questionnaires go into further depth to gauge the patient’s ability to recall past events or more recent ones or how comfortable they feel handling abstract concepts such as money, and so on. Test scores will indicate whether or not the patient is suffering from dementia.

If the patient has a recorded medical history of a vascular event such as a stroke or a severe head injury, then diagnostic imaging may be requested. Blood tests can help to identify infections if any. In the instance of rare diseases like Creutzfeldt-Jakob disease, the only way to definitively identify it is to carry out a biopsy of a sample of tonsil tissue. In such cases, a brain tissue biopsy would be useful too but it is not always feasible.

What Should Be Done To Treat It?

Damage to nerve cells is permanent and irreversible. Hence, there is no way to cure dementia. At least, not with the current state of technology and medicine available to us. However, it is certainly possible to support the patient and ensure that they manage to continue their lives with dignity and purpose. Brain training treatment can help to slow down the progress of the disease. Medications can help to control symptoms. In cases where brain damage can be traced to reversible causes like drug interactions, immediate steps should be taken to correct this.

In the moderate to later stages of dementia, patients will require help to enable them to perform daily activities. At the disease worsens, they will need to be kept under supervision to ensure that they do not get lost or hurt themselves. They may lose the ability to communicate and may no longer recognize family and friends. In such instances, families too may benefit from counseling.

Once dementia sets in, it remains for life. In fact, it gets progressively worse. It can occur in the form of a progressive disorder like Alzheimer’s disease, an inherited condition like Huntington’s disease, or as a result of a sudden event like a stroke. In a majority of cases, the culprit is Alzheimer’s disease, a progressive disorder that leads to the death of nervous tissue in the brain due to the formation of plaques in the neurons. Patients and their families require not only medical support but also more holistic therapies to help them cope with the situation.

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