What is dementia?
Dementia is an umbrella term covering a wide range of symptoms including, memory loss, thinking abilities, decline in social skills, reasoning skills and other mental abilities severe enough to interfere with daily life. It is caused by physical changes in the brain.
Dementia is often incorrectly termed as 'senility' or 'senile dementia,' which reflects the widespread incorrect belief that serious mental decline is a natural part of ageing.
How does dementia occur?
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 are affected, the person’s thinking, communication abilities, motor abilities, or behaviour gets affected.
Different regions of the brain are responsible for different functions. For instance, the part of the brain called the hippocampus is responsible for learning and memory. If this part gets affected memory loss can occur.
Thus, the damage of particular types of brain cells in particular regions of the brain can cause different types of dementia, such as:
- Alzheimer’s Disease: This accounts for 60-80% of dementia cases. It is known as neurodegenerative disease, meaning there is progressive brain cell death that occurs over a course of time. The total brain size shrinks with Alzheimer’s meaning the brain has fewer nerve cells and connections. Some causes of Alzheimer’s include leading a sedentary lifestyle, family history, obesity, high blood pressure, down syndrome, type 2 diabetes, and unhealthy diet.
- Vascular Dementia: This condition occurs when vessels that supply blood to the brain become blocked or narrowed as a result of which strokes take place since the supply of blood carrying oxygen to the brain is suddenly cut off. Long-term damage on your brain blood vessels due to the wear and tear associated with ageing, high blood pressure, hardening of the arteries, diabetes, lupus erythematosus, brain haemorrhage, and temporal arteritis can also lead to vascular dementia.
- Dementia with Lewy bodies (DLB): This is the second most common type of progressive dementia after Alzheimer's disease. This condition occurs due to the abnormal build-up of protein deposits, called Lewy bodies, in the nerve cells in the brain regions involved with thinking, memory and movement (motor control). People suffering from DLB may experience visual hallucinations and changes in alertness and attention. Other effects can include symptoms similar to Parkinson's disease such as rigid muscles, slow movement and tremors.
- Mixed dementia is a condition where changes representing more than one type of dementia occur simultaneously in the brain. Signs of Alzheimer’s disease can co-exist with DLB.
- Parkinson's disease: is primarily caused by low and falling dopamine levels. The cells in the area of the brain called the substantia nigra produces the chemical called dopamine. Dopamine has a very important function in the body. It acts like a messenger that tells another area of your brain when you want to move a particular part of your body.
Thus 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.
- Frontotemporal dementia: When the frontal and temporal lobes of the brain ( the front, right side of the brain) are affected, Frontotemporal dementia occurs, which is an umbrella term for a diverse group of uncommon disorders. The frontal and temporal lobes of the brain are the areas associated with personality, behaviour, and language. Thus this disease affects our judgment, personality, and ability to manage complex tasks. The disease also affects the way in which an individual is able to use and understand language.
- Huntington's disease: Huntington disease (HD) is an inherited brain disorder in which cells in parts of the brain (specifically the caudate, the putamen) die. The cerebral cortex of the brain is also affected. As the brain cells die, a person’s emotions and cognitive abilities are affected. The person suffers from depression, apathy, irritability, anxiety, obsessive behaviour, inability to focus, plan, recall or make decisions; impaired insight.
- Wernicke-Korsakoff Syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). Thiamine helps brain cells produce energy from sugar. When thiamine levels fall too low, brain cells cannot generate enough energy to function properly. The most common cause is alcohol misuse.
- Creutzfeldt-Jakob disease is a rare, degenerative, and an invariably fatal form of dementia. It affects about one person in every one million people per year worldwide. In this condition, the brain cells get destroyed, and tiny holes form in the brain. People suffering from this disease experience difficulty in controlling body movements have an abnormal gait and slurred speech.
Who is prone to dementia?
People who are prone to dementia include:
- Older adults (above the age of 60 years)
- Those who have a family history of dementia
- Those who suffer from some medical conditions such as high blood pressure, diabetes, high cholesterol
- Those who lead a sedentary lifestyle
- Those who have suffered serious head injuries
- Those who overindulge in alcohol and smoking
- Women are at a higher risk of dementia than men, hormones could be the reason why
- Those who suffer from depression
- Those who indulge in unhealthy diets
What are the causes of dementia?
Dementia is mainly caused by damage to the brain cells and death of the brain cells. What is not clear, however, is whether dementia causes the death of brain cells, or the death of the brain cells cause dementia.
There are a number of factors which can cause dementia such as:
- a head injury
- a stroke
Existing medical conditions such as:
- coronary artery disease
- HIV infection
- Prion diseases (rare progressive neurodegenerative disorders)
- vitamin deficiencies
- a brain tumour
- thyroid abnormalities
What are the symptoms of dementia? How is dementia diagnosed?
The symptoms of dementia include:
- Short term memory changes
- Struggling to communicate thoughts and finding the right words
- Difficulty following narrations and storylines
- Failing sense of direction
- Saying or doing the same thing repeatedly
- Listlessness or apathy
- Impairments in language, communication, focus, reasoning
- Confusion such as not able to remember people’s faces
- Difficulty in adapting to change
- Struggling to complete routine tasks
Dementia can be diagnosed by an experienced general practitioner, who might also refer the patient to a psychiatrist. The doctor will ask the patient about his/her symptoms, when the symptoms started, whether they are affecting daily life, and whether the patient has any existing conditions, such as heart disease, diabetes, depression or stroke. The doctor will check if the existing medical conditions are being properly managed, review any medicines the patient may be currently taking, and perform a physical examination.
The accompanying family members can provide their input about the daily routine, cognitive abilities, and any recent behavioural changes of the patient that they may have noticed. The doctor will also ask the patient and the attendants questions about the patient’s everyday activities, such as personal care (bathing and dressing), cooking and shopping, paying bills.
The patient may be asked to undergo a memory or cognitive test to measure any problems with memory or ability to think clearly.
To rule out other causes of memory problems, the doctor may ask the patient to undergo a blood test.
The doctor may also suggest that the patient undergoes an MRI and a CT scan to check for signs of stroke or a brain tumour which could be responsible for the symptoms.
What are the complications of dementia?
The complications of dementia include:
- losing ability function efficiently or care for self
- loss of ability to interact with others
- susceptible to infections
- forgetting recent events or conversations
- repeating the same actions or saying the same thing again and again
- difficulty in multitasking
- difficulty in solving problems
- difficulty finding the right words
- misplacing items
- getting lost on familiar routes
- loss of social skills
- more withdrawn or personality changes
- listlessness and losing interest in things previously enjoyed
- difficulty performing tasks that used to be easy
- learning new information or routines
- forgetting details about current events
- forgetting events in your own life history
- losing awareness of oneself
- change in sleep patterns, often waking up at night
- difficulty swallowing both foods and liquids
- difficulty reading or writing
- poor judgment and loss of ability to recognize danger
- no correlation of topics while speaking
- violent behaviour at times
- difficulty doing in performing routine tasks, such as preparing meals, choosing proper clothing, and driving
What is the treatment for dementia?
Medical Treatment for Dementia
Treating dementia does not involve only medicines. Medicines may be prescribed for advanced cases but care for the patient is more important for him/her to live well.
Group activities and exercises designed to improve memory and problem-solving skills will be suggested, which is cognitive stimulation therapy. Cognitive rehabilitation which involves working with a trained professional may also be suggested to be able to perform everyday tasks efficiently.
Most importantly getting time and care from family members is the biggest medicine for patients suffering from dementia.
If the patient suffers from symptoms such as delusions, anxiety, hallucinations, and aggression, the doctor will prescribe medicines to control these symptoms. The doctor may also prescribe medicines to treat some conditions, such as heart problems, which can affect symptoms of dementia, particularly vascular dementia.
These conditions include:
Consider physical activities that are mentally or socially engaging, such as walking with a friend, taking a dance class, joining an exercise group or golfing, if you think you are suffering from symptoms of dementia. Let them be activities that you enjoy so that you will continue to engage in it.
Bike riding, gardening or walking the dog are pleasurable activities which can also provide the much-needed exercise.
If it's safe for you to engage in cardiovascular exercises, this will increase the blood flow to the brain and body, providing nourishment while reducing potential dementia risk factors such as high blood pressure, diabetes and high cholesterol.
It is advisable to consult your doctor before deciding on any exercise regimen.
Questions answered by trusted doctors
Did you know?
An epidemic in the making
Aging population is increasing in developing countries and dementia is going to become epidemic among elderly in the coming decades.
Dementia in India
In India, more than 4 million people have some form of dementia.
A global crisis
Worldwide, at least 44 million people are living with dementia, making the disease a global health crisis that must be addressed.
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