Dementia
Dementia is a general term for a decline in cognitive function (thinking, remembering, and learning) that is severe enough to interfere with daily life.
Dementia Explainer
Video Credits: National Institute on Aging
Types of Dementia
Alzheimer's Disease
Vascular Dementia
Mixed Dementia
Frontotemporal Dementia
Dementia related to Parkinson's
Dementia related to Hintington's
Dementia related to Normal Pressure Hydrocephalus
Overview
Dementia is an umbrella term used to refer to the host of diseases that cause a decline in an individual's memory and other mental abilities. Most conditions and diseases classified under dementia are caused by neurodegenerative changes occurring in the brain, meaning the brain breaks down over time. These changes tend to affect the daily activities carried out by a person. Some common types of dementia include Alzheimer's disease, vascular dementia, Lewy body dementia, and mixed dementia.
People commonly associate deteriorating mental capabilities with age. However, the memory loss may not be due to age alone but instead may be due to underlying dementia, which tends to progress with age.
The most common type of dementia is Alzheimer's disease, constituting 60-80% of dementia cases. Followed by Alzheimer's is vascular dementia, which occurs due to blockage in the blood vessels in the brain and microhemorrhages. The blockage in small blood vessels leads to small vessel ischemic disease or damage from lack of blood flow. Several other factors can also cause dementia, such as a deficiency of specific vitamins or thyroid problems.
Alzheimer's Disease
Alzheimer’s is a progressive neurodegenerative disorder that can impair significant memory. In saying that it is developed, it will progress over time. It is mainly caused by the deposition of a protein that builds up both in and around brain cells. This also leads to the formation of plaques around the brain cells that hinder brain activity. In addition to memory loss, patients in the late stages of Alzheimer’s have speech challenges and difficulty registering their surroundings properly.
There are medications in the class “Acetylcholinesterase inhibitors” that can help with memory loss and behavior changes earlier in the disease process. Still, they do not stop the underlying neurodegenerative process. In effect, they can delay the course of the disease for some time. Although there is no known cure, research is being carried out to look into various therapies to slow down and stop the progression of the underlying disease process. Short-term memory impairment is one of the first symptoms of Alzheimer’s since it targets the part of the brain that influences memory and learning.
Vascular Dementia
Vascular dementia is the second most common cause of dementia in the US. As the name suggests, the leading cause of vascular dementia is a problem with the blood vessel – either ischemic or hemorrhagic stroke and small vessel ischemic disease – leading to cognitive loss. Stenosis and blockage in brain blood vessels, impaired brain blood circulation, and the brain’s deprivation of vital nutrients could also cause vascular dementia. Alzheimer’s and vascular dementia have many overlapping symptoms, such as cognitive impairment, lack of concentration, difficulty understanding and communicating, and memory loss.
At times, Vascular dementia has a more step-wise course of worsening rather than the more smooth progressive worsening in Alzheimer’s dementia. To prevent vascular dementia, it is essential to control vascular risk factors such as high blood pressure, diabetes, high cholesterol, and smoking.
Mixed Dementia
Mixed dementia is a condition in which a person has two or more types of dementia at the same time. The most common type of mixed dementia is Alzheimer's disease and vascular dementia. People with mixed dementia may experience symptoms of both Alzheimer's disease and vascular dementia, such as memory loss, difficulty thinking and problem-solving, and changes in mood and behavior. The symptoms of mixed dementia can vary depending on the type and severity of the two dementias involved. There is no cure for mixed dementia, but there are treatments that can help to manage the symptoms.
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It is estimated that about 1 in 10 people with dementia have mixed dementia.
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Mixed dementia is more common in older adults, especially those over the age of 75.
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The risk of developing mixed dementia increases if you have a family history of dementia, high blood pressure, diabetes, or stroke.
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There is no single test that can definitively diagnose mixed dementia. Doctors will typically use a combination of tests, such as a physical exam, blood tests, and brain imaging, to make a diagnosis.
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Treatment for mixed dementia is focused on managing the symptoms. There are no medications that can slow the progression of the disease.
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People with mixed dementia can live for many years with the condition. However, the symptoms will gradually worsen over time.
Frontotemporal Dementia
Frontotemporal dementia (FTD) is a group of brain disorders that primarily affect the frontal and temporal lobes of the brain. These areas of the brain are generally associated with personality, behavior, and language. In FTD, portions of these lobes shrink (atrophy). Signs and symptoms vary, depending on which part of the brain is affected. Some people with FTD have dramatic changes in their personalities and become socially inappropriate, impulsive, or emotionally indifferent, while others lose the ability to use language properly. FTD can also cause changes in movement, as well as problems with eating and swallowing.
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FTD is a progressive disease, meaning that the symptoms get worse over time. There is no cure for FTD, but there are treatments that can help to manage the symptoms. These treatments may include medications, therapy, and support groups.
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FTD is most common in people between the ages of 45 and 65, but it can occur at any age. It is estimated that FTD affects about 1 in 10,000 people. The cause of FTD is not fully understood, but it is thought to be caused by a combination of genetic and environmental factors.
Dementia Related to Parkinson's Disease
Dementia is a common symptom of Parkinson's disease, and it can drastically affect the lives of those who suffer from it. Dementia, in this context, is a decline in mental abilities that can include memory loss, confusion, difficulty with decision-making or problem-solving, disorientation, and even personality changes. It can be difficult for patients to cope with the changes in their mental health, and it is essential to seek professional help if symptoms of dementia arise.
Parkinson's dementia can be caused by a buildup of specific proteins in the brain that damage nerve cells, leading to changes in behavior and cognitive abilities. Treatments may include medication or therapy, depending on the severity of symptoms. Lifestyle changes are also significant; regular exercise, healthy dieting, and mental stimulation can all help to slow down the progression of dementia. Additionally, staying in touch with family and friends is essential so that loved ones are aware of any changes in behavior or cognition. Ultimately, the goal is to maintain a high quality of life for those affected by Parkinson's dementia.
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It's important to remember that dementia is a complex condition, and there is no single cure. However, with the proper support from family and medical professionals, those affected by Parkinson's dementia can still live meaningful lives. Individuals can remain independent and overcome this problematic condition by taking proactive steps to improve mental health and stay connected to loved ones.
Dementia Related to Huntington's
Disease
Dementia, when it comes to Huntington's disease (HD), poses unique challenges for medical professionals. HD is a hereditary condition that causes progressive damage to the brain, leading to motor, cognitive, and psychiatric symptoms. Sadly, one of the most significant effects of HD is the development of dementia, which can significantly impact a person's daily life.
The cognitive decline in HD often shows up as difficulties with memory, attention, problem-solving, and communication. This happens because some brain regions, like the basal ganglia and cerebral cortex, gradually deteriorate. It's also linked to imbalances in neurotransmitters like glutamate and dopamine.
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To support individuals with HD-related dementia, a team of healthcare experts, including neurologists and psychiatrists, collaborate to create a comprehensive treatment plan. Medications like cholinesterase inhibitors may be prescribed to improve cognitive symptoms. Additionally, cognitive rehabilitation and counseling are vital in enhancing overall well-being.
Dementia Related to Normal Pressure Hydrocephalus
Normal Pressure Hydrocephalus (NPH) is a unique form of dementia that offers hope for control or even reversal with appropriate treatment. This condition occurs when there is an abnormal accumulation of cerebrospinal fluid in the brain, leading to enlarged ventricles and increased pressure. The resulting symptoms include cognitive decline, gait disturbance, urinary incontinence, and impaired decision-making abilities. However, through shunting, a surgical procedure that diverts the excess fluid, approximately 40% to 50% of patients experience improved functioning.
It is important to note that diagnosing NPH can be challenging, as there is no single definitive test. A comprehensive evaluation considering the hallmark symptoms of cognitive decline, difficulty walking, and urinary incontinence is essential for an accurate diagnosis.
Causes of Dementia
Dementia is caused by damage to brain cells, which disrupts their functions and impairs their ability to communicate with each other. The brain is divided into parts responsible for a specific action. If any of these parts are affected, a person faces difficulty performing that action.
For instance, in Alzheimer’s, protein deposits in and around brain cells affect the region that controls memory and learning. In this way, a person starts losing memory and other functions. Dementia can be caused by other factors, as well. While effects on memory and thinking functions are often permanent in many types of dementia, those caused by lack of vitamins, thyroid, excessive drinking, depression, and after-effects of medication can be treated and cured. In this way, it is of the utmost importance when a person has memory loss to seek Neurological care to diagnose the cause.
Signs and Symptoms of Dementia
All signs and symptoms of dementia vary from person to person, depending on the brain’s affected region. However, some types of dementia share common symptoms, including difficulty in learning new information, confusion, loss of memory, and cognitive disability. Most dementias tend to be progressive, which means that the symptoms exacerbate over time.
If dementia is diagnosed from its onset, doctors can provide treatments and therapies to reduce its growth. However, dementia is often disregarded in its early stages due to mild symptoms like weakening memory, getting lost, or forgetting the time. Symptoms increase in the developing stages in which people can forget the way to their own home, need someone to look after them, forget names and events, and even face difficulties in communicating.
The late stages are quite severe, with high memory loss and evident signs of dementia. In the later stage, more primitive functions can also be impaired, such as those that allow a person to swallow food and water.
Diagnosis of Dementia
There is no simple way of diagnosing dementia. Doctors have to run multiple tests, medical examinations, and complete a thorough physical examination. Additionally, doctors must keep an eye on the day-to-day behavioral changes in people to confirm the presence of dementia.
It can be challenging to diagnose the specific subtype of dementia of which a person may be suffering because the symptoms tend to overlap. To judge the type of dementia, a doctor must observe the pattern of changes occurring in a person and compare what functions a person can and cannot perform. Medical developments have made this work easier, including having some blood tests for identifying causes, such as biomarkers being studied to diagnose Alzheimer’s dementia more easily.
Diagnosing dementia includes cognitive and neuropsychological tests in which thinking skills are reviewed. Then, a neurological evaluation takes place to evaluate speech, memory, balance, and movement. Brain scans such as MRI, CT, and PET are ways of looking at brain activity to find any strokes or protein deposits in the brain. Simple lab tests also play an essential role in the diagnosis since they can show the deficiency of a vitamin or detect a thyroid problem. Finally, at times, a psychiatric evaluation may be necessary to check the mental health of a person.
Treatment of Dementia
Treating dementia relies upon diagnosing the type of dementia and its cause. Currently, there is no cure for progressive kinds of dementia. Nonetheless, specific treatments can help slow down the process and improve symptoms. Medications may be prescribed to manage dementia symptoms temporarily. Therapies are conducted to control symptoms, such as behavioral and mood changes. Moreover, occupational therapies can help people to adapt to their illnesses and manage their lives accordingly.
In some reversible types of dementia – such as Wernicke encephalopathy or Hashimoto’s encephalopathy – if the cause is found early and treated, the person can fully recover.
Prognosis
With the improvement of technology in the medical field, many studies are being carried out on dementia and its causes. The most challenging part is to diagnose the type of dementia a person is suffering from, with much more research being required in this area. Moreover, the progressive nature of most kinds of dementia limits the use of medical treatment. However, as seen in the case of Alzheimer’s disease, some symptoms can be alleviated and slowed down, adding more years to the patient’s life. Volunteers in clinical research are necessary to improve the study of dementia.
Even though we associate dementia with memory loss and senility, there is much more to it. As new types of dementia and symptoms are showing up in people, more research and studies are being carried out to gauge the right kinds of treatment for them.