What is Dementia?

T

he term “dementia” doesn’t refer to a specific illness; instead, it is used to describe symptoms comprising a broad spectrum of brain diseases which are severe enough to affect a person’s daily life.

Dementia affects a person’s cognitive functions, such as memory, language, thinking, and orientation, amongst other aspects of their life, such as emotional control, and social behavior.

Dementia has become more common as life expectancies grow longer, and it is one of the more common causes of disability in the elderly.

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What Causes Dementia?

There are several conditions which can cause dementia. Some of them are more frequent than others, some progress faster, and some can be reversed while others can’t. Each of these causes can affect different parts of the brain. Here are some of the main causes of dementia.

Alzheimer’s Disease

This is the most common cause of non-reversible, progressive dementia. It represents the majority of dementia cases, and there is evidence that some genetic factors can increase the chance to suffer from it.

Vascular Dementia

The second most common cause of dementia, this is caused by injuries which damage the blood supply to the brain. This can be cause by minor strokes occurring over a period of time, or one stroke which affects a cognitive area of the brain; symptoms will depend on the area that has been affected.

Reversible Causes of Dementia Include

Neurosyphilis, hypothyroidism, and vitamin B12 deficiency. A patient should always be tested for reversible causes of dementia if they are exhibiting a decrease in their cognitive functions.

Other Causes of Dementia Include

Dementia with Lewy Bodies (DLB), frontotemporal dementia, traumatic brain injury, Parkinson disease dementia, amongst others. A mixed form of dementia can occur, with two or more causes coexisting in one patient.

Although the exact causes for many of the diseases which cause dementia haven’t been discovered, there are certain risk factors which can increase a person’s chance of suffering from dementia. These risk factors include:

  • Age: this is the most important risk factor. Dementia is very infrequent in people below the age of 60 years old, but by 80 years old it becomes very common, and it has been estimated that it affects nearly half of people over 90 years old.
  • Genetics: certain genes can increase a person’s risk of developing Alzheimer’s disease.
  • It has been theorized that suffering from diseases such as hypertension and diabetes, and unhealthy habits such as smoking and leading a sedentary lifestyle can increase the chance of suffering from dementia later on in life.

How is Dementia Diagnosed?

Since dementia isn’t a specific disease, but rather a group of illnesses which cause certain symptoms, it is understandable that there isn’t a single test to diagnose it.

Doctors will review a patient’s history to check for symptoms which point to cognitive impairment; if necessary, the patient will be referred to another specialist, such as a geriatrician, psychiatrist, or neurologist.

Tests are usually carried out to determine the extent of the impairment and to rule out reversible causes of dementia. Brain scanning techniques, such as PET scans, can be used to determine which part of the brain has been affected; however, in some cases it is not possible to point to the exact cause of dementia.

The mini mental state examination (MMSE) is used to assess a patient’s cognitive functioning. There are other tests available for this purpose, such as the abbreviated mental test score (AMTS), the clock drawing test, and the Montreal Cognitive Assessment (MOCA).

Treating Dementia

There is no cure for the non-reversible causes of dementia; however, current treatments can help slow its progression and improve the patient’s quality of life.

Access to therapy is important after diagnosis, to make sure the patient is offered help in dealing with the disease and doesn’t develop anxiety or depression. Therapy can also help keep the patient’s mind active, retain skills, and relearn how to perform daily activities. Different types of therapy used in dementia include: reminiscence therapy, cognitive reframing, validation therapy, occupational therapy, and cognitive behavioral therapy.

Other activities should be offered to the patient to make sure they stay active both mentally and physically, such as music, art, gardening, dancing, and exercise, amongst others.

Medication can’t cure dementia, but it can be used to treat its symptoms. Some of these medications include:

  • Acetylcholinesterase inhibitors: these drugs may be useful in Alzheimer’s, Parkinson’s, DLB, by increasing the levels of acetylcholine. They include donezepil, rivastigmine, and galantamine.
  • N-methyl-D-aspartate (NMDA) receptor blockers: such as memantine, this medication is also used to treat Alzheimer’s, and it has been shown to slow the progression of symptoms in some cases. It works by reducing the amounts of glutamate in the brain.
  • Benzodiazepines, such as diazepam, are contraindicated in dementia, since they can worsen the cognitive impairment.

Since the condition of patients with dementia worsens over time, palliative care is an option that must be considered to help patients and their loved ones cope with dementia once it has reached a terminal stage.

Dementia Clinical Trials

Clinical trials for dementia and the conditions that cause it aim to discover ways to prevent, diagnose, and treat it. There are also trials that aim to find ways to improve dementia patients’ quality of life.

Treatment clinical trials have two aims: to discover therapeutic options that can reduce symptoms, and slow or stop the progression of the disease. Diagnostic studies try to find new ways to diagnose dementia in its early stages, and to better identify risk factors so that the condition can be diagnosed even before the patient starts to display symptoms. There are also prevention trials, which look for ways to prevent the disease from developing at all.

Many patients choose to participate in clinical trials to take control of their health, and to gain access to care provided by experts in the field. Clinical trials are led by a team of specialists, researchers, and healthcare personnel, and the patient can choose to leave the trial at any point.

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Lifestyle Changes
  • Seek professional help to help you cope with your diagnosis and the changes you are experiencing.
  • Make sure to communicate your needs to those closest to you so that they know how to help you.
  • Maintain a lifestyle that’s as active as possible, both physically and psychologically.
  • Allow yourself to grieve after your diagnosis, but don’t let dementia define who you are.
  • Think about your plans for the future. Talk to your loved ones about your wishes, and consider going to a lawyer to plan your financial future.
  • Don’t be ashamed to ask for help when you need it.
Tips For Friends and Family
  • Take time to accept and cope with your loved one’s diagnosis.
  • Show affection to your loved one and be reassuring.
  • Create a safe and understanding environment and prepare for future changes in your loved one’s condition.
  • Simplify daily tasks and activities when necessary, by breaking them down into smaller steps that are more manageable for your loved one.
  • Make sure to have people there to help, whether they are family members, friends or healthcare professionals.
  • Consider therapy to help you cope with the changes occurring in your life.
Sources
  1. Dementia. Mayo Clinic (Aug 2nd,2017) Recovered from https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013
  2. Dementia. World Health Organization (December, 2017). Recovered from https://www.who.int/mediacentre/factsheets/fs362/en/