Dementia is a broad term to describe a range of conditions causing a decline in cognitive functions. It progressively deteriorates mental abilities like memory, comprehension, and judgment. This may lead to behavioural changes in the affected individual.
Associated Anatomy
Neurons in the brain
Dementia Causes
- Brain disorders - Structural abnormalities in the brain can cause dementia.
- Degeneration of neurons - Damage to nerve cells leads to conditions like Parkinson’s disease and Huntington’s disease, which are related to dementia.
- Head injury - Traumatic brain injury is a leading cause of dementia.
- Other medical conditions - Infections in the thyroid, kidney, liver, heart or lungs, and vitamin deficiencies can generate dementia symptoms.
- Genetic factors - Certain gene mutations can induce dementia.
- Side effects of medications like anticholinergic, antidepressant, and antiepileptic drugs may trigger dementia.
Signs Or Symptoms of Dementia
- Frequent episodes of forgetfulness
- Visual and spatial disorientation
- Communication issues
- Getting lost in familiar places
- Difficulty in performing daily tasks
- Losing track of time
- Struggling to recognise known faces
- Misplacing items
- General confusion
- Repeating same questions
- Personality changes
Dementia Treatment
- Pharmacotherapy - Medications like cholinesterase inhibitors, memantine, anti-amyloids (Aducanumab) are the common prescription drugs.
- Rehabilitative therapy - A behaviour-specific and systemic approach (like memory training and breaking down routine tasks) is undertaken to teach coping mechanisms.
- Sociotherapy - The environment is modified by reducing stimuli (clutter and noise), making it easy for the person to focus.
Risk Factors
- Age - Individuals above 65 years of age are at greater risk.
- Strokes and tumors increase the chances of dementia.
- Family history - Having family members with dementia automatically puts one at higher risk.
- Excessive alcohol consumption can induce brain damage.
- Prolonged stress leads to depression and anxiety, which are concerning factors.
- Inadequate physical activity may cause diabetes, obesity and hypertension, which increase the risks.
- Smoking - Toxins in cigarette smoke cause oxidative stress, which is linked to dementia.
- Air pollution - Environmental toxins are major risk factors.
Dementia Stages
- Stage 1: Normal behaviour - Changes in the brain start taking place unknowingly.
- Stage 2: Forgetfulness - It starts with simple misplacing of things.
- Stage 3: Mild decline - Frequent forgetful episodes start occurring.
- Stage 4: Moderate decline - The symptoms become more evident. Loss of cognitive functions become pronounced.
- Stage 5: Moderately severe decline - The individual can take care of his/her personal needs and recognise immediate family and friends. But, they need help with things like address, phone numbers, and other basic facts.
- Stage 6: Severe decline - The individual requires complete supervision. There are noticeable behavioural changes. Even through the confusion, they are able to recognise people closest to them.
- Stage 7: Very severe decline - The individual loses sense of understanding and requires full-time professional care. Many do not survive up to this stage.
Typical Tests
A physical examination is done, where the symptoms, family history and current medical conditions are assessed. Laboratory tests, CT scan and MRI scan are conducted to rule out similar conditions. A positron emission tomography is done to study the brain activity. Mental ability tests and psychiatric evaluations are carried out.
Primary Prevention
- Mental stimulation - Keeping the brain engaged in cognitive leisure activities helps.
- Being socially active - This helps to reduce depression.
- Dietary considerations - Having a diet low in saturated fats, and rich in fruits and vegetables, is beneficial.
- Avoiding head injury - Using protective headgear can prevent potential accidents.
- Limiting smoking and alcohol - This reduces the risk factors.
- Preventing lifestyle diseases - Regular exercise and proper diet keeps one away from diabetes and hypertension, which are linked with dementia.
Secondary Prevention
- Encouraging communication - Speaking clearly in short sentences, maintaining eye contact, giving them time to answer, are some effective communication strategies.
- Exercise - It promotes blood flow to the brain and stimulates neuron growth.
- Staying active - This helps to keep the brain active.
- Therapies - Aromatherapy, massage/art/pet/music therapies are highly recommended.
- Alternative remedies - Herbal products and acupuncture may be considered, but after discussing with the healthcare provider.
- Being expressive - Finding ways to express feelings through singing, writing, painting or speaking, is beneficial.
- Joining support groups - Occupational therapists provide effective guidance.
Additional Types
There are five main types of dementia. Among them, Alzheimer’s disease (abnormal shrinkage of the brain, affecting its functions) and vascular dementia (brain damage due to strokes or injury) are the most common. Lewy body dementia occurs due to deposition of small proteins (known as Lewy bodies) on the neurons, which causes decline in mental abilities. Furthermore, neurodegeneration in the frontal and temporal lobes of the brain causes frontotemporal dementia. Another dementia is the mixed type, when the individual is affected by two conditions, usually Alzheimer’s and vascular dementia.
Alternate Name
Senility or cognitive disambiguation
Differential Diagnosis
Accurate diagnosis of dementia is crucial since its symptoms mimic a number of conditions like Parkinson’s disease, meningitis, multiple sclerosis, hypothyroidism, spinocerebellar degeneration, delirium, and vitamin B-12 deficiency.
Epidemiology
- Age - Common in people over 65 years of age.
- Gender - More prevalent in females.
- Race - Frequency rates are higher in African-Americans and Hispanics.
- Prevalence - According to the WHO, around 55 million people worldwide have dementia, with 10 million new cases every year. In India, about 4 million people live with some form of dementia.
Expected Prognosis
The median survival rate is 5-10 years. Recovery depends on age, gender, comorbidity status and cognitive function. According to the WHO, dementia is the seventh leading cause of mortality, and one of the major reasons of dependency in the older generation.
Natural Progression
Dementia is a progressive disorder. With time, the symptoms aggravate and affect more areas of the brain. If left untreated, it can worsen behavioural issues and result in injuries. It can make the person more agitated and anxious. Medical intervention helps the individual to cope better.
Pathophysiology
Most types of dementia are caused due to accumulation of proteins in the neurons. The cerebral cortex gets degenerated, and amyloid plaques are formed. In vascular dementia, ischemic injury (restricted blood flow) to the brain occurs, leading to neuron damage.
Possible Complications
Decreased life expectancy, inability to express or interact, and loss of self-care are initial complications associated with dementia. These may advance to chronic depression, delusions, aggressive behaviour, injuries, poor nutrition, and total dependency for life activities.
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