Dementia is not a specific disease but rather a general term used to describe a gradual decline in mental capacity. It influences intellectual and social capacities to the point of making daily life difficult. Dementia can alter memory, language skills, judgment and decision-making ability, lead to disorientation, and transform personality.
Dementia can be caused by a variety of diseases affecting the brain, the most common being Alzheimer’s disease. Other diseases influencing the brain include vascular dementia, Lewy body dementia, frontotemporal dementia, and mixed dementia. The types of dementia differ based on deeper causes and may influence certain specific symptoms as well as their progression.
In the United States, nearly 6 million people are living with a form of dementia.
Causes of dementia
Alzheimer’s disease is the most common cause of dementia. It accounts for 60% to 80% of dementia cases and affects about 5% of people over 65. It usually appears at an advanced age, affecting 20% to 25% of people over 80 years old. Despite the continual advancement of science and the many promising theories that abound in it, the exact causes of Alzheimer’s disease remain unclear at this time. Aging and genetic factors (family history) are considered to be the most important risk factors for the development of Alzheimer’s disease.
Vascular dementia occurs due to decreased blood flow leading to the death of cells in the brain. This can happen when the blood vessels in the brain are blocked by blood clots or fat deposits, for example during a stroke. Vascular dementia constitutes between 15% and 25% of dementia cases. This disorder causes loss of mental capacity which can be sudden, gradual, or gradual and constant.
Lewy body dementia accounts for 5% to 15% of dementia cases. Lewy bodies are deposits of a protein that builds up in the brain causing mood swings, problems with motility, disturbances in thinking and behavior. This type of dementia usually progresses quickly and its symptoms often include the appearance of visual hallucinations.
Frontotemporal dementia is caused by a crack in nerve cells in two specific parts of the brain called the frontal lobe and temporal lobe. Frontotemporal dementia alters language skills, personality and behavior.
Dementia can also have mixed origins, and particularly in old age. The most common mixed dementia is caused by a combination of Alzheimer’s disease and vascular dementia.
Diseases such as Huntington’s disease, Parkinson’s disease, and Creutzfeldt-Jakob disease could cause symptoms specific to dementia. Dementia can also have its roots in a number of factors that can damage the brain, such as alcoholism and drug use.
Some cases of dementia may be reversible or may improve after the cause is treated. Unfortunately, when dementia is caused by conditions such as Alzheimer’s disease, brain damage, or changes in blood vessels, the damage is irreversible.
Symptoms and complications of dementia
Many of us are careless. Sometimes we forget where we left our car keys, or we tell the same story again to a friend or family member. These behaviors are usually explained by information overload due to an active and stressful life, and are not necessarily signs of dementia. As people get older, their memory sometimes functions differently. It happens, for example, that it processes more slowly the information it receives. This type of change is normal and does not interfere with daily life. Dementia is, on the contrary, disabling, and is not attributable to the normal aging process.
Although dementia manifests differently in everyone, some of the most common symptoms are:
- a gradual loss of memory of recent events, and the inability to learn new things;
- an increased tendency to repeat oneself, lose things, become confused and get lost in familiar places;
- a disintegration of judgment and reasoning skills;
- increased propensity for irritability, anxiety, depression, confusion and agitation;
- increasing difficulties in communicating and using language (eg forgetting words or using them incorrectly);
- changes in personality, behavior, or moodiness
- a decrease in the ability to concentrate or pay attention;
- an inability to plan and perform multistep tasks (eg paying bills);
Symptoms of dementia can vary depending on their underlying cause. For example, people with Lewy body dementia often have prolonged visual hallucinations. Some forms of dementia can also affect younger people compared to other people with dementia and progress more quickly.
Diagnostic of dementia
Dementia is diagnosed by studying the symptoms that preceded it and by a physical exam. Your doctor may ask you a series of questions to assess your cognition, which is all the brain functions associated with memory, recalling memories, making decisions, speaking, daily recognition of familiar objects and the ability to follow directions.
Brain tomograms can show changes that have taken place in brain structure. Computed tomography or magnetic resonance imaging are useful in helping to spot conditions (eg, stroke) that may cause dementia.
Final confirmation of the diagnosis can only be obtained after a biopsy which will allow the structure of a fragment of brain tissue to be studied or an autopsy carried out after death.
Treatment and Prevention
Treatment for dementia may vary depending on the cause of it. To alleviate memory loss and gradually worsening behavioral symptoms, treatment for Alzheimer’s disease usually involves a variety of medications (which can also be used to treat other forms of dementia) including:
- cognitive enhancers;
- anxiolytic drugs;
There is no treatment that can “cure” Alzheimer’s disease, nor drugs that can stop or reverse the brain damage it may have caused. However, there are drugs that can reduce the extent of some symptoms and slow the progression of the disease. Medicines like donepezil *, rivastigmine, and galantamine can help stop memory loss.
Prevention of stroke is very important in vascular dementia. People who have high blood pressure or high cholesterol, have transient ischemic attacks (TIAs), or have had a stroke should receive continuous treatment for these conditions to prevent the onset of strokes in the future.
To treat and help people with dementia, it is important to focus on all the activities that the person can still perform safely. He or she should be encouraged to continue his or her daily activities and maintain social relationships as much as possible. They should also be helped to maintain a healthy lifestyle through exercise, a proper diet and sufficient fluid intake. Special diets and supplements are generally unnecessary.
Here are some quick tips that might come in handy if you are caring for someone with dementia:
- give the patient to-do lists including the time, location and appropriate phone numbers to facilitate the completion of these tasks;
- structure and stabilize the living environment by minimizing noise and unnecessary disturbances that cause anxiety;
- establish routines to regulate activities performed during the day and at bedtime to try to reduce disorientation and anxiety;
- speak slowly and calmly, formulate only one idea and one instruction at a time;
- reduce the risk of wandering by producing a card with their name, address and telephone number;
- ensure that your home is safe by leaving furniture in the same place, eliminating unnecessary items, installing a lock on the medicine cabinet and setting the water heater to a low temperature in order to avoid scalding;
- prohibit the person with dementia from driving a vehicle. Be the driver or have someone drive the patient to where he or she needs to go.
Caring for someone with dementia is a huge task. It is important to show understanding, patience and compassion. Being part of a support group is sometimes helpful for people caring for a patient with Alzheimer’s disease.
We must prepare for the progressive deterioration of the condition of the loved one, provide for the administration of full-time care. In some cases, accommodation in a nursing home is the best solution for the person and their family.