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Dementia

Dementia refers to a broad term used to describe a set of symptoms including loss of memory, word-finding, problem-solving, thinking, communication, logical and social abilities. It is not a disease rather a decline in cognitive function.


What Is Dementia?

Dementia is a psychological condition, often identified as a major neurocognitive disorder, in which people lose their cognitive functioning such as thinking, reasoning, remembering, behavioral, and other mental abilities. A recent 2021 research paper 1 characterizes it as a progressive, gradual and persistent deterioration of cognitive function. It is “an overall decline in memory and other thinking skills severe enough to reduce a person’s ability to perform everyday activities,” added the researchers. It is an umbrella term used to describe a group of significant symptoms caused by several underlying brain conditions, disorders, and injuries. It is not a single psychological disorder rather it involves a wide range of different medical conditions. Patients with such conditions often experience difficulties in:

  • Personalities
  • Abstract thinking
  • Logical reasoning
  • Language finding
  • Complex attention
  • Executive functioning
  • Social and visuospatial skills

Though the symptoms may range from mild to severe and vary from person to person, they are significant enough to interfere with an individual’s everyday functionality. A 2017 study 2 explains that patients who experience only mild deficits and do not meet the criteria for dementia are often considered to be diagnosed with Mild Cognitive Impairment (MCI). This study further suggests that it is an extremely serious psychological condition that places a physical, emotional, and financial burden on the sufferers, their caregivers, and society. This irreversible mental deterioration involves progressive symptoms which tend to get worse over time. Despite having several other causes, studies have shown that Alzheimer’s disease is the leading cause or the most significant type of progressive dementia in older adults.

Research 3 suggests that the global prevalence of this clinical syndrome is around 3.9% in people aged 60 and above. Though the symptoms can be improved with treatment, most of the diseases or mental conditions that cause dementia are not completely curable.

Understanding Dementia

Certain abnormal brain changes often lead to several disorders or psychological conditions grouped under dementia. These changes trigger the balance or the state of equilibrium between many cognitive functionalities that influence a decline in cognitive abilities. Mild to severe symptoms mostly occur in three significant circumstances, including:

  • healthy neurons or nerve cells in the brain stop working
  • their functions change gradually
  • they lose connections with other brain cells and die

Psychological aging includes all the changes that occur in organisms with old age. People lose some neurons as they get older which is a very natural phenomenon. Meanwhile, people with this clinical syndrome experience far greater loss of their cognitive abilities which is not at all related to aging. A 2013 research paper 4 suggests that “The psychological determinants of dementia have been implicated as neural function disruptors, or by participating in neuronal death or a reduction in neuronal number.” Studies 5 have defined it as a clinical psychic disorder triggered by neurodegeneration and brain damage. It says neural death often leads to brain damage, followed by cognitive decline, memory loss, learning and thinking disabilities.

Signs And Symptoms Of Dementia

The signs and symptoms can vary from person to person depending on their age and causes. The sufferers mostly experience thinking and memory difficulties that often affect their daily activities. According to a 2012 research paper 6 , the most common cognitive and psychological signs and symptoms include:

1. Cognitive symptoms

  • Short-term memory loss 7
  • Difficulty in finding or understanding words and communication problem
  • Difficulty in logical reasoning and problem-solving 8
  • Trouble in performing familiar tasks such as paying bills, preparing meals, keeping track of the wallet 9
  • Being repetitive regarding speech, behavior, and action 10
  • Difficulty in handling complex tasks
  • Difficulty in motor functioning and coordination 11
  • Problem in dealing with changes
  • Confused sense of direction or disorientation 12
  • Impairments in judgments 13
  • Difficulty in comprehending
  • Changes in social awareness

2. Psychological changes

  • Personality and behavioral changes 14
  • Depression, anxiety, and withdrawal 15
  • Obsessive tendencies 16
  • Hallucination and paranoia 17
  • Inappropriate behavior
  • Agitation and mood swings 18
  • Loss of interest

The sufferer may notice certain signs themselves and their close ones, caregivers, and any mental health professional may detect the others.

Types Of Dementia

This neurocognitive disorder can be characterized by a set of different symptoms of specific diseases. Different diseases lead to different types of dementia that are progressive and not reversible. The most common types include:

1. Alzheimer’s disease

It is considered to be the most common type of neurocognitive disorder. A recent 2020 research paper 19 suggests that “plaques” and “tangles” develop in between brain cells due to certain changes in the protein that often leads to Alzheimer’s disease. Plaques refer to clumps of beta-amyloid protein and tangles refer to fibrous tangles made up of tau protein. A 2011 study 20 claims that these clumps destroy healthy neurons and fibers. This medical condition may pass down from parent to child.

Read More About Alzheimer’s Disease Here

2. Vascular type

Research 21 says that the leading cause of this medical condition is microscopic bleeding and blood vessel blockage in the brain. It is the second most common type of this neurodegenerative syndrome in older people that may be the result of plaque buildup in arteries. Blood vessel blockage often leads to stroke and has a harmful impact on the brain.

3. Lewy body type

Lewy body refers to some abnormal balloon-like protein clumps that develop in the sufferer’s brain. Parkinson’s disease and Alzheimer’s disease patients may also have such protein clumps in their brains. According to a 2004 study 22 , these proteins that deposit in nerve cells prevent the brain from sending chemical signals that often result in the decline of cognitive function.

4. Frontotemporal type

Studies 23 have shown that this medical condition damages certain brain areas, including the frontal and temporal lobes. It can be also characterized by the breakdown or death of nerve cells due to protein clumps developing inside the brain. This disease damages the brain areas that are associated with behavior, personality, and language. Thus, it affects certain factors such as behavior, communication, personality, thinking, judgment, and movements.

5. Huntington’s disease

Research 24 describes it as an inherited genetic condition that includes several significant symptoms of dementia. This disease may affect an individual’s thinking, multitasking, planning, concentrating, and organizing abilities. The symptoms of Huntington’s disease often occur before movement changes develop.

6. Parkinson’s disease

A 2016 research paper 25 suggests that people with Parkinson’s disease can also be diagnosed with dementia. This medical syndrome often increases irritability, depression, and paranoia in patients.

7. Mixed type

Some people who experience brain changes of several significant types of dementia can be diagnosed with mixed dementia. A 2002 study 26 suggests that people aged 80 or above often experience a combination of several medical conditions such as Alzheimer’s disease, Parkinson’s disease, Vascular dementia, etc. However, this claim requires more research to determine how the mixed type of this neurodegenerative syndrome affects a person.

Causes Of Dementia

The human brain includes many distinct regions that are associated with different body and brain functions. A 2019 study 5 says that brain cells damage leads to dementia and prevents the brain cells from communicating with each other. This condition affects an individual’s ability to think, remember, judge, move, and feel. Particular types of brain cell damage in particular brain regions result in different types of neurocognitive disorders. However, the most common causes include:

Certain degenerative neurological diseases may cause some neurocognitive symptoms associated with dementia. The diseases are also considered to be individual types. These diseases include:

  • Alzheimer’s disease 27
  • Huntington’s disease 28
  • Parkinson’s disease 29
  • Several significant types of multiple sclerosis 30

There are some other factors or conditions that affect the blood circulation in the brain and can cause similar symptoms. These conditions include:

  • Side effects of certain medication 31
  • Depression 32
  • Stroke, traumatic brain injuries, or tumor 33
  • A buildup of fluid in the brain 34
  • Alcohol or any other substance use 35
  • Infections such as HIV, meningitis, neurosyphilis 36
  • Vitamin B12 deficiency 37
  • Thyroid diseases 38
  • Low blood sugar 39

Identifying The Risk Factors

Though researchers are still exploring the impacts of several risk factors of dementia, a 2009 study 40 mentions certain physical and lifestyle factors that can trigger certain symptoms, such as:

  • Age
  • Genetics
  • Depression
  • Medical conditions including diabetes, multiple sclerosis, sleep disorder, down syndrome, heart diseases
  • Brain injury
  • Stroke
  • Infection of the brain
  • Smoking
  • Physical activity
  • Ethnicity
  • Alcohol and drug use
  • Comorbidity
  • Body mass index
  • Other environmental factors

Read More About Major Depressive Disorder ( Depression ) Here

Stages Of Dementia

Due to its progressive nature, this disorder gets worse over time. The stages it goes through depends on the brain area that’s affected. However, a 2015 research paper 41 divides it into 7 significant stages, including:

1. No visible symptoms

During this phase, a person experiences no symptoms. But a proper medical diagnosis may reveal the problem.

2. Extremely mild decline

Though the sufferer cannot notice any difference, a third person or a close one may observe certain slight behavioral changes.

3. Mild decline

During this stage, the sufferer slowly starts to experience mild symptoms. They may experience difficulties in thinking, remembering, and reasoning. They may start to repeat their behaviors and actions.

4. Moderate decline

They may experience extreme difficulties in making plans and become more forgetful. It will become a difficult task for them to travel or handle money.

5. Moderately severe decline

They may feel lost in their places, experience difficulties in communicating with others and require help to perform their daily activities. A person with this syndrome often starts to forget people’s names and get confused about the time of day or day of the week.

6. Severe decline

The sufferer becomes unable to perform daily activities like eating or wearing clothes without any help during this stage. They may experience extreme changes in their personalities, emotions, and behavior.

7. Extremely severe decline

At this phase, the sufferer needs full-time assistance. They become unable to express their thoughts and spend most of their time in bed. They become unaware of where they are and fail to recognize their loved ones. They face extreme difficulties in walking and experience drastic behavioral changes such as aggression.

Diagnosis Of Dementia

The diagnosis process can be very challenging and involves several medical tests. The health care professional must detect the pattern of the lost skills and determine what the sufferer is still capable of doing. The assessment often involves various important questions and tasks. The doctor will review the patient’s medical history and conduct a physical examination. According to a 2012 research paper 42 , some of the medical tests to diagnose this syndrome include:

1. Cognitive test

A health care professional may ask the patient about their age, address, birth date, and other general questions to ensure whether the patient is able to remember certain things or not. The health professional may take into account observations by the patient’s family members and caregivers.

2. Neuropsychological test

This test is designed to evaluate the sufferer’s thinking ability. It measures their memory, problem-solving skills, reasoning abilities, orientation, judgments, and attention.

3. Mini-mental state examination

This specific test, also known as neurological evaluation, has been in use since the 1970s. It measures the patient’s orientation to time and place, language abilities, calculational skills, word recall, and visuospatial skills. It even evaluates the patient’s movements, senses, reflexes, balances, and other important areas. It is considered the most beneficial one to diagnose Alzheimer’s disease and can determine the severity also.

4. Mini-cog test

The mini-cog test includes a clock drawing test and a three-item delayed word recall task. It is a short examination for primary care screening. It is quite similar to the mini-mental state examination regarding the specificity and classification of the community causes of dementia.

5. Laboratory test

The doctor may recommend some blood and spinal fluid tests to detect any physical problem that can affect brain function. These laboratory tests are extremely useful to detect whether the patient has a vitamin deficiency, an underactive thyroid gland, an infection, or any kind of inflammation.

6. Brain scan

A Computed tomography (CT) or Magnetic resonance imaging (MRI) can be prescribed to detect any stroke, internal bleeding, tumor, or hydrocephalus in the brain. The doctor may also recommend Positron Emission Tomography (PET) in some instances to detect the patterns of the brain’s activities and functions.

7. Psychiatric evaluation

A mental health specialist may examine whether the patient has depression or any other underlying medical condition that is contributing to the symptoms.

Dementia Treatments

Treatment options for dementia and its other types are quite limited. There is neither any cure for this neurocognitive disease nor it is possible to reverse brain cell death. However, there are certain treatments that can help manage the severity of symptoms. The treatments include:

1. Medications

The following medicines are generally used to improve the symptoms:

  • Memantine 43
  • Donepezil 44 (Aricept)
  • Rivastigmine 45 (Exelon)
  • Galantamine 46 (Razadyne)
  • Other medicines to treat depression, hallucination, sleeping disorders, parkinsonism, or agitation

2. Non-drug therapies

Certain significant therapies can rescue the severity of the symptoms and behavioral problems, but alleviate some manageable complications. Here are some non-drug therapies used for treatment:

3. Modifying the environment therapy

A 1997 research paper 47 says that this therapy helps the sufferer to focus and concentrate by reducing the clutter, noise, and overstimulation. The mental health professional may ask the patient’s close ones to hide certain objects, such as knives and car keys.

4. Occupational therapy

A 2019 study 48 has shown that this therapy is designed to teach coping behaviors and home safety. It is intended to prevent accidents and manage behavioral changes.

5. Modifying common task therapy

Research 49 says that the therapist helps to break down everyday tasks into smaller steps to make them easier for the patients. The tasks include showering or grooming, eating, and wearing clothes.

How To Cope With Dementia

There is no way to completely prevent the development of this neurocognitive disorder. However, some beneficial coping strategies that can decrease the risk factors or the severity of the symptoms include:

  • Do regular physical exercise
  • Enhance your communication skill
  • Stay engaged in different joyful activities
  • Maintain your optimal health, including your blood sugar, cholesterol, and blood pressure level
  • Avoid smoking and any other substance use
  • Establish a proper sleep schedule
  • Plan for your future
  • Maintain a healthy weight
  • Consume healthy diets and drink plenty of liquids
  • Spend quality time with your close ones
  • Write about your feelings and thoughts in a journal
  • Join a local support group
  • Seek help from a trusted person regarding decision making or problem-solving
  • Get individual counseling if required
  • Seek medical support if the coping strategies are not working

Takeaway

Dementia is considered to be a neurocognitive or neurodegenerative syndrome that is not completely curable. It affects an individual’s remembering, thinking, and behavioral abilities. Several significant diseases are strongly associated with this syndrome such as Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and more. The symptoms may worsen if not treated properly at the correct time. You can help a person with this syndrome by listening to their problems and being supportive and positive towards them. One can adopt certain coping strategies to help manage the symptoms and behavioral change, but the person may eventually require full-time help.

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