Dementia

Dementia is an acquired condition that is characterized by impairment of intellect, memory, and personality but without impairment of consciousness’ more commonly affecting elderly people. Dementia occurs mainly due to significant loss of neurons and volume in brain regions that are responsible for memory and higher mental functioning and by structural and chemical changes in the brain as a result of physical diseases such as Alzheimer’s disease.

Dementia caused due to cortical involvement tends to cause problems with memory, language, thinking, and social behavior. Subcortical dementia tends to cause changes in emotions and emotions and movement in addition to problems with memory.

Dementia mainly presents with symptoms of memory loss, impaired judgment, difficulty with thinking, faulty reasoning, inappropriate behavior, loss of communication skills, and disorientation to place and time. gait, motor and balance problems, neglect of personal care and safety, hallucinations, paranoia, and agitation.

The diagnosis of dementia is mainly based on the presence of its characteristic symptoms. Imaging tests can be used to look for structural changes in the brain. Blood tests may be required to rule out the underlying cause.

Treatment options for dementia include treating the underlying causes, supportive therapy to prevent the symptoms, and medications like anti-depressants, cholinesterase inhibitors, memantine, and cognitive stimulation therapy can help these patients to some extent. Several methods followed can reduce the risk of dementia.

Dementia: Causes

Various factors are known to result in the development of dementia.

Untreatable and irreversible dementia is caused by various degenerative disorders of the central nervous system

• Alzheimer’s disease which is the most common of all dementing illnesses

• Pick’s disease

• Huntington’s chorea

• Parkinson’s disease

Treatable and reversible causes of dementia include −

• Vascular-multi-infarct dementia

• Intracranial space occupying lesions

• Metabolic disorders-hepatic failure, renal failure

• Endocrine disorders such as myxedema, Addison’s disease

• Infections such as AIDS, meningitis, encephalitis

• Intoxication by Alcohol, heavy metals such as lead, or arsenic

• Decreased oxygen supply to the brain in conditions like anemia, post-anesthesia, and chronic respiratory failure

• Environmental factors such as infection, metals, and exposure to various toxins.

• An excessive amount of metal ions, such as zinc and copper, in brain secondary to various causes

• Deficiencies of vitamin B6, B12 and Folate

• Tumors such as meningioma or metastatic breast or lung cancer

• Traumatic subdural hematoma

Dementia: Symptoms

The symptoms of the patient with dementia develop some time. The symptoms of these patients can be explained in 3 stages.

Stage I or the early stage develops over the period of 2 to 4 years. This patient presents with the following symptoms −

• Forgetfulness

• Declining interest in the environment

• Hesitancy in initiating actions

• Poor performance at work

Stage II or the Middle stage develops over the period of 2 to 12 years. These patients present with the following symptoms −

• Progressive memory loss

• Hesitates in response to questions

• Has difficulty following simple instructions

• Irritable, anxious

• Wandering

• Neglects personal hygiene

• Social isolation

Stage III or the Final stage develops over a period of a year. These patients present with the following symptoms −

• Marked loss of weight because of inadequate intake of food

• Unable to communicate

• Does not recognize family

• Incontinence of urine and feces

• Loses the ability to stand and walk

• Death can occur due to aspiration pneumonia

Dementia: Risk Factors

Several factors play an important role in the development of dementia which includes −

• People who are above the age of 65yrs

• Males are more commonly affected than females

• A patient with a family history of dementia

• Decreased physical activity and improper nutrition

• An individual with obesity

• A person with drug abuse, smoking, and alcohol consumption

• Chronic medical health issues like diabetes mellitus, hypertension, heart disease, HIV infection, and tumors

• An individual with a history of head injury

• Patient under constant stress and depression

Dementia: Diagnosis

The diagnosis of dementia is mainly done based on history, and characteristic symptoms, oms and some of the tests may be required for confirmation and to rule out underlying causes

• Diagnostic criteria for delirium include the presence of Memory loss, impairment of language, praxis, recognition, or abstract thinking.

• A series of cognitive and neuropsychological tests are conducted to assess memory, thinking, and behavior. These tests may include the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the clock-drawing test

• Laboratory tests such as blood tests may be performed to rule out underlying medical conditions that could be causing the symptoms.

• Functional dementia scaling is done to indicate the degree of dementia)

• Magnetic resonance imaging of the brain to look for structural and neurologic changes

• Spinal fluid analysis shows increased beta-amyloid deposits

Dementia: Treatment

There is no specific treatment available for treating dementia. The treatment is based on the cause and severity of the symptoms. Various treatment options available for treating dementia include −

Conservative Treatment

Conservative treatment includes −

• Treat the underlying cause of dementia, such as thyroid replacement for hypothyroidism, vitamins for lack of vit-B12, or antibiotics for infections.

• To maintain mental functioning for as long as possible when dementia cannot be reversed. To prevent further strokes in people who have dementia caused by stroke (vascular dementia).

• To manage mood or behavior problems, such as depression, insomnia, hallucinations, and agitation.

• Antidepressant agents and mood stabilizers such as low doses of selective serotonin reuptake inhibitors and other newer and depressive agents should be considered.

• Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), & rivastigmine (Exelon) are used to treat Alzheimer’s

• Memantine is used to treat the symptoms of Alzheimer’s disease and also help with mild-moderate vascular dementia

• Cognitive stimulation therapy, music therapy, and art therapy can help to improve cognitive function and reduce behavioral symptoms in individuals with dementia

Dementia: Prevention

Some of the measures that can help to prevent dementia include −

• Maintaining a healthy balanced diet with proper micronutrients and vitamins such as plenty of fruits, vegetables, whole grains, lean protein, and healthy fats can help reduce the risk of dementia

• Regular physical activity can help improve cardiovascular health and reduce the risk of developing dementia

• Maintaining a healthy weight

• Adequate sleep at least 7-8 hours of sleep per night.

• Managing chronic conditions such as diabetes, high blood pressure, and high cholesterol

• Avoid smoking and alcohol consumption

• Engaging in mentally stimulating activities such as reading, puzzles, and socializing. These activities can help to improve cognitive function and reduce the risk of developing dementia.

Conclusion

Dementia is a neurological disorder affecting memory, thinking, and behavior. Various causes are known to cause this condition. Alzheimer’s disease is the main cause almost affecting 80% of people. Other causes like degenerative CNS conditions, vascular causes, inflammatory diseases, intoxications, certain medications, trauma, certain tumors, and vitamin deficiencies are also known to result in dementia.

Patients with dementia mainly present with problems of memory loss, and impairment of language, recognition, or thinking abilities. The condition is mainly based on the presence of its characteristic symptoms. Investigations may be required to look for the underlying causes.

There is no cure for the disease. Treatment options for dementia include treating the underlying causes, supportive therapy to prevent the symptoms, and medications like anti-depressants, cholinesterase inhibitors, memantine, and cognitive stimulation therapy can help these patients to some extent. Several methods followed can reduce the risk of dementia.