Dementia

Dementia!!!! Hearing this, everyone assumes that it is something related to mental illness and it can be caused only to the geriatric (elderly) patients and to the ones who do not lead an active life. This is totally a misunderstanding of the disease condition. Dementia can occur in any human race, age, gender, social class, and education status. In India, more than 10 million cases were identified with dementia per year. Once it occurs, it can be treated but it cannot be cured completely.

Patients with dementia have difficulty in cognitive functions such as memory, language, reasoning, planning, recognizing, or identifying people or objects. It is caused due to progressive degeneration of cerebral cortex in the brain. It can be caused by one medical condition or multiple medical conditions.

Signs and Symptoms

The signs and symptoms of dementia include loss of memory, communication difficulty, disorientation, difficulty in concentration, focus, and thinking, difficulty in completing the tasks, mood changes, loss of initiation, personality changes, misplacement of things, loss of visual perception, loss of reasoning and judgment. The dementia symptoms may be different in different people.

Treatment

There is no cure for dementia as the neurodegenerative process is irreversible. Some of the symptoms can be temporarily treated with medications such as Donepezil, Alantamine, Rivastigmine, Tacrine. These medications can be used to minimize the symptoms of Alzheimer’s disease. An NMDA receptor antagonist (Memantine) can also be used in combination with a cholinesterase inhibitor to reduce the symptoms of dementia. The behavioral problems associated with Parkinson’s disease can be minimizes with cholinesterase inhibitors.

“Brain training” sessions can be useful for improving the cognitive functioning in early stages. Memory aids such as computerized recall devices can be helpful for the patients for improving the memory.

Causes

Dementia is usually caused by degeneration of the cerebral cortex in the brain. The cerebral cortex is the main part of the brain that is responsible for thoughts, memories, actions, and personality of an individual. The degeneration of the brain cells leads to the cognitive impairments that characterize dementia. Vascular dementia accounts for 20% of cases. This is caused by atherosclerosis in the brain arteries. Alzheimer’s is an irreversible cause for dementia. Some of the other cases that lead to dementia include brain tumors, injuries, infections (meningitis, HIV, and syphilis). Creutzfeldt-Jakob disease is also a cause for dementia in some cases.

Prevention

Any activity or health condition that directly or indirectly has an impact on cardiovascular system can also affect on the brain functioning. So the brain health can be protected by maintaining healthy blood pressure, blood sugar, and cholesterol. Maintaining an ideal body weight can help in good cardiovascular health. A healthy diet with essential vitamins and nutrients can help in achieving this. Smoking can be equally dangerous to both cardiovascular system and brain. A regular physical exercise can improve blood and oxygen flow to the brain and thereby reducing the risks of dementia.

To diagnose the disease condition the doctor will first advice to undergo several tests to confirm the diagnosis to help decide the dementia treatment.

Family history: family history of dementia is assessed to determine any chances of inheritance.
Prior illness: History of any prior illnesses, previous injuries and surgeries, and current chronic conditions are assessed. For instance, reduced blood flow can also lead to decreased brain functioning.
Medication history: A complete assessment of past and current medications is done to identify any medical interactions.
Physical examination: A complete physical examination is performed to assess the psychomotor functioning.
Laboratory tests: Depending on the person's medical history and current symptoms observed all the laboratory tests will be performed including blood tests, ECG, and brain scan.
Neurological examination: Assessment of motor system, reflexes, gait, sensory perception, and coordination are examined to identify problems with the brain and nervous system.
Neuropsychological tests: A thorough assessment of cognitive functions is performed by questionnaires to the patient by asking to recall words or perform any action.
Alzheimer ’s disease: It is a chronic neurodegenerative disease that is responsible for 60-70% cases of dementia. It becomes worse on progression. The brain size totally shrinks in a patient with Alzheimer’s. It is due to the degeneration of the brain tissues, nerve cells and connections in the brain.
Huntington's Disease: It leads to progressive breakdown of nerve cells in the brain. It is a hereditary brain disorder. It leads to uncontrolled movements, emotional problems, and loss of thinking ability
Dementia with Lewy bodies: It is a neurodegenerative condition that leads to abnormal structures in the brain. It has the symptoms of both Parkinson’s disease and Alzheimer’s disease. It is the cause for 10-15% cases of dementia. It is mostly seen in adults.
Parkinson's disease: It is a type of neurodegenerative disorder that impairs movement. It is closely related to dementia and dementia with Lewy bodies.
Mixed dementia: It is the condition where two or three types of dementia are observed in a patient. Blood vessel changes (vascular dementia) and nerve cell changes such as tangles and plaques (Alzheimer’s disease) can be found simultaneously in a patient.