Dementia – Alzheimer’s 101

What is Dementia?

Dementia is defined as a set of symptoms indicating cognitive decline without a loss of consciousness, typically appearing gradually in adulthood. The most common form of dementia is Alzheimer’s disease. The term “senile dementia” is an older term that is increasingly becoming less used.

These disorders manifest subtly and in stages, leading to noticeable dysfunction in a person’s daily life compared to their prior normal state. Memory impairment is naturally the core symptom.

In the latest edition of the American psychiatric diagnostic system, DSM V, the term “dementia” has been limited, and the concept of neurocognitive disorders has been introduced. These are categorized as major and mild. If there is NO decrease in a person’s daily functionality, then the disorder is considered to be in a mild stage.

When and How Does Dementia Start?

Dementia begins very gradually and may not be evident initially.

Less frequently, symptoms may appear more quickly or be more disruptive.

Approximately 95% of cases of geriatric dementia (sporadic form) occur in people older than 65.

Less commonly, it manifests in people under the age of 65, usually in cases with a stronger genetic component.

Different forms of dementia manifest with varying symptoms at the onset and throughout the course of the disorder.

The life expectancy for geriatric dementia is shorter if the symptoms are more severe at the beginning of the disease.

Alzheimer’s Dementia: Symptoms

Alzheimer’s Disease is the most common cause of dementia, accounting for 70 to 80% of all cases. It can either occur sporadically or have a genetic component.

Initial Stage

In the early stages, patients with symptoms of dementia increasingly struggle with recalling recent events while retaining older memories. Short-term memory dysfunction gradually impairs their ability to function as they forget things and names.

Communication abilities decline, including the onset of aphasia, or difficulty in finding the right words or understanding others.

Apraxia, the inability to perform motor activities, is another symptom that may manifest.

As the disease progresses to an intermediate stage, cognitive deficits increase. Executive dysfunction might manifest as difficulty in dressing, cooking, toileting, self-care, and financial management, and eventually in performing basic tasks.

Loss of orientation manifests as a gradual loss of a sense of time, for instance, not knowing what day, month, or season it is. Additionally, patients can easily become lost as spatial orientation deteriorates.

There may be agnosia, the inability to identify or recognize objects.

Other manifestations include altered sleep-wake cycles, mobility issues, falls, wandering, and anosognosia, which is a lack of awareness of one’s own medical condition.

Advanced Stage

As the disease progresses to a more advanced stage, the deterioration of nerve cells intensifies, rendering patients increasingly bedridden and incapable of self-care. At this stage, even the recognition of close family members eventually becomes compromised.

Swallowing ability is often impaired. In this final phase, complications like blood clots, severe vascular incidents, serious infections, and aspiration pneumonia are more likely to occur. These conditions are the most common causes of death in dementia patients.

Cognitive Functions Affected

• Memory
• Attention/Concentration
• Judgment
• Executive Function
• Speech
• Social Skills
• Perception
• Spatial and Temporal Orientation
• Problem-solving

Psychiatric Symptoms

Mood disorders, depression, emotional instability, uninhibited behavior, aggression, severe anxiety, and paranoia are some psychiatric symptoms associated with the condition. Other manifestations may include perceptual disturbances like hallucinations or delusions, and a refusal to eat.

Vascular Dementia

Vascular dementia accounts for 5% to 10% of all dementia cases. Its prevalence increases with age, doubling every five years. Risk factors include age, atrial fibrillation, high cholesterol, diabetes, hypertension, smoking, cardiovascular diseases, and a history of cerebrovascular disease, as well as geographic origin and genetic predisposition.

Vascular dementia arises from brain damage primarily caused by microvascular obstructions, although not exclusively. Usually, a series of such incidents lead to reduced blood and oxygen supply to specific brain areas, causing a gradual, step-by-step deterioration in cognitive functions.

People with this form of dementia experience progressive cognitive decline and significant memory loss, often coupled with focal neurological signs such as hemiparesis (partial paralysis), heightened reflexes, Babinski sign, ataxia (lack of coordination), pseudobulbar palsy, bradykinesia (slowness of movement), walking difficulties, and swallowing issues.

Currently, there are no medications specifically approved for the treatment of vascular dementia. The focus should be on prevention, which aligns with preventing the cerebrovascular incidents that cause it.

Frontotemporal Dementia

Frontotemporal Dementia (FTD) generally begins at a younger age, between 45-65 years old. It stands as the second most common cause of dementia syndrome in patients under 65, accounting for 25% of all cases in patients over the age of 65.

Unlike other forms of dementia where memory loss is often the first symptom, the initial signs of frontotemporal dementia often involve disinhibition in social behavior. This condition is characterized by apathy, emotional dysregulation manifesting as either irritability or unexplained laughter, neglect of personal hygiene, inappropriate language use, increased food intake, a tendency for oral preoccupations, and a progressive decline and stereotyping of speech.

Other Forms of Dementia

Lewy Body Dementia represents 5% to 10% of dementia cases. The epidemiological data may not be completely accurate as this type is often misdiagnosed.

Creutzfeldt-Jakob disease, a prion disease, is extremely rare, affecting about 1 in 1 million people.

Mixed dementia is a condition where patients experience more than one type of dementia. In such cases, Alzheimer’s disease often coexists with Lewy Body Dementia or the vascular form, making these the most common overlapping types of dementia.

What Conditions and Disorders Can Cause Dementia Symptoms?

In addition to Alzheimer’s disease and the other previously mentioned types of dementia, there are also other medical conditions that can trigger symptoms of dementia.

• Brain Trauma: Injury to the brain can result in symptoms similar to those of dementia.
• Subdural Hematoma: This is an accumulation of blood on the surface of the brain, which can mimic dementia.
• Chronic Alcohol Abuse: Long-term abuse of alcohol can lead to cognitive decline and symptoms akin to dementia.
• Drug Use: For instance, prolonged misuse of anti-anxiety medications can result in dementia-like symptoms.
• HIV & Other CNS Infections: Infections affecting the Central Nervous System can also cause symptoms similar to dementia.
• Parkinson’s Disease: This neurodegenerative disorder can lead to dementia symptoms over time.
• Huntington’s Disease: Another neurodegenerative condition that can result in dementia-like symptoms.

Other Causes:

• Fahr’s Disease: This involves the calcification and destruction of key ganglia in the brain.
• Wilson’s Disease: This is characterized by the destruction of basal ganglia due to copper deposits.
• Multiple Sclerosis: This autoimmune disorder affecting the central nervous system can also cause cognitive decline.
• Hydrocephalus: An abnormal accumulation of cerebrospinal fluid in the brain can cause symptoms resembling dementia.
• Metabolic Disorders: Various metabolic imbalances can lead to dementia-like symptoms.
• Thyroid Disorders: Conditions affecting the thyroid can also result in cognitive issues similar to dementia.
• Tumors: Brain neoplasms can cause symptoms mimicking dementia.

Can Dementia Be Reversed?

The severity of a potential Alzheimer’s disease can range from mild to major. Additionally, in some cases, there may be multiple causes behind a neurocognitive disorder. In a small percentage of cases, the cause of dementia symptoms may be reversible if identified early enough.

Reversible causes of dementia symptoms can include conditions such as hydrocephalus, infections, alcohol abuse, thyroid disorders, among others.

How to Increase the Odds of Preventing Alzheimer’s Dementia

It’s worth noting that the incidence of dementia is on the rise globally. This increase is largely due to lifestyle factors, with the exception of cases that involve high genetic vulnerability. The modern way of life, which often undermines previously mentioned preventive strategies, is largely to blame for the increasing rates of dementia. Therefore, the prevention of dementia may well come through lifestyle changes, featuring the following strategies.

Exercise Your Mind

Engaging in activities that stimulate cognitive brain functions can be incredibly beneficial. Reading books or newspapers, solving crosswords, and keeping a journal are some of the ways to boost your mental acuity. Even at a young age, learning new languages can enhance cognitive abilities. Strengthening our memory through new information has been shown to be effective, according to research.

Exercise Your Body

Prioritize physical activity as much as possible, whether it’s a solo or group exercise that suits your lifestyle.

Modern research confirms what has been known since ancient times: “A healthy mind in a healthy body.” In other words, if we want to reduce the risk of developing Alzheimer’s later in life, mild physical activities should be a part of our routine. Exercise helps in combating mental disorders like depression and physical conditions like hypertension and obesity.

Follow a Healthier Diet

Focus on a diet aimed at reducing cholesterol, triglycerides, and sugar levels. Olive oil, a staple of the Mediterranean diet, contains an anti-inflammatory and antioxidant substance called oleocanthal, which is associated with reduced beta-amyloid accumulation in the brain. The accumulation of beta-amyloid is one of the triggers for Alzheimer’s disease.

Don’t Leave Health Issues to Chance

Effectively manage conditions like diabetes, hypertension, and cardiac issues.

Be More Social

Engage in more recreational and social activities.

Reduce Smoking and Alcohol

Limit the intake of tobacco and alcohol as they can have detrimental effects on your health.

How is Dementia Managed?

Identifying a neurocognitive disorder like dementia can be significantly delayed, often because the family of the elderly individual may not notice changes in daily behavior until symptoms become highly disruptive.

Once dementia is diagnosed, the first step is to address any reversible causes. Alongside this, a combination of pharmacological treatment and physical/occupational, psychosocial interventions is usually recommended to slow down the progression of the disease as much as possible and improve the quality of life for the elderly patient.

Medications for dementia can’t stop the disease, but they can delay its progression. The main drugs used today are memantine and cholinesterase inhibitors. The earlier these drugs are administered, the better the chances are for delaying memory deterioration.

For accompanying symptoms like depression and anxiety, other medications such as antidepressants may be used. Some antipsychotics (in low doses) may be necessary when there are severe psychomotor agitation, delirium, and hallucinations/delusions that complicate daily life for dementia patients.

Caring for elderly patients with dementia is demanding both emotionally for the family and professional caregivers and practically. Care can be provided either at home or in specialized facilities for the elderly. The significant functional decline caused by Alzheimer’s disease may qualify one for disability benefits.

Research into new treatments for dementia is ongoing. For example, ultrasound therapy is a promising approach that may one day be used to reduce amyloid plaques partially responsible for Alzheimer’s disease.