Understanding Dementia

Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life. Alzheimer’s is the most common cause of dementia. The significant progressive changes in brain chemistry and atrophy trigger a decline in cognitive abilities, severe enough to impair daily life, independent function, behaviour, feelings and relationships.

Other than Alzeheimer’s , Vascular dementia, which occurs because of microscopic bleeding and blood vessel blockage in the brain, is the second most common cause of dementia. Creutzfeldt-Jakob disease causes a type of dementia that gets worse unusually fast. Dementia with Lewy bodies (DLB) is a type of progressive dementia that leads to a decline in thinking, reasoning and independent function. Its features may include spontaneous changes in attention and alertness, recurrent visual hallucinations, REM sleep behavior disorder, and slow movement, tremors or rigidity. Frontotemporal dementia (FTD) or frontotemporal degenerations refers to a group of disorders caused by progressive nerve cell loss in the brain’s frontal lobes (the areas behind your forehead) or its temporal lobes (the regions behind your ears).Those who experience the brain changes of multiple types of dementia simultaneously have mixed dementia.

Dementia is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life. Alzheimer’s is the most common cause of dementia. The significant progressive changes in brain chemistry and atrophy trigger a decline in cognitive abilities, severe enough to impair daily life, independent function, behaviour, feelings and relationships.

Other than Alzeheimer’s , Vascular dementia, which occurs because of microscopic bleeding and blood vessel blockage in the brain, is the second most common cause of dementia. Creutzfeldt-Jakob disease causes a type of dementia that gets worse unusually fast. Dementia with Lewy bodies (DLB) is a type of progressive dementia that leads to a decline in thinking, reasoning and independent function. Its features may include spontaneous changes in attention and alertness, recurrent visual hallucinations, REM sleep behavior disorder, and slow movement, tremors or rigidity. Frontotemporal dementia (FTD) or frontotemporal degenerations refers to a group of disorders caused by progressive nerve cell loss in the brain’s frontal lobes (the areas behind your forehead) or its temporal lobes (the regions behind your ears).Those who experience the brain changes of multiple types of dementia simultaneously have mixed dementia.

Dementia is often incorrectly referred to as “senility” or “senile dementia,” which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging. On the contrary, there is nothing normal about dementia.

The early stage signs of Alzheimer’s include –

• Becoming forgetful, especially of things that have just happened.
•  Some difficulty with communication
• Becoming lost and confused in familiar places – may lose items by putting them in unusual places and be unable to find them.
•  Losing track of the time, including time of day, month, year.
• Difficulty in making decisions and handling personal finances.
• Having difficulty carrying out familiar tasks at home or work – trouble driving or forgetting how use appliances in the kitchen.
• Mood and behaviour changes-
• Less active and motivated, loses interest in activities and hobbies.
•  May show mood changes, including depression or anxiety.
• May react unusually angrily or aggressively on occasion.

 The middle stage signs of Alzheimer’s include-

• Becoming very forgetful, especially of recent events and people’s names.
• Having difficulty comprehending time, date, place and events.
• Increasing difficulty with communication.
• Need help with personal care
•  Unable to prepare food, cook, clean or shop.
•  Unable to live alone safely without considerable support.
• Behaviour changes like wandering, repeated questioning, calling out, clinging, disturbed sleeping and hallucinations.
• Inappropriate behaviour

The late stage Signs include-

• Unaware of time and place.

• May not understand what is happening around them.
• Unable to recognize relatives and friends.
• Unable to eat without assistance.
•  Increasing need for assisted self-care.
•  May have bladder and bowel incontinence.
•  May be unable to walk or be confined to a wheelchair or bed.
•  Behaviour changes may escalate and include aggression towards carer
•  Unable to find their way around in the home.

Risk factors for dementia includes age, even though while age increases risk, it is not a direct cause of Alzheimer’s. Most individuals with the disease are 65 and older. After age 65, the risk of Alzheimer’s doubles every five years. After age 85, the risk reaches nearly one-third.  

Dementia does not exclusively affect older people – young onset dementia (defined as the onset of symptoms before the age of 65 years) accounts for up to 9% of cases. Studies show that people can reduce their risk of cognitive decline and dementia by being physically active, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy blood pressure, cholesterol and blood sugar levels. Additional risk factors include depression, social isolation, low educational attainment, cognitive inactivity and air pollution.

The diagnosis is made after thorough assessments by neurologists, psychiatrists and clinical psychologists. There is currently no treatment available to cure dementia. Anti-dementia medicines and disease-modifying therapies developed to date have limited efficacy and are primarily labelled for Alzheimer’s disease, though numerous new treatments are being investigated in various stages of clinical trials . Much can be offered to support and improve the lives of people with dementia and their carers and families. The principal goals for dementia care include:

• early diagnosis in order to promote early and optimal management
• optimizing physical health, cognition, activity and well-being
• identifying and treating accompanying physical illness
• understanding and managing behaviour changes
• providing information and long-term support to carers