Dementia - ‘Another truth of ageing’, types, causes and cures

 

According to a World Health Organization (WHO) recent report–‘Dementia is currently the seventh leading cause of death among all diseases. Worldwide, around 55 million people have dementia, with over 60% living in low- and middle-income countries. As the proportion of older people in the population is increasing in nearly every country, this number is expected to rise to 78 million in 2030 and 139 million in 2050.’

What is Dementia? Why does it affect elderly people  more? What are its symptoms and treatment? Is it different from Alzheimer? Is this a common disease related to aging? Let us try to know through this article…

What is Dementia

Dementia, which is another form of mental aberration, is a syndrome for which age is one of the strongest known risk factors.  It is not a chronic disease or any kind of mental disorder but is simply a mental stage, affecting memory, decision-making capacity, thought process and understanding, emotional degradation and normal functioning in old age.

On the other hand, Dementia may also develop after a stroke or in the context of certain infections such as HIV(HIV associated neurocognitive disorder), harmful use of alcohol, repetitive physical injuries to the brain (known as chronic traumatic encephalopathy) or nutritional deficiencies. The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.

Is dementia a common disease  of older age?

In general, it is normal to have symptoms such as weakening of muscles and bones, hardening of arteries and vessels, and some related memory changes with age. In such conditions, the effect of dementia on the brain and memory of the elderly people up to 65 years of age or more, is visible. But it is not necessary that all people of this age group may be victims of it.

Basically, Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain, such as Alzheimer's disease or stroke. In many cases it has also been observed that those who have parents or siblings with dementia are more likely to develop dementia themselves.

What are the signs and symptoms of dementia?

Although dementia mainly affects older people, it is still not an inevitable consequence of ageing. Although dementia never affects the consciousness of the sufferer however symptoms such as loss of cognitive function are often seen in them such as mood swings, emotional degradation, body control, loss of memory.

People with dementia have problems with: memory, attention, communication, reasoning, judgment, and problem solving, visual perception beyond typical age-related changes in vision. Basically, its symptoms can vary widely from person to person. The strongest known risk factor for dementia is increasing age, with most cases affecting those of 65 years and older.

Other symptoms of dementia- Getting lost in a familiar neighborhood, Using unusual words to refer to familiar objects, Forgetting the name of a close family member or friend, Forgetting old memories, Not being able to complete tasks independently.

Risk factors

Older people who are the patients of Poor heart health, high blood pressure, high cholesterol, and smoking increase the risk of dementia if not treated properly. Traumatic brain injuries, as well as head injuries can increase the risk of dementia, especially if they are severe or occur repeatedly. Additional risk factors include depression, social isolation, low educational attainment, cognitive inactivity and air pollution.

People who have dementia may have a reversible underlying cause such as side effects of medication, increased pressure in the brain, vitamin deficiency, and thyroid hormone imbalance. Medical providers should screen for reversible causes in patients who are concerned for dementia.

Common types of Dementia

Alzheimer's disease

It is the most common cause of dementia, occurring in 60 to 80 percent of the elderly people. Its trademark symptom is to face difficulty in recalling recent events, such as conversations that happened minutes or hours ago. While, difficulty in retracing more distant memories occurs later in the disease. Other concerns, such as difficulty in walking or not to talk properly where, changes in personality also come later. Actually, it is caused by specific changes in the brain.

Vascular dementia:

In about 10 percent of cases, dementia is linked to a mantle stroke or issues with blood flow to the brain. At the same time, diabetes, high blood pressure and high cholesterol have also been considered some risk factors. To know the disease step by step, it is also seen how much of the brain is affected. Treatment is done on the basis of severe or mini stroke or by estimating the depth of the disease.

Lewy body dementia:

In addition to more specific symptoms such as memory loss like Alzheimer’s disease , people with lewy body dementia may have problems with movement or balance such as stiffness or tremors. (abnormal aggregates of protein that develop inside nerve cells) These include daytime sleepiness, confusion or staring, trouble sleeping at night, or visual hallucinations. The victim begins to see people, objects or figures that are not actually there.

Mixed dementia:

Mixed dementia is also often seen in people 80 years of age and older. Where more than one type of dementia is present in the brain at the same time. For example, a person may have Alzheimer's disease and vascular dementia, or rather, the two types of symptoms are likely to overlap.

Preventive measures

Studies show that people can reduce their risk of cognitive decline and dementia by

• Being physically active
• Being socially active
• Participate in mentally stimulating activities, learn languages, or continue education
• Drink moderately
• Quit smoking and minimize drug use
• Eat a healthy diet. Research has found that a mediterranean diet high in fish, nuts, whole grains, and plant-based foods may be the most beneficial for dementia prevention.
• Adequately manage cardiovascular diseases like diabetes, high cholesterol, or high blood pressure

Medication and Therapies for Dementia

Medication:

• Vitamin B12 deficiency can cause pernicious anemia, leading to dementia that can be treated by addressing the deficiency. Medication and supplements that can completely cure reversible dementias include:
• Vitamin B12 supplements for pernicious anemia
• Hormonal supplements for hyperthyroidism, hypothyroidism, or other imbalances
• SSRIs or other antidepressants for depression symptoms which may mimic dementia
• Antibiotics or medications to treat brain infections like encephalitis or meningitis

Therapies:

Dementia is correlated with increased anxiety and depression, so professional counseling and a strong support system are integral to maintaining and improving overall well being. Patients can choose from many different types of therapy, including therapies that align with their interests like music or art therapy.

Cognitive Stimulation Therapy (CST)

CST involves training memory, language ability, and problem solving skills in order to improve cognitive functioning, and can increase memory and reasoning skills without medication.

Behavioral therapy

Behavioral therapy involves tackling the triggers or causes of unwanted behaviors like aggression or wandering in order to alleviate and provide outlets for these behaviors without medication. This  therapy is usually administered by qualified family or loved ones of dementia sufferers, or by the caregivers of afflicted individuals.

Reality Orientation Therapy

Which works to reduce confusion and disorientation that accompanies dementia by providing orienting information about time and location several times throughout the day.

Validation Therapy

Which involves discussing and accepting the ideas and values of dementia patients in order to foster positive communication and reduce stress for the sufferer.

WHO response

WHO recognizes dementia as a public health priority. In May 2017, the World Health Assembly endorsed the Global action plan on the public health response to dementia 2017-2025. The Plan provides a comprehensive blueprint for action – for policy-makers, international, regional and national partners, and WHO as in the following areas: addressing dementia as a public health priority; increasing awareness of dementia and creating a dementia-inclusive society; reducing the risk of dementia; diagnosis, treatment and care; information systems for dementia; support for dementia carers; and, research and innovation.

Dementia is also one of the priority conditions in the WHO Mental Health Gap Action Programme (mhGAP), which is a resource for generalists, particularly in low- and middle-income countries, to help them provide first-line care for mental, neurological and substance use disorders.

In July 2021, WHO released “Towards a dementia-inclusive society: WHO toolkit for dementia-friendly initiatives”, which to support countries in establishing, scaling and evaluating dementia-friendly initiatives to foster societies where people with dementia and their carers can meaningfully participate.

Older African Americans are twice more likely to have dementia than whites. Hispanics 1.5 times more likely to have dementia than whites (CDC report)