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Dementia

Definition


Disease: Dementia Dementia
Category: Neurological diseases
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Disease Definition:

There’s no specific disease called dementia; rather, there is a group of symptoms that describe as affecting intellectual and social abilities harshly enough to hamper daily performance. Conditions or changes in the brain cause dementia and there are different types of dementia depending on the cause. Alzheimer is the most common type.

 

Memory loss is usually connected with dementia, but memory loss alone doesn’t mean that someone has dementia. Dementia means at least two problems in brain functions such as memory loss coupled with impaired language or judgment. Dementia makes a person puzzled and unable to remember places, people and names. Changes in social behavior and personality are also possible. Nevertheless, some of the causes of dementia could be treated and even reversed.
 

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Depending on the cause of dementia its signs and symptoms could vary, they may include:

 

  • Paranoia
  • Agitation
  • Memory loss
  • Hallucinations
  • Inability to reason
  • Personality changes
  • Inappropriate behavior
  • Difficulty communicating
  • Difficulty with planning and organizing
  • Failure to learn or remember new information
  • Difficulty with organization and motor functions.

 

If someone goes through memory problems or other dementia problems, they should see a doctor. Seeing the doctor for determining the underlying cause of dementia is very important because some of the medical conditions that can cause symptoms of dementia are treatable. Treating dementia will be easier if it is done before the symptoms get worse, meaning that an early diagnosis is quite helpful.

 

Yet another good thing about early diagnosis is that it'll give the patient time to plan their future while they're still able to contribute in the decision making. This is especially true if the diagnosis is a type of dementia that will progressively get worse over time, such as Alzheimer's disease. A person should talk to their doctor in case their symptoms start getting worse after diagnosis.
 

Causes:

Dementia isn't always caused by the same disease and there are many things that contribute to it.
Some types of dementia like Alzheimer's disease occur on their own and not as a consequence of another disease.
Till now, much is still left unknown about how diseases might be linked to dementia. 

 

The types of dementias are classified in different ways, but the most common way is grouping them together depending on what they have in common, for instance, whether they are progressive dementias or what part of the brain is affected. Dementias that are caused by an infection or a reaction to medications can be reversible if treated appropriately.

 

PROGRESSIVE DEMENTIAS:

Some types of progressive dementia that worsen by time are:

Alzheimer's disease:

Demolition of brain cells causes Alzheimer's disease. Even though the main reason behind this disease is not known, but two types of brain cell damage are common in people who have Alzheimer's; these two types are: PLAQUES (clumps of a normally harmless protein called beta-amyloid) and TANGLES (fibrous tangles made up of an abnormal protein called tau protein). Alzheimer develops slowly, from 7 to 10 years, causing a slow decline in cognitive abilities.
The affected part of the brain eventually won't be able to act properly due to limited functions, such as those that involve movement, judgment, memory, abstract thinking, behavior and language. In people over the age of 65, Alzheimer's disease is the most common cause of dementia. After the age of 60, symptoms usually start appearing. However, in case a person has a defective gene, they may develop an early-onset form of the disease. 

Frontotemporal dementia:

This type contains a group of diseases that are marked by the collapse of nerve cells in the frontal and temporal lobes of the brain, the areas responsible for personality, behavior and language. Even though this type of dementia is sometimes related to genetic mutations, but its exact cause is still not known.  Yet, many people have no family history of dementia. In Pick’s disease, a form of this condition, the affected parts of brain contain fibrous tangles created of an abnormal protein called tau protein. Progressive dementia could be caused by Pick's disease. Symptoms of frontotemporal dementia often appear between the ages of 40 and 65, which could include problems with thinking and concentration, loss of mental flexibility, socially inappropriate behaviors and language problems. 

Vascular dementia:

This type of dementia is the result of damage to the brain caused by problems to the arteries that serve the brain or heart. Signs start immediately and may occur in people with high blood pressure, previous strokes or heart attacks.  Another reason could be an infection of the heart valve (endocarditis) or an increase of amyloid protein in the brain's blood vessels (amyloid angiopathy) that sometimes causes "bleeding" (hemorrhagic) strokes.

 

Types of vascular dementia vary and differ according to their causes and symptoms.  Some only affect one side of the body, while others cause memory loss, confusion and mood changes.  Some types are progressive and so worsen by time, while others seem to improve and are temporary. Vascular dementia is common with age and usually occurs along with Alzheimer's.

Lewy body dementia:

Lewy bodies are abnormal clumps of protein found in the brains of people with Lewy body dementia, Alzheimer's and Parkinson’s disease. It shares symptoms of Alzheimer but has its own unique features like fluctuations in confusion and clear thinking (lucidity) and visual hallucinations. It also shares symptoms of Parkinson’s disease like rigidity and tremor. Such people will have a condition called REM sleep behavior disorder (RBD) in which they act out dreams, like thrashing and kicking during sleep.

 

Some of the other disorders that could be linked to dementia are:

Dementia pugilistica:

Chronic traumatic encephalopathy or boxer's dementia is the outcome of repetitive head trauma such as what happens to boxers.  Signs and symptoms depend on the areas of the brain injured, causing memory problems, poor organization and impaired verbal communication, in addition to tremors, slow movement and muscle stiffness (parkinsonism). However, signs might not show until years after the actual trauma. Posttraumatic dementia could be the reault of a single traumatic head injury. This is much like dementia pugilistica, but may include long-term memory problems.

Huntington's disease:

This is an inherited disease in which some nerve cells of the brain and spinal cord start wasting away. Signs normally show in the 30’s or 40’s.  A slight personality change, irritability, anxiety and depression are some of the symptoms that may progress to severe dementia. This disease may also cause walking and movement difficulties in addition to general clumsiness and weakness.

HIV-associated dementia:

A widespread destruction of brain matter may be caused by an infection with HIV (human immunodeficiency virus), resulting in difficulty concentrating, apathy, impaired memory, problems with movement and social withdrawal.

Creutzfeldt-Jakob disease:

This is a rare fatal brain disorder that occurs in people at different intervals to people with no known risk factors.  Yet, some cases of the disorder are genetic and others are due to exposure to diseased brain or nervous system tissue. At the age of 60, signs and symptoms begin showing and may include impaired memory, thinking, vision and judgment, personality changes and problems with coordination. As the illness progresses, the mental impairment will become severe, leading to blindness. Some of the other conditions that usually occur along with this disease are infections and pneumonia. 

Secondary dementias:

Symptoms of dementia may develop in people who have other disorders that affect movement, such as Parkinson's disease. However, the connection between dementia and these disorders is still not known.

 

CAUSES OF DEMENTIA THAT CAN BE REVERSED:

There are some causes of dementia or dementia-like symptoms that can be reversed. Some of those conditions are:

Infections and immune disorders:

In some cases, fever or other side effects of the body's attempt to fight off an infection may end up causing dementia. Conditions that compromise the immune system, such as leukemia; and brain infections such as encephalitis and meningitis, in addition to disease like untreated syphilis and Lyme disease are some examples of the infections mentioned above. Sometimes, dementia may also be caused by conditions that result from the body's immune system attacking nerve cells, such as multiple sclerosis.

Reactions to medications:

As a response to one medication or interaction of several drugs, symptoms of dementia may be caused. 

Nutritional deficiencies:

Dehydration, lack of thiamin (vitamin B- 1) which is common among alcohol addicts, and a deficiency in vitamin B-6 and B-12 could lead to symptoms of dementia. Good sources of all types of vitamin B are milk, whole-wheat bread, eggs, spinach, bananas, chicken, lentils, pork, fortified breakfast cereals and salmon.

Metabolic problems and endocrine abnormalities:

Hypoglycemia, an impaired ability to absorb vitamin B-12, too much or too little sodium or calcium, and thyroid problems are some of the problems that may cause dementia.

Heart and lung problems:

No one could live without oxygen. A heart condition that deprives the brain of the oxygen it needs and chronic lung problems may cause symptoms of dementia.

Poisoning:

Exposure to heavy metals like lead, manganese and other poisons like pesticides could lead to dementia symptoms. Symptoms of dementia may also occur in people who have abused recreational drugs and alcohol. Usually, after treatment, or after exposure to the substance has ended, the symptoms of dementia disappear.

Anoxia:

Also called hypoxia, this is a condition that occurs when insufficient amounts of oxygen get to organ tissue. Severe asthma, high-altitude exposure, carbon monoxide poisoning, an overdose of anesthesia and strangulation are some of the causes of this condition.  Symptoms may occur during recovery; and recovery will depend on the severity of the oxygen deprivation. 

Subdural hematomas:

Bleeding between the surface of the brain and its outer covering is the main cause of subdural hematomas.

Brain tumors:

Damage caused by a brain tumor may cause dementia, but this is rare.
 

Complications

Complications:

The ability to perform daily activities is hampered in dementia because this condition affects the function of many body systems. Some of the problems that dementia may cause include:

Reduced hygiene:

In the progression of dementia from moderate to severe, a person can lose the ability to perform daily tasks on their own. So they won't able to bathe, dress, brush their teeth, comb their hair, or go to the toilet without help.

Inadequate nutrition:

Reduced or stopped eating and drinking is a focal point to everyone who has dementia.  Mostly, in advanced dementia, people lose control over the muscles used for chewing and swallowing. Thus, eating puts them in the risk of choking or aspirating food into their lungs. In case this occurs, it may block breathing and cause pneumonia. In advanced dementia, people lose their appetite and the feeling of hunger vanishes away. Other factors that contribute to the process of losing appetite are depression, side effects of medication, constipation and infections. 

Deterioration of emotional health:

Personality and behaviors are affected by dementia.  Some of these changes result from the actual decline of the brain, while others may be a simple effect of the emotional confrontations of dealing with the declination changes. Depression, confusion, aggression, frustration, disorientation, a lack of inhibition and anxiety may result from dementia.

Difficulty taking medications:

Remembering what the correct amount of medication was on the right time could be really tough since the patient suffers from memory loss.

Difficulty communicating:

The patient's ability to remember the names of people and things will be lost when dementia progresses.
This will hinder communication at all levels, whether letting a caregiver know what they need and how they feel or communicating socially. Agitation, isolation and depression are all possible results of lack of communication.

Delirium:

This is a stage marked by recoil of attention, awareness, and mental clarity. Delirium is common among hospitalized people who have dementia. The cause of this may be the sudden change in environment and surroundings.

Personal safety challenges:

Some daily actions and activities could present safety issues for people with dementia since they have a reduced ability to make decisions and solve problems. As such, driving, cooking, falling and negotiating could be problematic.

Sleeping problems:

The disturbance to the sleep-wake cycle is very common; a person may stay up at night and sleep during the day. Other common complications could be insomnia, restless legs syndrome, and sleep apnea.
 

Treatments:

The goal of treating dementia is to slow or minimize the development of symptoms.

 

MEDICATIONS:

 
Cholinesterase inhibitors:

These medications work by boosting the levels of a chemical messenger involved in memory and judgment. They are usually used for treating Alzheimer's disease but they can also be used in treating Lewy body dementia, vascular dementia and Parkinson's disease. Diarrhea, nausea and vomiting are some of its side effects. Some examples of these medications are galantamine hydrobromide, donepezil and rivastigmine.

Memantine:

This medication works by regulating the activity of glutamate, a chemical messenger that is involved in all brain function, including memory and learning. This medication is mainly used to treat Alzheimer's disease, but it could also be used in treating other dementias. Dizziness is the most common side effect of this medication. Some research has shown that results may be better if memantine is combined with a cholinesterase inhibitor.

Other medications:

Some of the symptoms of dementia can be treated, but there is no standard treatment for this disease. Reducing the risk factors for further brain damage is the main goal of additional treatments. The progression of dementia could be slowed or even stopped in case the underlying causes of dementia are treated. For instance the patient may be prescribed medications to control diabetes, high cholesterol, heart disease and high blood pressure in order to prevent a stroke. People with vascular dementia may also be prescribed medications to treat insomnia, anxiety and blood clots.

 

Moreover, antidepressants, sedatives and other medications can treat some specific symptoms and behavioral problems; however, these medications may worsen the other symptoms of dementia.
Management of Creutzfeldt-Jakob disease is focused on making sure the person is comfortable because until now it doesn't have a known treatment.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
Certificate:
Specialty: -

Expert's opinion:

There’s no specific disease called dementia; rather, there is a group of symptoms that describe as affecting intellectual and social abilities harshly enough to hamper daily performance.

For Specialists

Clinical Trials:

Not available

 

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