Dementia

Symptoms Of Dementia

A person can be suspected to have dementia if he/she exhibits the following symptoms: 

1. Progressive memory loss may start as simple forgetfulness and gradually increase to an extent where the person cannot recollect vital information, such as his/her name, address, etc.

2. Problems in performing basic tasks, such as grooming, wearing clothes, eating, etc., that he/she could complete with ease previously. 

3. Difficulty establishing new memories and learning new things.

4. Loss of ability to communicate effectively. The individual may struggle to remember even simple words.

5. The individual is often confused and disoriented.

6. Other psychological symptoms, such as anxiety, depression, inappropriate behavior, paranoia, and hallucinations, may also be present.
   
   

Note: Worldwide, around 50 million people have dementia, and this number is expected to hit 152 million by 2050. Although there are many types of dementia, Alzheimer's disease-associated dementia is the most common and accounts for 60-70% of all cases. 

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Types Of Dementia

There are many types of dementia and results in various neurological disorders like : 

1. Dementia of Alzheimer’s disease

This is the most common type of dementia, caused by harmful protein buildup in the brain that damages nerve cells. This leads to memory loss, confusion, and difficulty in thinking.

2. Fronto-temporal dementia

Degeneration of nerve cells in the brain’s frontal and temporal lobes leads to this type of dementia. It is associated with personality changes, mood alterations, and abnormal behavior.

3. Vascular dementia

It happens when a stroke, injury, or abnormal blood pressure hamper the blood supply to the brain. It leads to memory problems, resulting in cognitive decline.

4. Lewy-body dementia

Lewy bodies are abnormal clumps of protein found in the brain in neurological diseases like Alzheimer’s or Parkinson’s disease. This type of dementia is associated with stiffness and rigidity in the body and slow, uncoordinated movements.

5. Mixed dementia

This is a type of dementia that occurs due to an overlap of different causes.

6. Progressive dementia

All the types of dementia mentioned earlier gradually worsen over time, starting with mild symptoms that slowly become more severe.

7. Reversible type dementia

It is a type of dementia in which there is a cognitive decline caused by underlying conditions like vitamin deficiencies, infections, or due to side effects from medications which can improve with proper treatment.

Causes Of Dementia

• The way dementia affects the brain depends on its type. Most types, except vascular dementia, occur due to the buildup of certain proteins in the brain.

• Alzheimer’s disease happens due to shrinkage of the brain and the accumulation of clumps of proteins, which damage brain cells.

• Lewy body dementia & Parkinson’s disease dementia result from clumps of alpha-synuclein protein (Lewy bodies) inside brain cells.

• Frontotemporal dementia is linked to genetic mutations that cause protein buildup in the frontal and temporal lobes of the brain.

• Huntington’s disease is an inherited condition caused by a faulty gene that causes brain cell damage.
  
  

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Risk Factors For Dementia

Certain factors are known to increase the risk of dementia, such as: 

1. Age

The risk of dementia increases with increasing age, especially after 65 years. However, it is important to understand that it is not a part of the normal aging process.

2. Family history

Chances of dementia are higher if a close family member suffers from dementia due to the same genetic sequencing.

3. Chronic illness or diseases

Comorbid conditions like diabetes, hypertension, etc., can increase the risk of dementia.

4. Nutritional deficiencies

A diet deficient in vitamin B complex can increase the risk of dementia.

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5. Alcohol abuse

Excessive alcohol consumption can increase the risk of dementia.

6. Medications

Certain antidepressant medications like amitriptyline, and anti-allergy medications like diphenhydramine, benzodiazepines, anticholinergics, and opioids may increase the risk of dementia.

Diagnosis Of Dementia

To evaluate a person with memory loss, the doctor takes a detailed history of the onset of symptoms, notes family history, and evaluates the patient's neurological and psychological condition with physical and cognitive assessments. Certain supporting lab tests and imaging studies may be required to establish the cause of dementia. They include: 

1. Blood tests

• Thyroid profile total: It helps detect thyroid imbalances which can cause cognitive issues similar to that of dementia.
  
  

• Vitamin B-12: This test identifies vitamin B-12 deficiency-linked memory problems and neurological decline.
  
  

• Vitamin D (25-OH): It assesses deficiency, which may contribute to cognitive impairment.
  
  

• Complete blood count (CBC): This test is used to check for infections or anemia that can affect brain function.
  
  

• Erythrocyte sedimentation rate: It detects inflammation, which may be linked to dementia-like symptoms.
  
  

• Protein electrophoresis CSF: It helps identify abnormal proteins in cerebrospinal fluid (a clear liquid that surrounds and protects the brain and spinal cord) associated with neurodegenerative diseases.
  
  

2. Imaging studies

• CT scan (head): This test gets clear images of the brain and helps detect brain shrinkage, strokes, or structural abnormalities linked to dementia.
  
  

• MRI brain: It provides detailed images of brain tissue to identify atrophy, strokes, or other dementia-related changes.
  
  

• MR angiography brain: It examines blood vessels in the brain to check for blockages or reduced blood flow, which can contribute to vascular dementia.
  
  

• CT angiography brain: This test uses contrast dye to visualize blood vessels and detect vascular issues that may cause dementia symptoms.

3. Other tests

• EEG (Electroencephalography), Electrocardiography (ECG), and Echocardiography may be required to evaluate brain and heart activity.
  
  

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Prevention Of Dementia

Certain types of dementia cannot be entirely prevented. Making healthy lifestyle choices can help prevent dementia that originates from a poor lifestyle. These lifestyle choices are:

1. Nourish your brain

Eat a well-balanced diet packed with essential vitamins and minerals to support cognitive health.

2. Stay active, stay sharp

Engage in regular physical activity for overall health. Keep your brain engaged with puzzles, reading, and other stimulating activities for your brain health.

3. Manage your health

Keep conditions like diabetes, hypertension, and thyroid issues in check with proper treatment.

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4. Prioritize rest

Stick to a consistent sleep schedule to ensure deep, restorative sleep for a healthy brain.

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Specialist To Visit

Close family members or loved ones often observe the symptoms of dementia. When a person starts forgetting important or routine things often and displays changes in behavior, speech, and other cognitive abilities, it is essential to evaluate him/her for probable dementia. The specialists who can diagnose and treat dementia are: 

• General physician
• Neurologist
• Neuropsychologist
• Psychiatrist
  
  

A general physician can evaluate overall health, provide initial assessments, and refer to specialists for further diagnosis and treatment.

A neurologist specializes in diagnosing and managing neurological conditions, including dementia, by identifying underlying brain-related causes.

A neuropsychologist conducts cognitive testing to assess memory, thinking, and behavior, helping to monitor the progression of dementia.

A psychiatrist treats any psychiatric symptoms associated with dementia and prescribes medication to manage mood and behavior.

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Treatment Of Dementia

The treatment for dementia mainly consists of supportive care and treating the causative factors wherever possible. It consists of:

1. Medicines to improve cognitive functions. 

• Acetylcholinesterase inhibitors: These drugs prevent the breakdown of acetylcholinesterase enzymes which helps in taking care of the symptoms but do not have any effect on the progression of the disease. Examples of drugs in this class are Donepezil, Galantamine, and Rivastigmine.

• Nerve-protecting medicine: This class of drugs nourishes the nerve cells, protects them from damage, and improves their survival. Examples include Citicoline.

• N-methyl-D-aspartate (NMDA) agonists: These are drugs that decrease the activity of glutamate (a chemical that helps transmit signals between nerve cells), thereby controlling the symptoms. Example: Memantine.

• Antioxidant drugs: These drugs help to improve the symptoms of dementia by fighting the free radicals that could be responsible for symptoms such as decline in memory. The class of drugs which are popular include Coenzyme Q10, Ginkgo biloba, etc

• Nootropic drugs: Nootropic drugs like piracetam work by affecting certain brain receptors to improve memory and mental sharpness, potentially helping with cognitive issues. 

• Cyclooxygenase (COX) inhibitors: These are designed to relieve pain, decrease inflammation, and reduce fever. It can decrease the production of nitric oxide (NO), and protect neurons against glutamate toxicity, thereby controlling the symptoms of dementia. Example: Ibuprofen.

• Statins: These are a type of drug that can help treat dementia caused by small blood vessel blockages in the brain by reducing these blockages and improving symptoms. An example includes: Atorvastatin.
  
  

2. Medicines to calm anxiety and improve sleep

• Selective serotonin reuptake inhibitors (SSRIs): Such as fluoxetine or sertraline for depression and anxiety.

• Benzodiazepines: Like lorazepam for short-term relief of anxiety.

• Antipsychotic medications: Such as quetiapine for irritability or aggression.

3. Other medicines for reversible causes of dementia

• Supplements: Sometimes dementia is caused by nutritional deficiencies. Correcting these with vitamin supplements can help reverse dementia.
  
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• Antidiabetics & antihypertensives: Treating diabetes with oral hypoglycemic drugs or insulin and hypertension with antihypertensives is essential if dementia is found to be a complication of these comorbidities.

• Antibiotics & anti-inflammatory drugs: Any infection or inflammatory condition in the body must be treated with appropriate antibiotics and anti-inflammatory drugs if dementia results from an infection or inflammation in the body.

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Home Care For Dementia

Some home remedies may help relieve dementia symptoms, but further research is needed to confirm their effectiveness. It is important to understand they should not replace standard medical treatment. They include:

1. Sage: A herb that may help improve memory and thinking. 

How to use it?
Use it as a tea or add it to your meals for a memory boost.

2. Ginkgo biloba: A plant believed to help with brain circulation and clarity. 

How to use it?
Take in capsule or tablet form to support cognitive function.|

3. Lemon balm: A calming herb that can help reduce stress and agitation. 

How to use it?
Use it as a tea or apply it as an essential oil for relaxation.


4. Lavender: Known for its ability to reduce anxiety and improve sleep. 

How to use it?
Diffuse the oil or use it in a pillow spray before bed for better sleep.

5. St. John's wort: A plant that may help improve mood and reduce depression. 

How to use it?
Take it as a supplement or tea, but check with a doctor for the right dosage.

6. Curcumin: A compound in turmeric that may protect brain cells. 

How to use it?
Add turmeric to your food or take it as a supplement for its potential brain benefits.

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Complications Of Dementia

Dementia is a progressive condition that can worsen with time. The treatments currently available are known to slow the progression of the disease but cannot entirely stop it. Dementia can cause the following complications as it worsens gradually.

• Safety issues: Individuals with dementia are at an increased risk of injuries even while performing activities like walking, cooking, cleaning, etc.

• Personal hygiene: In the later stages, people with dementia struggle with basic human hygiene, such as brushing, bathing, grooming, and using the bathroom. 

• Nutritional challenges: With advanced dementia, a person may forget to eat and may lose interest in eating. This can lead to malnutrition.

• Aspiration or choking: Trouble swallowing food can lead to aspiration or choking and cause pneumonia.

Alternatives Therapies Of Dementia

Alternative therapies may help manage dementia symptoms, but they should not replace conventional medical treatment. Some beneficial therapies include:

1. Exercise and yoga

Performing light exercises can help enhance mood, manage anxiety in individuals with dementia, and maintain their physical activity status. These light exercises can include a home-based aerobic routine, dancing as a form of exercise, lifting light weights, and yoga such as Pranayama.

2. Physiotherapy and occupational therapy

Certain modifications suggested by physiotherapists or occupational therapists may need to be implemented in an individual with dementia home or work environment to make it safer and prevent injuries due to falls.

3. Massage therapy and aromatherapy

Massage therapy and aromatherapy induce relaxation and may be helpful for people with dementia.

4. Ayurveda

Dementia is known as Smrutibuddhirhass in Ayurveda. Panchkarma and medicinal herbs like Shankhpushpi, Guduchi, Brahmi, Ashwagandha, Shatavari, etc., may be useful in managing the symptoms of dementia.

Living with Dementia

Often, receiving a diagnosis of dementia can be a life-altering and challenging situation for patients and their caregivers. Coming to terms with the diagnosis can invoke feelings of anxiety, depression, anger, rage, guilt, etc. However, it is important to remember that a diagnosis of dementia does not necessarily mean the end of life. It is possible to live a happy life even after being diagnosed with dementia. Certain things that can help include:

1. Establish a routine

• A consistent daily routine can help reduce confusion and anxiety. 

• Break tasks down into smaller steps to make them more manageable.
  
  

2. Promote mental stimulation

• Engage in cognitive activities like puzzles, reading, or social interactions to keep the brain active.
  
  

3. Seek emotional support

• Join support groups or seek professional counselling to cope with emotional challenges.

• Stay connected with loved ones and participate in social activities to avoid isolation.
  
  

4. Monitor your condition

• Work with a doctor to ensure the correct medications are being administered,and  manage symptoms and comorbid conditions.

• Always keep your doctor informed about any new symptoms.
  
  

Tips for caregivers

• Encourage the person to maintain a diary or calendar to note down important things or days, which will help them remember.

• Always keep the atmosphere at home pleasant, positive, and caring. 

• Ensure that the individual with dementia has access to important data, such as identity documents, home addresses, important telephone numbers, etc., at all times

• People with dementia are often at an increased risk of falls due to concurrent motor issues. Hence, take care and ensure that their surroundings are well-lit, spacious, and free of obstacles.

• Do not allow a person with dementia to drive or operate heavy machinery, always assist them.

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