Dementia

Symptoms Of Dementia

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

• A progressive loss of memory, which 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.
• Problems in performing basic tasks, such as grooming, wearing clothes, eating, etc., that he/she could complete with ease previously. 
• Difficulty establishing new memories and learning new things.
• Loss of ability to communicate effectively. The patient may struggle to remember even simple words.
• The patient is often confused and disoriented.
• Other psychological symptoms, such as anxiety, depression, inappropriate behavior, paranoia, and hallucinations, may also be present.

Causes Of Dementia

Dementia of Alzheimer’s disease

This is the most common type of dementia and accounts for 70-80% of all cases of dementia. Patients with Alzheimer’s disease have abnormalities in their brain, like deposition of beta-amyloid proteins or plaques and tangles in the brain which damage healthy neurons and are thought to cause the symptoms. Another feature is the loss of connection between neurons in the brain which transmit messages between different parts of the brain, and from the brain to muscles and organs in the body.

Fronto-temporal dementia

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

Vascular dementia

When the blood supply to the brain is hampered by a stroke, injury, or abnormal blood pressure, it damages the neurons and leads to memory problems, resulting in cognitive decline.

Lewy-body dementia

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

Other brain disorders

Certain neurological conditions, such as traumatic brain injury, Huntington’s disease, Creutzfeldt-Jakob disease, etc., may also cause symptoms of dementia like memory loss, speech difficulties, etc.

Mixed dementia

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

Progressive dementia

All types of dementia described above are progressive types that often begin with mild symptoms. There is no possibility of a complete cure for such types of dementia. 

Reversible type dementia

These types of dementia can be improved if the underlying  causative factor is taken care of. These dementias can be due to nutritional deficiencies, infections, medications effect, hormonal imbalances, brain tumors, hydrocephalus, excess fluid buildup in the brain, poisoning, etc. Correcting these causative agents usually helps improve the symptoms.

Risk Factors For Dementia

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

Age: The risk of dementia increases with increasing age, especially after 65 years. However, it is not a part of the normal aging process, which is a common misconception.

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

Chronic illness or diseases: Comorbid conditions like diabetes, hypertension, etc., increase the risk of dementia.

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

Alcohol abuse: Excessive alcohol consumption can increase the risk of dementia.

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

Diagnosis Of Dementia

To evaluate a person with memory loss, the doctor takes a detailed history about 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. 

Lab Tests: Laboratory tests to evaluate dementia include Thyroid profile total, Vitamin B-12, Vitamin D (25-OH), Complete blood count (CBC), Erythrocyte sedimentation rate, Protein electrophoresis CSF, etc. check for infectious conditions, autoimmune conditions, or nutritional deficiencies as these are other potential causes of dementia. Depending on the test results, further more detailed tests may be recommended to confirm the findings.

Imaging Studies: CT scan (Head), MRI brain, MR angiography brain, CT angiography brain are useful to study the structural changes to the brain and surrounding vasculature in-depth.

Others: EEG (Electro-Encephalograph), Electrocardiography (ECG), and Echocardiography may be required to evaluate brain and heart activity.

With timely preventive health check-ups, one can spot and address risk factors for certain diseases that might crop up with old age. Read more on the need for preventive health check ups for the elderly. 
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Treatment Of Dementia

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

Medicines to Improve Cognitive Functions

The common types of medications prescribed to patients with dementia to improve their cognitive symptoms. 

1. 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.

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

3. N-methyl-D-aspartate (NMDA) agonists: These are drugs that decrease the activity of glutamate, thereby controlling the symptoms. The formulations that belong to this class are Memantine.

4. 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, Saint John’s Wort, etc

5. Nootropic drugs: These drugs which include piracetam target α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA ) receptors, that play a key role in the transmission of signals across synapses in the brain. By stimulating or suppressing certain signal transmissions in the brain, piracetam may help to decrease cognitive impairment and improve mental acuity.

6. Ibuprofen: It is a cyclooxygenase (COX) inhibitor designed to relieve pain, decrease inflammation, and reduce fever. It decreases the production of nitric oxide (NO), protects neurons against glutamate toxicity, and decreases the production of proinflammatory cytokines thereby controlling the symptoms of dementia. 

7. Statins: This class of drugs are known to help in the treatment of certain types of dementia caused by small blockages in blood vessels that carry blood to the brain. Statins may help to reduce these blockages and improve the symptoms.

Medicines to Calm Anxiety and Improve Sleep

Often, patients with dementia also suffer from anxiety, irritability, depression, and sleep disturbances. Anti-anxiety or antidepressant medications that help calm these symptoms are prescribed.

Other Medicines for Reversible Causes of Dementia

• Supplements: Sometimes dementia is caused by nutritional deficiencies. Correcting these with vitamin supplements such as Polybion SF Syrup and Meg-B12 Capsules can help reverse dementia.

• 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.

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:

• Consuming a balanced diet rich in vitamins and minerals.
• Regularly exercising for an active physical and social life.
• Brain-stimulating exercises, such as solving puzzles, reading, etc.
• Avoiding heavy smoking and excessive alcohol consumption.
• Taking proper treatment for comorbid conditions like diabetes, hypertension, thyroid issues, anxiety, etc.
• Establishing a sleep schedule for adequate, sound sleep.

Specialist To Visit

The symptoms of dementia are often observed by close family members or loved ones. 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: 

• Neurologist

• Neuro-psychologist

• Psychiatrist

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Alternatives Therapies Of Dementia

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

Physiotherapy and Occupational Therapy: Certain modifications suggested by physiotherapists or occupational therapists may need to be implemented in a patient’s home or work environment to make it safer and prevent injuries due to falls.

Massage Therapy and Aromatherapy: Massage therapy and aromatherapy induce relaxation and may be helpful for patients with dementia.

Ayurveda: Dementia is known as Smrutibuddhirhass in Ayurveda. Panchkarma and medicinal herbs like Shankhpushpi, Guduchi, Bhrahmi, Ashwagandha, Shatavari, etc., may be useful in treating 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.

• Make sure that the person understands the diagnosis and its health implications. 

• Motivate the patient to stay socially active, such as going to a movie or taking a walk in a park. Engage them in community activities like attending functions or help them join a support group. 

• Encourage them to spend time with friends and family.

• Love, understanding, patience, and reassurance are cornerstones of living with a loved one who has dementia.

Home Care For Dementia

It is important to ensure safety and quality of life for patients suffering from dementia. Caring for a relative or loved one who is suffering from dementia can be challenging and often tiresome. Here are a few things that can help with home care for dementia patients. 

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

2. Always keep the atmosphere at home pleasant, positive, and caring. Never make the patient feel that they are a burden.

3. Ensure that the patient has access to important data, such as identity documents, home address, important telephone numbers, etc., at all times. This can help in situations where the patient loses his/her way home or is unable to remember their identity or whereabouts.

4. 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.

5. Do not allow a patient with dementia to drive or operate heavy machinery. 

Even though the disease mostly affects people in their old age, Alzheimer’s disease is not a part of the natural ageing process. Know about the 7 lifestyle changes to lower the risk of Alzheimer's disease. 
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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: Patients with dementia are at an increased risk of injuries even while performing activities like walking, cooking, cleaning, etc.

Personal hygiene: In the later stages, patients 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 a variety of malnutrition-related problems.

Aspiration or choking: Trouble swallowing food can lead to aspiration or choking and cause pneumonia in the lungs.