Dementia (Latin: de-' apart';mens-'mind') refers to the progressive degeneration in cognitive functions, caused by rapid or gradual alterations in the brain. These changes may be triggered by brain damage or by certain diseases.
Dementia is not the name of a specific disease, but is a term used to refer to a group of symptoms. It commonly affects the older people, although it may manifest at any stage of adulthood.
Cognitive functions involve the ability to think, to perceive, and to learn. Some of the common cognitive functions that are impacted by dementia are:
• Attention span
• Making Decisions
• Problem solving
• Verbal communications, and
• Spatial orientation
The prevalence of dementia has multiplied over the past decades. This could stem from greater awareness, precise diagnosis or better treatment modalities resulting in an expanding population of the elderly.
A recent estimate showed an existing population of 24·3 million dementia-affected persons, with 4·6 million new cases being added every year. This score is likely to double, every 20 years.
The majority of the affected individuals live in developing countries (60% in 2001, expected to rise to 71% by 2040). Rates are expected to increase by more than 300 % in India, China, South Asian and in the Western Pacific countries.
In the United States, an estimated 2 million people are reported to be affected by severe dementia, while 1 to 5 million people are victims of mild to moderate dementia. 5-8% of those above 65 years of age, have some form of dementia; the estimate doubles for every 5 years after 65 years.
Dementia can be broadly classified as reversible and non -reversible dementia. Some types of dementia are partially or totally reversible with treatment. The nature of damage and the speed with which the underlying cause is treated determines whether the disease is reversible or not.
a) Alzheimer's Disease (AD), the most common cause, is incurable and can be classified under irreversible dementia. It is present in two thirds of the affected people. AD is a progressively degenerating disease, characterized by brain lesions, that gradually kill the neurons responsible for cognition.
b) Vascular Dementia, also called Multi-Infarct Dementia, shares many symptoms with Alzheimer's disease. It is caused by a defect in the blood supply to the brain. There is no cure for this type of dementia. Symptoms may appear suddenly and they include-
• Getting lost in familiar surroundings
• Memory problems
• Rapid, shuffling steps
• Slurred speech
• Loss of bladder / bowel control
• Unwarranted laughing / crying
c) Mixed dementia, or Alzheimer's Disease, with Concomitant Cerebrovascular Disease (AD with CVD), is now recognized by many as a specific clinical condition.
Causes of Memory Loss
Dementia results from the destruction of brain cells. The greatest risk factor implicated in dementia is, of course, old age.
Some of the other causes/risk factors indicated in dementia are listed below-
• A head injury/ stroke
• Brain tumor
• Family history
• Untreated infectious diseases
• Kidney failure
• Liver disease
• Thyroid disease
• Cardiovascular diseases
• Drug /other substance abuse
• Vitamin Deficiency
• Alzheimer's Disease
• Huntington's disease
• Parkinson's Disease
• Pick's Disease
• Creutzfeldt-Jakob disease or Mad Cow Disease
• Lewy Body Disease
From Jekyll to Hyde: Symptoms
Dementia may affect the personality and the mood of the affected individual, depending on the area of the brain affected. This can result in behavioral changes, which the individual may not be aware of. Eventually, they 'evolve' into different personalities.
• Memory loss,without recollection, is the most common symptom of dementia
• People with dementia may have trouble doing normal chores, such as getting dressed or eating.
• They may repeat the same questions
• They are often found to misplace things
• They may become unaware of time and place
• They may even not even recollect their loved ones.
• In extreme cases they forget who they are.
• Their hygiene may take a back seat
• They may increasingly become disoriented
• They may become passive and may lose their initiative to do things they always did
• Memory loss may lead on to disruptive behavior in individuals suffering from dementia.
• They may become easily disturbed and may be unable to to keep their emotions under a lid
• They may even begin to see things that do not exist
Proper diagnosis of the disease is quintessential for an effective treatment.
Short tests,such as the Mini-Mental state examination, are available to screen the cognitive status of an individual. The scores from these tests are interpreted in accordance with an individual's educational status and other personal background.
Magnetic resonance imaging and magnetic resonance spectroscopy help to detect alterations in the structure and in the biochemical functions of the brain in individuals with dementia. These brain scans also helps to monitor disease progression and the therapeutic effect of certain treatments.
Management of dementia often involves a group of health care specialists such as the neurologist, psychologists and geriatric specialists.
In some cases of reversible dementia, appropriate treatments, such as medications (for infection) or surgery (in case of clot or tumor) may help to resolve the dementia.
Treatment for irreversible dementia aims to alleviate the symptoms. Three FDA-approved drugs for Alzheimer's are Donepezil, Galantamine and rivastigmine.
Tranquilizers and sedatives can ease restlessness, sleeplessness, anxiety or other forms of disruptive behaviors. Almost all the symptoms associated with dementia can be controlled with medications.
Lifestyle Changes for Prevention
Most cases of dementia do not have a cure hence, prevention through lifestyle changes is the sensible way to a 'memorable' life.
Some of the means and methods are listed below-
- An active life, both mentally and physically, is a sure-fire way of preventing dementia.
- A well balanced diet, preferably mediterranean, rich in fish,vegetables and beta carotenes and low in saturated fat is believed to keep dementia at bay.
- Staying away from tobacco and drugs may help to reduce the risk of dementia.
- Drugs for hypertension and diabetes should be taken appropriately.Some studies say that medications such as those for hypertension, diabetes and NSAIDs have the ability to reduce the risk of dementia.
- Some studies indicate that the regular consumption of moderate levels of alcohol may reduce risk of dementia.
- Cultivate lifestyle habits,such as wearing helmets, that will prevent head injury
- Safe-sex practices will help to keep AIDS and Syphillis at bay.
The coming years will see a growing population of 'seniors'. This means that the number of people affected by dementia, is likely to increase in the coming years, despite preventive measures being implemented. Focussed research, concerned policy makers and a compassionate society will ease the existence of the affected individuals and ensure that they lead safer lives.