Dementia is a general term that describes a sustained, acquired impairment in intellect or cognition that may affect a person’s behavior and significantly interfere with his/her ability to function normally on a day-to-day basis. It is usually caused by anatomical and chemical changes in the brain that result in loss of mental abilities such as the ability to think, remember, and reason. Its diagnosis is often suspected on a patient who has a history of cognitive decline and function, as related by their family and caregivers. This is further supported by abnormalities on neuropsychological tests and neuroimaging.
There are several types of dementia, and each specific condition may present with varying symptoms. The following are some of the more common types encountered by clinicians. Alzheimer disease is the most common type of dementia in the elderly. It mainly affects the memory, presenting gradually as difficulty remembering recent events. It is caused mainly by neurodegeneration due to the deposition of abnormal proteins in the brain. Vascular dementia is another common type of dementia, which is related to patients who suffered a stroke or other vascular conditions. Patients with this type of dementia often manifest with cognitive decline of sudden onset. Frontotemporal Dementia is the type of dementia that presents with dramatic behavioral changes such as obsessive-compulsive behaviors, disinhibition, hyperorality, apathy, inappropriate impulsivity, and lack of empathy accompanied by dysexecutive symptoms. Lewy Body Dementia (DLB) presents with fluctuating cognition, prominent hallucinations which are most often visual in nature, and motor symptoms. Parkinson Disease Dementia is another type of dementia that is related to another neurodegenerative condition known as Parkinson’s disease. Patients with this condition present with prominent motor symptoms, such as tremors, rigidity, and postural instability followed by gradual onset of cognitive decline.
Symptoms may vary depending on the type and cause of dementia but these are the following most common signs:
Cognitive: Memory loss usually affects a person’s job or home situation. The person can be disoriented to time, place and person. He/she has difficulty in communication, and difficulty with multi-tasking and planning. He/she frequently misplaces things, gets confused easily, and often gets lost even in familiar places. He/she has poor judgment, poor abstract thinking, poor problem solving skills, and is unable to perform complex tasks. He/she likewise experiences motor and coordination problems.
Behavioral: There is loss of interest in the things they used to enjoy. They often exhibit depression, anxiety, paranoia, and disinhibition. They also frequently manifest with wandering, restlessness, difficulty sleeping, mood changes, personality changes, loss of initiative, agitation, and hallucinations.
As we age, our bodies and brains slow down. We become less physically and mentally flexible, thus lapses in memory tend to occur. We often take more time to process information as we get older, so it’s quite common to have greater difficulty remembering names of people, places and other things.
This is what is known as age-related memory decline, which may manifest as follows:
To differentiate it from dementia, age-related memory decline is not disabling nor does it interfere with our daily activities. We are still able to function independently and pursue the things we normally do. Our judgment and decision-making ability remain intact.
However, when memory loss becomes so pervasive and severe that it disrupts your work, hobbies, social interactions, and family relationships, you may be showing some warning signs of dementia. This may be the time for you to consult your doctor or a health professional about this problem.
Whether dementia can be inherited or passed down from an affected relative would depend on the type or cause of the dementia. As previously mentioned, there are different types of dementias -- Alzheimer’s disease, vascular dementia, frontotemporal dementia, dementia with Lewy bodies, etc. Majority of these dementias are not inherited. In Alzheimer’s disease, only one percent of cases are considered hereditary. This very rare form of AD is known as Familial Alzheimer’s Disease where defects in the genes have been identified. In vascular dementia, unhealthy lifestyle choices would play a more important role in developing the disease rather than genetics. Other rare forms of dementia that can be inherited include Huntington’s disease and some forms of frontotemporal dementia.
Researchers have identified several important factors that affect our risk of developing dementia. These include age, genetics, medical conditions (e.g., hypertension, diabetes and high cholesterol levels) and lifestyle choices. A person’s risk of developing dementia depends upon a combination of all of these risk factors.
Age is the strongest known risk factor for dementia. While it is possible to develop the condition earlier (only 1 out of 20 people with dementia developed it under the age of 65), the chances of developing dementia rise significantly as we get older. Above the age of 65, a person’s risk of developing Alzheimer’s disease or vascular dementia doubles roughly every 5 years. This may be due to factors associated with ageing, such as higher blood pressure, increased risk of cardiovascular diseases, weakening of the body’s natural repair systems and changes in the immune system.
In Alzheimer’s disease, women are at a higher risk of developing this disease than men. The exact reason for this is still unclear, but it may have something to do with the fact that women lose estrogen after menopause. For most dementias other than Alzheimer’s disease, men and women have much the same risk. For vascular dementia, men are actually at slightly higher risk than women. This is because men are more prone to stroke and heart disease, which can cause vascular and mixed dementia.
The role of genes in the development of dementia is not yet fully understood, but researchers have made important advances in recent years. More than 20 genes have been found that do not directly cause dementia but affect a person’s risk of developing it. For example, inheriting certain versions of the gene apolipoprotein E (APOE) increases a person’s risk of developing Alzheimer’s disease.
There is very strong evidence that conditions that damage the heart, arteries or blood circulation all significantly affect a person’s chances of developing dementia. These are known as cardiovascular risk factors. The main ones for dementia are type 2 diabetes, uncontrolled hypertension, and high total blood cholesterol levels.
Other medical conditions that can increase a person’s chances of developing dementia include Parkinson’s disease, depression, multiple sclerosis and HIV.
There is overwhelming evidence that our lifestyle choices affect our risk of developing dementia. These include:
Knowing the risk factors for developing dementia, you can actually do a lot of things do to reduce your chances of developing dementia.
To date, there is still no specific cure for dementia. There are no medications or interventions that have been proven to be effective in reversing this condition and in bringing the afflicted person back to the normal state. However, there are approved and available drugs that can slow down the progression of dementia and can considerably benefit the patients’ cognition, behavior, function and quality of life.
Treatment options include pharmacologic and non-pharmacologic interventions. Acetylcholinesterase inhibitors and NMDA receptor antagonist are the two main medications that are indicated for the different stages of the disease.
Non-pharmacologic interventions include psychological and behavioral therapies, physical and cognitive exercises, and education and training of carers. Environmental modifications involve creating a safer environment for persons with dementia. These include fall-related techniques and maximizing awareness on risk behaviors.
Other non-pharmacologic interventions include physical, occupational, and speech therapy. Physical therapy for dementia aims to decrease the occurrence of falls in people with dementia as well as treat secondary problems such as balance and coordination problems, agility, mobility and gait.