Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

All rights reserved with siahmsr digital healthcare[siahmsr wellness]

Reviewed by SIAHMSR medical team.

Dementia

   Dementia is a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities. Alzheimer’s disease is the most common type of dementia.

 Currently more than 55 million people suffer from dementia globally. Among them, over 60% of the people belong to low-and middle-income countries. There is an annual increase of nearly 10 million new cases. Dementia mostly affects old people; however, dementia is not simply forgetting something due to age related changes. It is more complicated than the occasional forgetfulness in old people. 

What happens to brain cells in dementia?

The risk of dementia increases with ageing, particularly after age 65. In dementia there is destruction or degeneration to nerve cells of brain, ultimately leading to deterioration in cognitive function (i.e. the ability to process thought) and it is more complex than the age-related changes in cognition. While consciousness is not affected in dementia.

The impairment in cognitive function is commonly followed, and occasionally preceded, by changes in mood, emotional control, behavior, or motivation. In short dementia is associated with impairment in memory, changes in emotional control, behavior etc.

Who are more predisposed to get dementia problems?

  Dementia runs in families in sometimes. But every case of dementia is not familial. There wouldn’t be a positive family history in all types of dementia. Genes have some role in the occurrence of dementia.

Older African Americans are twice more likely to have dementia than whites. Hispanics 1.5 times more likely to have dementia than whites. Smoking also enhances the risk for dementia.

Other reversible causes of dementia include side effect of medication, increased pressure in the brain, vitamin deficiency, and thyroid hormone imbalance etc.

  Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older people globally.

Women suffer more disability-adjusted life years and death from dementia.

What are the different types of dementia ?

1. Dementia associated with Alzheimer's disease

Alzheimer’s disease is the most common cause of dementia, accounting for 60 to 80 percent of cases. The risk increases by 10 to 30 percent with presence of Alzheimer’s disease in the family.

2.Vascular Dementia 

  About 10 percent of dementia cases are happening after strokes or other issues with blood flow to the brain. This is known as vascular dementia. Diabetes, high blood pressure and high cholesterol are risk factors for vascular dementia.

3.Lewy body dementia

This is another type of dementia associated with memory loss, balance problems, stiffness or trembling.

4.Fronto-temporal dementia

 It is a special type of dementia linked with changes in personality and behavior because of changes in specific brain areas. People with this dementia behave inappropriately, making offensive comments without reason and start neglecting responsibilities at home or work. Their language skills like speaking or understanding also affected.

5.Mixed dementia

In some people more than one type of dementia may coexist, particularly in people aged 80 and older. Dementia due to Alzheimer’s disease and stroke may occur in the same person. This is called mixed dementia.

Factors which enhance the risk for development of dementia include:

·       Old age (more common in those 65 or older)

·       high blood pressure (hypertension)

·       high blood sugar (diabetes)

·       Overweight  or obesity

·       Smoking

·       drinking too much alcohol

·       Physical  inactivity

·       Social isolation

·       Depression

                                                                                        SIAHMSR 

Symptoms of dementia

 In dementia there will be a decline in cognitive abilities that impacts a person's ability to perform everyday activities.

People with dementia may experience various types of problems in:

·       Memory

·       Attention

·       Communication

·       Reasoning, judgment, and problem solving

·       Visual perception beyond typical age-related changes in vision

Signs

o   Getting lost in a familiar neighborhood

o   Using unusual words to refer to familiar objects

o   Forgetting the name of a close family member or friend

o   Forgetting old memories.

        Losing or misplacing things

o   getting lost when walking or driving

o   being confused, even in familiar places

o   Losing track of time

o   Difficulties  in solving problems or making decisions

o   Losing the ability to do things independently.

 

      Changes in mood and behavior also follow or precede the main symptoms of dementia and these include:

 

o   anxious, sad, or angry  mood about memory loss

o   personality changes

o   inappropriate behavior

o   withdrawal from work

o   indifferent to social activities

o   not interested in other people’s emotions

How does dementia progress overtime? 

Usually most of the symptoms of dementia worsen over time, while a few symptoms diminish for a particular period or only occur in the later or advanced stages of dementia. As the disease progresses, the ability to do things independently decreases. Dementia has physical, psychological, social and economic impacts.The people affected with dementia fail to recognize family members or friends.There can be loss of control over their bladder and bowls.They may have trouble eating and drinking.Aggressive behavior may happen in dementia and it will be troublesome to care givers and the patient too.

How to diagnose dementia?

The diagnosis of dementia requires observation of a change from a person's usual mental functioning and a greater cognitive decline than what is caused by normal aging. Diagnosis is usually based on history of the illness and cognitive testing with imaging studies [ MRI, CT scans]. Blood tests may be done to rule out other probable but reversible causes.

 What treatments are available for managing dementia?

  The treatment is decided based on the type of dementia and the underlying causes.In vascular dementia stroke is the cause of dementia. It is addressed with post stroke medications, nutrition and exercise programs.Alzheimer’s disease is a neurodegenerative disorder with genes as its most probable cause. There is no effective cure till date.

    Recently oxidative stress by free radicals has been implicated with significance. Therefore the role of nutrition and antioxidant rich food is included in the treatment and prevention of Alzheimer’s disease and other neurodegenerative disorders.Being  physically active or taking part in activities and social interactions that stimulate the brain and maintain daily function is important in prevention as well as management of dementia.

Medications

Some medications in modern or conventional medicine can help manage dementia symptom

Cholinesterase inhibitors like donepezil are used to treat Alzheimer disease.

NMDA receptor antagonists like memantine are used for severe Alzheimer disease and vascular dementia.

Medicines to control blood pressure and cholesterol can prevent further damage to the brain due to vascular dementia resulting from stroke.

Selective serotonin reuptake inhibitors (SSRIs) can help with severe symptoms of depression in people living with dementia if lifestyle and social changes found ineffective. 

Dementia patients who are at risk of hurting themselves or others, medicines like haloperidol and risperidone can help.

 All the medications are to be recommended by a board certified healthcare provider after careful analysis of each person having dementia. Do not take over the counter medications.

Complementary & alternative system of medicine

Following therapies are available to mitigate the psychological, behavioral and speech related problems.

·   Occupational therapy

·   Speech therapy

·    Mental health counseling.

·    Music or art therapy

·    Homeopathy

Follow the link below.

 http://siahmsrwellness.in/dementia-loss-of-memory                                     SIAHMSR

How to prevent dementia?

A healthy lifestyle, including regular exercise, healthy eating, and maintaining social contacts may help to prevent occurrence of dementia.

Life style changes to incorporate:

·       Stay physically active

·       Stop smoking

·       Avoid alcohol

·       Reduce stress

·       Pursue a hobby

·       Improve mental health being socially active

·       maintaining healthy blood pressure, cholesterol and blood sugar levels

Healthy diet to prevent dementia should include:

·       Green leafy vegetables

·       Fruits

·       Nuts

·       Seeds

·       Fish

·       chicken

·       Legumes

All these categories of food are rich in antioxidants, micronutrients [ vitamins, minerals], protein and omega fatty acids which are crucial for the health of brain cells.

 Copyright of the article- dr sanjana vb siahmsr

References

1.    https://www.cdc.gov/aging/dementia/index.html
2.    https://www.who.int/news-room/fact-sheets/detail/dementia
3.    https://medlineplus.gov/dementia.html