Dementia is a medical term which denotes impaired ability to remember, think, or make decisions that interferes with doing everyday activities. Around more than 55 million people suffer from dementia globally. Currently Alzheimer’s disease is the most common type of dementia.
In this neurocognitive °enerative disorder there is destruction or degeneration of nerve cells of brain. The end result of this degeneration is deterioration in cognitive function (i.e. the ability to process thought) . This state can not be compared with age related degenerative changes in brain and gradual loss of memory and other brain functions. It is more complex than the age-related changes in cognition.
The consciousness is not affected in this disorder of brain. Some kind of changes in mood, emotional control, behavior, or motivation occur in most of the dementia affected people before or after the impairment in cognition or functions of brain.
It is believed that dementia runs in families sometimes. But we cannot conclude that every case of dementia may have a history of occurrence of the disease in the family. Briefly, there wouldn’t be a positive family history in all types of dementia.
This neurocognitive disorder seems to be linked with some ethnic groups.
Older African Americans are twice more likely to have dementia than whites. Hispanics 1.5 times more likely to have dementia than whites.
It has been found that dementia rate is accelerated by some habits in people such as smoking. Smoking can enhance the risk for dementia.
What are the different types of dementia?
- 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 if te disease is present among family members.
- Vascular dementia
About 10 percent of dementia cases are happening after strokes or other impediments 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.
- Lewy body dementia
Lewy body dementia is another type of dementia associated with memory loss, balance problems, stiffness or trembling.
- Fronto-temporal dementia
Fronto-temporal dementia is a special type of dementia linked with changes in personality and behavior because of changes in specific brain areas. In people with this dementia behavior is affected worst. They may make offensive comments without any reason. Also neglecting responsibilities at home or work is common in these patients. Their language skills like speaking or understanding also affected.
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.
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.
Risk factors for dementia:
· 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
Dementia affects the potentials of a person & quality of life .
It affects:
· Memory
· Attention
· Communication
· Reasoning, judgment, and problem solving
· Visual perception beyond typical age-related changes in vision
Signs that may indicate dementia include:
· Getting lost in a familiar neighborhood
· Using unusual words to refer to familiar objects
· Forgetting the name of a close family member or friend
· Forgetting old memories
· losing or misplacing things
· getting lost when walking or driving
· being confused, even in familiar places
· losing track of time
· difficulties solving problems or making decisions
· Losing the ability to do things independently.
Changes in mood and behavior also follow or precede the main symptoms of dementia and these include:
· anxious, sad, or angry mood about memory loss
· personality changes
· inappropriate behavior
· withdrawal from work
· indifferent to social activities
· not interested in other people’s emotions
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 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.
Diagnosis
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.
Treatment
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 symptoms.
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 consequent to 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. In aggressive 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
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
4. https://siahmsrwellness.in/dementia-homeopathic-management
5. Homeopathic medical repertory Mind dementia [p- 1574]