By Faozat Aragbaiye
Dementia is a broad term that describes a loss of thinking ability, memory, attention, logical reasoning,impaired judgment, and problems with day-to-day activities, which are caused by injury or loss of brain cells (neurons).and other mental abilities. These changes are severe enough to interfere with social or occupational functioning.
Dementia isn’t a disease. Instead, it’s a group of symptoms caused by other conditions. It happens when the parts of brain used for learning, memory, decision making, and language are damaged or diseased.
About 5%-8% of adults over age 65 have some form of dementia. This percentage doubles every 5 years after 65. As many as half of people in their 80s have some dementia.
●Causes of Dementia
The most common causes of dementia include:
▪︎Degenerative neurological diseases. These include:
*Some types of multiple sclerosis.
These diseases get worse over time.
▪︎Vascular disorders. These conditions affect the blood circulation in the brain.
Traumatic brain injuries caused by car accidents, falls, concussions, etc.
▪︎Infections of the central nervous system.
These include meningitis, HIV, and Creutzfeldt-Jakob disease.
*Long-time alcohol or drug use
*Certain types of hydrocephalus, a buildup of fluid in the brain
*Some reversible causes of dementia include:
*Alcohol or substance use disorder
*Subdural hematomas, blood clots beneath the outer covering of the brain
*Normal-pressure hydrocephalus, a buildup of fluid in the brain
*Metabolic disorders such as a vitamin B12 deficiency
*Low levels of thyroid hormones, called hypothyroidism
*Low blood sugar, called hypoglycemia
*HIV-associated neurocognitive disorders (HAND)
Risk factors for dementia include:
*Heavy alcohol use
*Hardening of the arteries
*High blood pressure
●Signs and symptoms
Signs and symptoms of dementia are varied, but typically include:
*Problems with speaking or communicating (word-finding difficulties, repetition)
*Impairments in judgment
*Struggles completing tasks
* Difficulty comprehending what is seen
▪︎:Stages of Dementia
Usually, dementia goes through these stages. But it may vary depending on the area of the brain that’s affected.
1. No impairment. Someone at this stage will show no symptoms, but tests may reveal a problem.
2. Very mild decline. You may notice slight changes in behavior, but your loved one will still be independent.
3. Mild decline. You’ll notice more changes in their thinking and reasoning. They may have trouble making plans, and they may repeat themselves a lot. They may also have a hard time remembering recent events.
4. Moderate decline. They’ll have more problems with making plans and remembering recent events. They may have a hard time with traveling and handling money.
5)Moderately severe decline. They may not remember their phone number or their grandchildren’s names. They may be confused about the time of day or day of the week. At this point, they’ll need assistance with some basic day-to-day functions, such as picking out clothes to wear.
6. Severe decline. They’ll begin to forget the name of their spouse. They’ll need help going to the restroom and eating. You may also see changes in their personality and emotions.
7. Very severe decline. They can no longer speak their thoughts. They can’t walk and will spend most of their time in bed.
Assessment of the patient’s history, physical examination and cognitive testing . Further testing might happen depending on the history and physical.
*Blood and urine tests
*Brain scanning (MRI or CT scanning)
*Spinal fluid analysis
Certain criteria are considered in the diagnoses of dementia. These include:
*impairment of attention
*Language, motor, and spatial skills and function. (By definition, dementia is not due to major depression or schizophrenia.)
The treatment for dementia is primarily supportive.
*Prescription medications cannot reverse or stop the process. Environmental changes, a structured schedule, regular exercise, and staying engaged with others can all be beneficial.
*Home care for dementia can be beneficial for patients and families, as a way for patients to remain close to family members. However, caregivers should confirm that they have help to avoid burnout.
*Prescription drugs to treat dementia include donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne), and memantine (Namenda). A new combination of donepezil and memantine (Namzaric) was recently approved by the FDA.
*Although there is no way to absolutely prevent dementia, modifying the risk factors of high blood pressure, high cholesterol, alcohol intake, and keeping diabetes as well-controlled as possible, as well as exercising regularly can help.
*The prognosis for a person with dementia is individual. Some patients have a rapidly progressive course, while others progress very slowly. Factors which contribute to the progression of dementia haven’t been fully identified
There’s no sure way to prevent dementia, but there are steps to be taken that might help. More research is needed, but it might be beneficial to do the following:
*Keep the mind active. Mentally stimulating activities, such as reading, solving puzzles and playing word games, and memory training might delay the onset of dementia and decrease its effects.
*Be physically and socially active. Physical activity and social interaction might delay the onset of dementia and reduce its symptoms. Aim for 150 minutes of exercise a week.
*Quit smoking. Some studies have shown that smoking in middle age and beyond might increase risk of dementia and blood vessel conditions. Quitting smoking might reduce the risk.
*Get enough vitamins. Some research suggests that people with low levels of vitamin D in their blood are more likely to develop Alzheimer’s disease and other forms of dementia. Getting Vitamin D through certain foods, supplements and sun exposure is advisable
*More study is needed before an increase in vitamin D intake is recommended for preventing dementia, but it’s a good idea to make sure of having adequate vitamin D. Taking a daily B-complex vitamin and vitamin C also might help.
*Manage cardiovascular risk factors. Treat high blood pressure, high cholesterol and diabetes. Lose weight if you’re overweight.
*High blood pressure might lead to a higher risk of some types of dementia. More research is needed to determine whether treating high blood pressure may reduce the risk of dementia.
*Treat health conditions. See your doctor for treatment for depression or anxiety.
*Maintain a healthy diet. A diet such as the Mediterranean diet — rich in fruits, vegetables, whole grains and omega-3 fatty acids, which are commonly found in certain fish and nuts — might promote health and lower your risk of developing dementia. This type of diet also improves cardiovascular health, which may help lower dementia risk.
*Get good-quality sleep. Practice good sleep hygiene, and talk to your doctor if you snore loudly or have periods where you stop breathing or gasp during sleep.
*Treat hearing problems. People with hearing loss have a greater chance of developing cognitive decline. Early treatment of hearing loss, such as use of hearing aids, might help decrease the risk.