Dr. Francis SANWO

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Dementia refers to a group of progressive or chronic diseases characterized by a gradual decline in mental abilities that are severe enough to interfere with daily life.  Due to the social, physical, psychological and financial consequences associated with dementia, it can be overwhelming for the patients and the caregivers alike. Moreover, the lack of awareness regarding this disease often results in delayed medical intervention, and this is particularly the case in developing countries.

Dementia is widespread and expected to rise.

In 2015, about 47 million people had dementia worldwide. This number is expected to rise to approximately 75 million by 2030 and 132 million by 2050; which is an increase of 281%

Approximately 9.9 million people are diagnosed with dementia each year.

Since the turn of the century, deaths by Alzheimer’s have risen by 89%.

The number of deaths caused by Alzheimer’s disease is higher compared to deaths caused by breast cancer and prostate cancer combined. Moreover, 1 in 3 elderly people die because of some form of dementia.

A large proportion of individuals with dementia are over the age of 65 but it can also affect individuals below this age bracket. Dementia is not a normal part of aging and its probability increases with age.

Dementia is a worldwide issue most prevalent in the developing countries. 60% cases of dementia are found in low to middle income countries, primarily due to lack of awareness and resources. In the next 20 years, we may see the largest increase in dementia cases in China, India and sub-Saharan Africa.

Dementia is not a disease itself; it is an umbrella term for a broad number of diseases all categorized by similar symptoms that include memory loss, disorientation, hallucinations and communication difficulties.

People with dementia require round the clock care and attention. In addition to financial issues, it can be overwhelming for a caregiver to see a loved one waning before their eyes. Consequently, 35% of dementia caregivers are reported to develop health issues compared to 19% of caregivers who look after seniors without dementia.

People with dementia often have comorbidities, i.e. secondary or additional diseases, such as fractures due to a fall, diabetes, urinary tract infections, chest infections and/ or depression. Only 12% dementia patients have no comorbidities, 40% have up to two other health issues while the remaining 48% have three or more health conditions.

While there is no cure for dementia, early diagnosis can improve the quality of life for the patients. They can also live independently in their own homes until the symptoms start causing significant difficulties in performing daily activities.

Though dementia generally involves memory loss, memory loss has different causes. Having memory loss alone doesn't mean you have dementia.

Symptoms

Dementia symptoms vary depending on the cause, but common signs and symptoms include:

Cognitive changes

Memory loss, which is usually noticed by a spouse or someone else, difficulty communicating or finding words, difficulty with visual and spatial abilities, such as getting lost while driving, difficulty reasoning or problem-solving, difficulty handling complex tasks, difficulty with planning and organizing, difficulty with coordination and motor functions, confusion and disorientation.

Psychological changes

Personality changes, depression, anxiety, inappropriate behavior, paranoia, agitation and hallucinations.                                                                                                    Behavioral changes

In addition to the obvious symptoms of dementia i.e. memory loss and disorientation, patients can also undergo drastic behavioral alterations resulting in aggression and severe mood swings.

Causes

Dementia is caused by damage to or loss of nerve cells and their connections in the brain. Depending on the area of the brain that's affected by the damage, dementia can affect people differently and cause different symptoms.

Progressive dementias

Types of dementias that progress and aren't reversible include:

Alzheimer's disease.  Alzheimer's disease is the most common cause of a progressive dementia in older adults. 

Although not all causes of Alzheimer's disease are known, experts do know that a small percentage are related to mutations of three genes, which can be passed down from parent to child.

Vascular dementia. This second most common type of dementia is caused by damage to the vessels that supply blood to your brain. Blood vessel problems can cause strokes or damage the brain in other ways, such as by damaging the fibers in the white matter of the brain. The most common symptoms of vascular dementia include difficulties with problem-solving, slowed thinking, focus and organization. These tend to be more noticeable than memory loss.

Frontotemporal dementia. This is a group of diseases characterized by the breakdown (degeneration) of nerve cells and their connections in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language. Common symptoms affect behavior, personality, thinking, judgment, and language and movement.

Other disorders linked to dementia

Traumatic brain injury (TBI). This condition is most often caused by repetitive head trauma. People such as boxers, football players or soldiers might experience TBI.

Depending on the part of the brain that's injured, this condition can cause dementia signs and symptoms such as depression, explosiveness, memory loss and impaired speech.

Parkinson's disease. Many people with Parkinson's disease eventually develop dementia symptoms (Parkinson's disease dementia).

Dementia-like conditions that can be reversed

Some causes of dementia or dementia-like symptoms can be reversed with treatment. They include:

Infections and immune disorders. Dementia-like symptoms can result from fever or other side effects of your body's attempt to fight off an infection. Multiple sclerosis and other conditions caused by the body's immune system attacking nerve cells also can cause dementia.

Metabolic problems and endocrine abnormalities. People with thyroid problems, low blood sugar (hypoglycemia), too little or too much sodium or calcium, or problems absorbing vitamin B-12 can develop dementia-like symptoms or other personality changes.

Nutritional deficiencies. Not drinking enough liquids (dehydration); not getting enough thiamin (vitamin B-1), which is common in people with chronic alcoholism; and not getting enough vitamins B-6 and B-12 in your diet can cause dementia-like symptoms. Copper and vitamin E deficiencies also can cause dementia symptoms.

Medication side effects. Side effects of medications, a reaction to a medication or an interaction of several medications can cause dementia-like symptoms.

Subdural hematomas. Bleeding between the surface of the brain and the covering over the brain, which is common in the elderly after a fall, can cause symptoms similar to those of dementia.

Poisoning. Exposure to heavy metals, such as lead, and other poisons, such as pesticides, as well as recreational drug or heavy alcohol use can lead to symptoms of dementia. Symptoms might resolve with treatment.

Brain tumors. Rarely, dementia can result from damage caused by a brain tumor.

Anoxia. This condition, also called hypoxia, occurs when organ tissues aren't getting enough oxygen. Anoxia can occur due to severe sleep apneas, asthma, heart attack, carbon monoxide poisoning or other causes.

Risk factors

Risk factors that can't be changed

Age. The risk rises as you age, especially after age 65. However, dementia isn't a normal part of aging, and dementia can occur in younger people.

Family history. Having a family history of dementia puts you at greater risk of developing the condition.

Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer's disease.

Risk factors you can change

You might be able to control the following risk factors for dementia.

Diet and exercise. Research shows that lack of exercise increases the risk of dementia. And while no specific diet is known to reduce dementia risk, research indicates a greater incidence of dementia in people who eat an unhealthy diet.

Heavy alcohol use. If you drink large amounts of alcohol, you might have a higher risk of dementia.

Cardiovascular risk factors. These include high blood pressure (hypertension), high cholesterol, buildup of fats in your artery walls (atherosclerosis) and obesity.

Depression. Although not yet well-understood, late-life depression might indicate the development of dementia.

Diabetes. Having diabetes may increase your risk of dementia, especially if it's poorly controlled.

Smoking. Smoking might increase your risk of developing dementia and blood vessel (vascular) diseases.

Sleep apnea. People who snore and have episodes where they frequently stop breathing while asleep may have reversible memory loss.

Vitamin and nutritional deficiencies. Low levels of vitamin D, vitamin B-6, vitamin B-12 and folate may increase your risk of dementia.

Complications

Dementia can affect many body systems and, therefore, the ability to function. Dementia can lead to:

Poor nutrition. Many people with dementia eventually reduce or stop eating, affecting their nutrient intake. Ultimately, they may be unable to chew and swallow.

Pneumonia. Difficulty swallowing increases the risk of choking or aspirating food into the lungs, which can block breathing and cause pneumonia.

Inability to perform self-care tasks. As dementia progresses, it can interfere with bathing, dressing, brushing hair or teeth, using the toilet independently, and taking medications accurately.

Personal safety challenges. Some day-to-day situations can present safety issues for people with dementia, including driving, cooking and walking alone.

Death. Late-stage dementia results in coma and death, often from infection.

Prevention

There's no sure way to prevent dementia, but there are steps you can take that might help. More research is needed, but it might be beneficial to do the following:

Keep your 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. Move more and aim for 150 minutes of exercise a week.

Quit smoking. Some studies have shown that smoking in middle age and beyond may increase your risk of dementia and blood vessel (vascular) conditions. Quitting smoking might reduce your risk and will improve your health.

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. You can get vitamin D through certain foods, supplements and sun exposure.

 Taking a daily B-complex vitamin and vitamin C may also be helpful.

Manage cardiovascular risk factors. Treat high blood pressure, high cholesterol, diabetes, and high body mass index (BMI). 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.

Maintain a healthy diet. Eating a healthy diet is important for many reasons, but 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 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.

Top of Form

Diagnosis

Diagnosing dementia and its type can be challenging. People have dementia when they have cognitive impairment and lose their ability to perform daily functions, such as taking their medication, paying bills and driving safely.

No single test can diagnose dementia, so doctors are likely to run a number of tests that can help pinpoint the problem.

Neurological evaluation

Doctors evaluate your memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes and other areas.

Brain scans

CT or MRI. These scans can check for evidence of stroke or bleeding or tumor or hydrocephalus.

Laboratory tests

Simple blood tests can detect physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. Sometimes the spinal fluid is examined for infection, inflammation or markers of some degenerative diseases.

Psychiatric evaluation

A mental health professional can determine whether depression or another mental health condition is contributing to your symptoms.

Treatment

Most types of dementia can't be cured, but there are ways to manage your symptoms.

Medications

There are  medications used to temporarily improve dementia symptoms and some to treat other symptoms or conditions, such as depression, sleep disturbances, hallucinations, parkinsonism or agitation.

Several dementia symptoms and behavior problems might be treated initially using nondrug approaches, such as: Occupational therapy in which an occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior; and prepare you for the dementia progression. Modifying the environment such as reducing clutter and noise can make it easier for someone with dementia to focus and function. You might need to hide objects that can threaten safety, such as knives and car keys.

Lifestyle and home remedies for dementia.

Dementia symptoms and behavior problems will progress over time. Caregivers might try the following suggestions:

Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present one idea or instruction at a time. Use gestures and cues, such as pointing to objects.

Encourage exercise. The main benefits of exercise in people with dementia include improved strength, balance and cardiovascular health. Exercise may also be helpful in managing symptoms such as restlessness. There is growing evidence that exercise also protects the brain from dementia, especially when combined with a healthy diet and treatment for risk factors for cardiovascular disease.

Some research also shows that physical activity might slow the progression of impaired thinking in people with Alzheimer's disease, and it can lessen symptoms of depression.

Engage in activity. Plan activities the person with dementia enjoys and can do. Dancing, painting, gardening, cooking, singing and other activities can be fun, but can help you connect with your loved one, and can help your loved one focus on what he or she can still do.

Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on in the bedroom, hall and bathroom to prevent disorientation.

Limiting caffeine, discouraging napping and offering opportunities for exercise during the day might ease nighttime restlessness.

Keep a calendar. A calendar might help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one.

Plan for the future. Develop a plan with your loved one while he or she is able to participate that identifies goals for future care. Support groups, legal advisers, family members and others might be able to help.

You'll need to consider financial and legal issues, safety and daily living concerns, and long-term care options.

You can help a person cope with the disease by listening, reassuring the person that he or she still can enjoy life, being supportive and positive, and doing your best to help the person retain dignity and self-respect. You can help a person cope with the disease by listening, reassuring the person that he or she still can enjoy life, being supportive and positive, and doing your best to help the person retain dignity and self-respect.

Other therapies

The following techniques may help reduce agitation and promote relaxation in people with dementia: Music therapy, which involves listening to soothing music, watching videos of family members and massage therapy.