Dementia

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Mental decline is one of the most concerning consequences of aging. That’s why it’s so important to understand what constitutes a normal part of getting older, or what could in fact be the onset of a more serious condition.

If you have been experiencing frequent problems with your memory or often find yourself confused in new places, you may be going through the early signs of dementia.

In 2010, there were an estimated 35.6 million people with dementia worldwide. This number will nearly double every 20 years, reaching an estimated 65.7 million by 2030.

While most forms of dementia have no cure, there is a lot you can understand about it to better equip you to meet the challenges posed by this disease and improve the quality of your life and that of your loved ones.

This section provides you with information about dementia, what symptoms you can expect, and tips on how to lower your risk of developing this condition. You can also find details about what tests are used to diagnose dementia, as well as a list of available treatments and management strategies.

What is dementia?

Dementia is not actually a specific disease. It’s a term that describes a range of symptoms, such as memory loss and a decline in social abilities, serious enough to interfere with a person’s day-to-day life. Dementia is almost invariably a condition of aging.

Dementia indicates problems with at least two brain functions, one of which is often memory loss. It can make you confused and unable to remember people, names and the appointments you have. It can also affect other everyday tasks like paying bills, preparing meals and keeping track of your wallet. Changes in personality and social behavior may also be experienced.

There are many causes of dementia symptoms, with Alzheimer’s disease accounting for the most common form of progressive dementia. While some forms of dementia are degenerative (get worse over time), other causes of dementia are treatable and sometimes even reversible.

How does dementia occur?

Dementia is caused by damage of nerve cells in the brain. This damage interferes with the ability of brain cells to communicate with each other, in turn, affecting a person’s thoughts, behaviour and feelings.

Dementia may affect people in a variety of ways, depending on the distinct region of the brain where the damage has occurred. As each part of the brain is responsible for different functions, the damage can impair functions like memory, judgment and movement.

What are the causes of dementia?

While the exact causes of dementia are not known, there are factors that can increase your risk of developing the condition. These include:

  • Age: Increasing age is the greatest known risk factor for dementia.
  • Family history and genetics: Your risk of developing dementia is higher if a first-degree relative (your parent, sibling or child) has the condition.
  • Past head trauma: People who have experienced severe head trauma appear to have a greater risk of dementia.
  • Lifestyle and health factors: Some evidence suggests that factors such as inadequate exercise, smoking, alcohol abuse and lack of social engagement can increase the chance of developing dementia.
  • Mild cognitive impairment: People with mild cognitive impairment (MCI) have symptoms of cognitive decline that are worse than might be expected for their age, but not severe enough to be diagnosed as dementia. Those with MCI have an increased risk of later developing dementia.
  • Depression: Late-life depression, especially in men, may be an indication for the development of Alzheimer's-related dementia.
  • Diabetes: If you have diabetes, you may have an increased risk of developing Alzheimer's disease and vascular dementia.
  • High estrogen levels: Women taking estrogen and progesterone years after menopause are at greater risk of developing dementia.
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Depending on the cause, there are a range of symptoms that can indicate the onset of dementia. If you or someone you love is experiencing one or more of the following symptoms, talk to a doctor. Some treatable medical conditions can cause dementia symptoms, so it is essential to have a professional evaluation to determine the cause. Early diagnosis gives you the maximum benefit from available treatments, as well as time to plan for the future.

  • Memory loss
  • Impaired speech and/or loss of communication skills
  • Difficulty carrying out complex tasks
  • Difficulty with coordination, balance and motor functions
  • Problems with disorientation, such as getting lost
  • Neglect of personal care and safety
  • Changes in personality or social behaviour, for e.g. becoming either withdrawn, or conversely losing the ability to restrain one’s behaviour
  • Faulty reasoning or impaired judgment
  • Paranoia and hallucinations
  • Irritability and agitation

Some people with dementia, particularly those with more advanced forms of dementia, can also develop other problems such as depression, disturbed sleep, aggression, inappropriate sexual behaviour and urinary incontinence.

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As there are several possible causes for memory loss and other symptoms of dementia, diagnosing this condition can be challenging and may require quite a few appointments.To diagnose dementia and rule out other conditions, the doctor will conduct a complete medical assessment. This will include a combination of the below tests:

  • Medical history assessment: During a review of your medical history, your doctor will want to know about any current or past illnesses, as well as any medications you are taking. They will also ask about related medical conditions affecting other family members, including whether any family members have suffered from any forms of dementia such as Alzheimer's disease.
  • Cognitive and neuropsychological tests: In these tests, doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention. Doctors use these tests to determine whether you have dementia, how severe it is and what part of your brain is affected.
  • Neurological evaluation: In a neurological evaluation, doctors will assess your movement, senses, speech, balance and reflexes. This evaluation can sometimes help to diagnose other conditions.
  • Brain scans: Doctors may order brain scans, such as a CT or MRI scan, to check for evidence of a stroke, damage from severe head trauma or a buildup of fluid in the brain. Such scans are also used to rule out the possibility of a tumor.
  • Laboratory tests: Simple blood and/or urine tests can detect whether physical problems, such as vitamin B-12 deficiency or an underactive thyroid gland, are affecting your brain function and causing similar symptoms to dementia.
  • Psychiatric evaluation: You may be referred to meet with a psychologist or psychiatrist who will evaluate whether depression or another psychological condition may be causing your symptoms.

Life after diagnosis

Receiving a diagnosis of dementia can be distressing for you and your loved ones. A number of factors should be considered so that you and those around you are as prepared as possible to deal with an unpredictable condition like dementia. Speak to your health care provider about treatment options, as well as arranging the most suitable care and support.

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Unfortunately, most types of dementia can’t be cured. However, doctors can offer a range of ways to help you manage your condition better by lessening the symptoms.

Medications

Cholinesterase inhibitors: These medications – including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) – work by boosting levels of a chemical messenger involved in memory and judgment. These medications are generally well tolerated and delay worsening of symptoms by an average of 6 to 12 months, for approximately half of the people who take them. Potential side effects include nausea, vomiting, diarrhea and/or loss of appetite

Memantine: Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions, such as learning and memory. Memantine delays the worsening of symptoms for some people temporarily. There is some evidence that suggests individuals with moderate to severe Alzheimer’s who are taking a cholinesterase inhibitor might benefit by also taking Memantine. Potential side effects include dizziness, headache, constipation and/or confusion.

Other medications: Your doctor may prescribe other medications to treat related symptoms, such as sleep disorder and depression.

Lifestyle adjustments

Modifying the environment at home: Getting rid of unnecessary furniture and clutter can reduce confusion, and make it easier for someone with dementia to function. Consider installing handrails through the house for extra support, as well as reducing the number of mirrors to avoid confusion.

Adjusting a caregiver’s responses: Despite best intentions, sometimes a caregiver’s response to a behaviour can actually make the behaviour worse. It's best to avoid correcting and quizzing a person with dementia. Reassuring the person and validating his or her concerns can defuse most situations.

Simplify tasks: Break tasks into easier steps and focus on completing them successfully. Creating structure and routine throughout the day can also help reduce confusion in people with dementia.

Other therapies

Occupational therapy: Your doctor may suggest occupational therapy to help you adjust to living with dementia. Therapists may teach you coping behaviors and ways to adapt movements and daily living activities as your condition changes.

Alternative Medicine: Herbal mixtures, vitamins and supplements can support cognitive help and be used to delay or prevent dementia. While some alternative treatments such as Vitamin E, Omega-3 fatty acids, Co-enzyme Q10 and Gingko bilboa are recommended for this use, there are concerns about the use of alternative medicine, especially when taken together with other drugs. It is best to speak with your doctor to create a treatment plan that’s right for you. 

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While there's no definitive way to prevent dementia, there are steps you can take that might help:

  • Keep your mind active: Mentally stimulating activities, such as puzzles, word games and memory training may delay the onset of dementia and help decrease its effects.
  • Exercise regularly: Regular physical activity not only improves a person’s overall wellbeing, but may also delay the onset of dementia and reduce its symptoms. Research suggests that exercise can directly benefit brain cells by increasing blood and oxygen flow. Staying physically active may also protect brain health through its proven benefits to the cardiovascular system.
  • Avoid smoking and limit drinking: Some studies have shown smoking in middle age and older may increase your risk of dementia. People who consume large amounts of alcohol also have a higher risk of developing dementia.
  • Connect socially and intellectually: A number of studies indicate that maintaining strong social connections and keeping mentally active as we age might lower the risk of mental decline. Researchers believe that intellectual activity may help your brain develop a strong nerve cell network that compensates for nerve cell damage caused by Alzheimer's disease.
  • Maintain a heart healthy diet: Having a healthy diet is important for many reasons, but a diet rich in whole grains, fruits, vegetables and healthy fats, may promote overall health and lower your risk of developing dementia.
  • Get regular and restful sleep: Your brain needs regular, restful sleep in order to function at optimum capacity. This is critical for memory formation and retention. Sleep deprivation not only slows your thinking and affects your mood, it can also put you at greater risk of developing symptoms of Alzheimer’s disease. Aim for the recommended 8 hours of sleep per night.
  • Avoid head trauma: There appears to be a strong link between future risk of dementia such as Alzheimer's and serious head trauma, especially when injury involves loss of consciousness. Protect your head by always wearing a seat belt and using protective head gear when playing sports.
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