Dementia – Types, Stages, Symptoms, Diagnosis, Treatments

What Is Dementia?

“DEMENTIA IS A CONDITION WITH DECLINING MENTAL FUNCTIONS”

Dementia is a name given to the overall condition characterized by loss of memory, problem-solving, speaking, language skills, attention, judgment, understanding information, and other abilities. This disease is known to affect people’s ability to perform everyday tasks. There are different types of Dementia which comes under the umbrella term.

The leading cause of Dementia is the damage of the brain by diseases such as Alzheimer’s Disease or stroke. Alzheimer’s is considered as one of the major causes of Dementia. The symptoms depend on the part of the brain-damaged. The damage restricts the ability of brain cells to communicate. It is the collection of symptoms depending on the disease that causes injury to a brain.

Dementias happen when the brain loses connection with the nerve cells in the body. The nerve cells are unable to perform motor functions, and they tend to die. Dementia is a progressive disorder that is not a single disease; it covers a vast range of medical conditions. It starts from the brain and then gradually spreads with the symptoms that worsen over time. It is a pathological process, as various illnesses cause it and thus reducing the quality of life. Aging is considered another leading cause of Dementia.

SOME COMMON TYPES OF DEMENTIA

Dementia is a progressive neurodegenerative disease. The most common types of Dementia are:

Alzheimer’s Disease

The most prevalent type of Dementia is Alzheimer’s disease. The first thing about Alzheimer’s disease is the loss of cognitive and functional abilities in the patient. It arises due to the abnormal proteins that surround the brain cells. These proteins are amyloid plaques and tau.

Amyloid plaques form the cluster in the brain called beta-amyloid, whereas the tau forms the tangles or twisted network in the brain. They damage the internal structure of the brain, infers the connection between the brain and the nerve cells is lost, resulting in cell death. The problems associated with this disease include memory loss, problem-solving, decision making, and perceiving the information in different directions.

Frontotemporal Dementia

Frontotemporal Dementia is also called Pick’s disease. The temporal and frontal lobes get damaged in this disease. It is the second most common old-age disease. In frontal lobe Dementia, the clumps of the abnormal proteins are formed in the brain, causing the nerve cells to die. The areas of the brain damage and a person may feel difficulties in language recognition and behavioral changes as per the damaged area.

The frontal part of the lobe is responsible for controlling the social behavior and judgment, and the patients who have frontotemporal Dementia may become rude, impulsive behavior, negligence, and are compulsive.

Post Stroke Dementia

Post-stroke Dementia is also called Vascular disease. It is a cognitive impairment, which is caused by the damaged blood vessels in the brain. During post-stroke dementia, the oxygen supply of the brain reduces due to the damage or narrowing of the blood vessels, and this leads to neuron death. The problems associated with this kind of Dementia are difficulties in planning, organizing, decision making, problem-solving, quick thinking, and concentration.

Lewy Body Dementia

Lewy Body Dementia is by the presence of Lewy cells in the brain. The Lewy bodies are the abnormal clumps of the protein that are present inside the brain cells. The formation of the abnormal structure leads to the disruption in the chemistry of the brain and results in damaging the brain cells or cell death. The condition is quite similar to Parkinson’s disease due to similar symptoms. The symptoms associated with Lewy body dementia include difficulty in movement, hallucination, or in judging distances.

Mixed Dementia

Mixed Dementia is the condition when a person is suffering from more than one type of Dementia, or a person may have a combination of symptoms associated with different kinds of Dementia. It usually considered as the abnormalities of Alzheimer’s disease, Vascular Dementia, and Dementia with Lewy bodies altogether.

Rare types of Dementia

Some people develop different types of Dementia with worse symptoms. These disorders links with Dementia:

Hippocampus Sclerosis:

Hippocampus Sclerosis is caused by neuronal loss and gliosis in the hippocampus, thus mimics different Dementia or tauopathies like Alzheimer’s disease.

Human Prion Disease

It is a neurodegenerative disease which is caused by the misfolding of the prion proteins, triggering the healthy proteins to fold abnormally. The condition can affect both animals and humans. The abnormally folded proteins cause changes in behavior, memory, and movement, thus resembling Dementia.

Progressive Supranuclear Palsy

Progressive Supranuclear Palsy is a degenerative disorder that causes the deterioration of the specific volumes of the brain. It causes problems while walking, balancing, stiffness of muscles in the neck and upper body. This disease can also be life-threatening.

Cortico-Basal Degeneration

It is also a neurodegenerative disorder; the condition arises with the cell’s loss and deterioration in the specific areas of the brain. The patient who is suffering from this disorder experience motor abnormalities in the one limb, which gradually spreads to other limbs. The characteristics are similar to Parkinson’s disease and frontotemporal Dementia and affect the cerebral cortex and basal ganglia of the brain.

Whipple’s Disease

Gram-positive bacteria are the primary reason behind Whipple’s disease. The bacteria cause problems in the small intestine, but it can also affect the other parts. The disease can cause problems in joints, nervous system, cardiovascular system, and the immune system. It can be fatal within a short period if not treated.

Parkinson’s Disease

Parkinson’s disease is caused due to imbalanced levels of Dopamine produced in the brain cells, thus affecting the movement. The symptoms associated with Parkinson’s disease include tremors, slow motion, stiffness, rigidity, and instability of posture. Parkinson’s disease shows similar characteristics as Lewy body dementia. Therefore, it is challenging to diagnose.

Huntington’s Disease

Huntington’s disease is hereditary and caused by a gradual break down of the nerve cell. Dementia, uncontrollable movement, and emotional disturbances are the characteristic features of Huntington’s disease.

Multiple Sclerosis

Multiple Sclerosis is an autoimmune inflammatory disease. It occurs when the immune system assaults the myelin sheet covering the nerves. The damage of the myelin sheets interrupts the process of communication between the brain and other parts of the body leading to neuron deterioration.

Posterior Cortical Atrophy

It is a neurodegenerative syndrome occurring when the outer part of the cortex at the posterior part of the brain worsens. It misguides as Alzheimer’s disease and Lewy body dementia in the majority of the patients. The affected area of the brain shows plaques and neurofibrillary tangles.

HIV-Related Cognitive Impairment

It is a rare type of disease that causes problems in thinking if the patient has HIV. The virus tends to affect the brain astrocytes by the activation of the macrophages. HIV-Related Cognitive impairment is an immunologic, neurodegenerative as well as inflammatory disease.

Stages Of Dementia

Stage 1:

Stage 1 is also called a No-Cognitive decline. The persons with no dementia are at Stage 1. During the first stage of Dementia, a person does not suffer from memory loss and can perform normal functions like a healthy individual.

Stage 2:

Stage 2 is a very mild cognitive decline. The person may experience forgetfulness and may forget names or familiar objects.

Stage 2 is associated with aging.

Stage 3:

Stage 3 is also a mild cognitive decline. The person with 3rd stage dementia may experience difficulties like increased forgetfulness, reduced concentration, decreased work capacity, these symptoms may remain up to seven years. A person faces symptoms like cognitive decline, lost, and faces difficulties in finding the right words.

Stage 4:

Stage 4 is a moderate cognitive decline. A person with this stage may experience difficulties like loss of concertation, the stress in memorizing the events, managing money, and traveling alone. The duration of this stage is usually two years. The patient with this stage may become anti-social, fear audiences, and is unable to perform tasks efficiently.

Stage 5:

Stage 5 is called a moderately severe cognitive decline. The duration for this stage lies for about 1.5 years, and the person with this stage may experience significant memory loss, they become unable to perform their daily activities thoroughly, they become dependent on others. Memory loss is the most prominent symptom of this stage. They may have difficulties in remembering dates, months, and the location where they are.

Stage 6:

Stage 6 is mid-stage Dementia and also called a severe cognitive decline. The average duration for this stage is about 2.5 years. There are many problems allied with this stage which includes:

• Memory loss
• Required assistance in daily activities.
• Difficulty in completing tasks
• Incontinence
• Behavioral changes
• Problems like delusion, compulsions, or anxiety may attack.

Stage 7:

Stage 7 is late-stage Dementia which leads to a severe cognitive decline. The duration for this stage is around 2.5 years. People in this stage completely lose their ability to speak, communicate, and walk. They require assistance in activities like eating, toilet.

Symptoms Of Dementia:

Dementia symptoms may vary from person to person, and they worsen over time. Every person experiences different symptoms depending on the types of Dementia. A person diagnosed with dementia experience cognitive impairment, pacing, restlessness, and agitation.

The early signs of Dementia include memory loss, confusion, difficulty in recalling date and time, behavioral change, and difficulty in performing everyday tasks.

Following are the general symptoms associated with Dementia:

• Patients with Dementia have trouble focusing, planning, and organizing.
• Decision-making capacity is compromised.
• Patients may experience difficulty in problem-solving.
• Patients with Dementia face difficulties in choosing the right words.
• The person may experience difficulties in judging distances and viewing the objects in three dimensions.
• Behavioral changes observed in the patients.
• Frustrated and impulsive behaviors.

What Causes Dementia?

Dementia is a condition that is caused by the damage of the brain cells. It interrupts the connection between the nerve cells and the brain, which causes the cell to die or to perform function abnormally. Due to the abnormal function of the brain cells, a person may have trouble communicating, thinking, behavior, and feelings of a person.

The brain is composed of different regions, and each region is responsible for performing the specific function such as memory, movement, and judgment, when the cells of the particular region deteriorate, the region is unable to perform regular functions.

Different types of Dementia are due to brain cell damage at the particular region, and they may vary as per the damaged region such as Alzheimer’s, Frontotemporal dementia. If we consider the case of Alzheimer’s disease, a high level of the abnormal proteins surrounds the brain cells; thus, they are unable to communicate with each other. The region responsible for learning and memory is the hippocampus; when the cells got damaged in the hippocampus, it may lead to memory loss in Alzheimer’s.

How To Diagnose Dementia?

If the person is facing problems with memory or thinking, he or she must get a proper assessment. Finding the right cause of the disease is fundamentally essential to check if the person is having Dementia or may be due to depression or infection. Correct diagnose of Dementia is also crucial as it will help the patient to get the right treatment.

The following doctors can usually diagnose Dementia:

Psychiatrist:

He is a mental health specialist and analyze the patient’s mental condition by a series of questions and determine if the patient has Dementia.

Geriatrician:

The geriatrician predicts Dementia as a specialist in the physical health of older people.

Neurologist:

A neurologist determines the disorders of the brain and concentrates on the diseases of the nervous system. There is no single test present for the diagnosis of Dementia. Following are the series of steps used in the diagnosis of Dementia:

Medical History

The first step for diagnosing Dementia is taking the medical history, collecting detailed information about a person, asking about the person’s medical health, and if the disease runs in the family. Try to identify how the symptoms begin with personality and behavioral changes.

Physical Examination

Physical examination includes the series of the test such as blood pressure, blood tests, the test of senses, movement, and tests to find out the normal functioning of the heart and lungs. It might help the doctor to predict the condition that causes Dementia.

Diagnostic Test

Various diagnostic tests performed for the diagnosis of Dementia include blood tests and urine tests some times; a small amount of spinal fluid for predicting the condition is also adequate.

Cognitive Testing

These tests are to assess the condition of the patient with memory loss, problem-solving skills, language skills, and other functions that involved mental abilities.

Brain Scans

Brain scans are to assess conditions like stroke, tumour. The scans determine the patterns of brain tissue loss as well as the structure and function of the brains. The most common scan performed for diagnosing Dementia include Computed Tomography (CT) that uses X-rays to develop the images of the Brain, Magnetic Resonance Imaging (MRI) that uses magnetic field detailed images of the brain and positron Emission Tomography (PET).

Psychiatric Assessment

Psychiatric evaluation determines the disorders such as depression, anxiety, or delusions that occur along with Dementia.

What Are The Treatment Options For Dementia?

There are two ways of treating this disease:

Non-Drug Treatment:

It can be with the help of the following:

• Counseling and talking therapies, help the doctor recognizing the type of Dementia and a person’s feelings.
• Cognitive stimulation therapy helps the patient to stay active. It is a theme-based activity approach.
• Cognitive-behavioral therapy helps the patients reduce the level of anxiety and anger and to cope up with behavioral changes.

Drug Treatment:

There are several medications used to treat it. Some of them are:

Cholinesterase Inhibitors (DOPENZIL)

The doctor prescribes cholinesterase inhibitor for treating the symptoms of mild, moderate, and severe Alzheimer’s

Memantine

The doctor prescribes memantine antagonist for treating the indications of moderate to severe Alzheimer’s

Rivastigmine

The doctor prescribes rivastigmine for treating the signs of mild to moderate Alzheimer’s and also for severe Alzheimer’s.

Other medications: For treating depression, sleep disturbances, hallucinations, parkinsonism, or agitation.

Other Approaches For Treating Dementia

Several other approaches used in treating patients with Dementia are as follows:

COGNITIVE STIMULATION THERAPY

Cognitive stimulation therapy involves using theme-based activities to learn the environment and to be aware of the environment using a small group setting.

EXTERNAL MEMORY AIDS

External memory aids help patients in daily activities by using the Personal Assistant Devices (PAD) to help the patient with everyday issues.

ENVIRONMENTAL MODIFICATIONS

It helps the patient improve cognitive power, visual, auditory skills, noise reverberation, and in assessing ques.

STIMULATED PERSON THERAPY

Stimulated person therapy is based on the emotional approach and is to reduce the level of anxiety and challenging behavior by listening to the voices of the loved ones. This approach helps the patient to improve the well being and reducing agitation.

MEMORY TRAINING PROGRAMS

Memory training programs helps patient in errorless learning, procedures for memory stimulation, disappearing cues, and moralistic approaches for improvising memory skills.