What is Dementia? Causes, Symptoms & Management Methods
Dementia is an umbrella term used to describe a set of specific and general symptoms which include a progressive mental decline of cognitive functioning that impacts a person\’s normal daily activities.It is not classified as a disease, per se,but rather as a syndrome which includes characteristic signs and symptoms. These signs also include actual physical deterioration of the brain which leads to the cognitive deterioration, as well as reduced physical mobility.
There are many different types of dementia for which they mostly fall under two categories: primary dementia and secondary dementia. Primary dementia does not result from any other disease. Secondary dementia is caused by another disease or illness which also leads to dementia like symptoms.The two most common forms of dementia are Alzheimer\’s Disease (AD) with 60-percent of all dementia cases, and Vascular Dementia which accounts for 20-percent.
Causes of Dementia
There are many different causes of dementia, which often result because of external or internal damage or changes to the brain.The most common causes of dementia include:
>> Diseases such as Alzheimer\’s disease, Parkinson\’s disease, and strokes.
>> Diseases that affect blood flow and circulation (vascular disease)
>> Excessive consumption of drugs and alcohol
>> Vitamin B12 and folate deficiency
>> Infections such as AIDS, or Creutzfeld Jacob\’s disease
>> Infections to other organs
>> Head injuries and trauma
>> Thyroid problems, hypoglycemia.
>> Bleeding on the brain, or fluid accumulation on the brain
>> Inadequate supply of oxygen to the brain
>> High cholesterol and atherosclerosis (clogged arteries)
Symptoms of Dementia
Recognition of symptoms early on can lead to better management of dementia and improve the general quality of life for the patient.Some of the most common signs and symptoms of dementia are:
>> Memory loss and memory confusion
>> Feeling of disorientation
>> Reduced ability to communicate
>> Inability to think in specific terms
>> Confusion or inability to perform familiar tasks
>> Mood and behavioral changes
>> Confusion over the location of personal items and familiar places
>> Decrease in personal initiative
>> Personality changes.
Management of Dementia
Unfortunately, there is no cure for primary dementia and Alzheimer\’s disease which can only be managed with palliative care which brings some relief of symptoms. Management for dementia falls under three main categories: pharmacotherapy, nonpharmacological therapy, and improved caregiver services.
Treatment for dementia with the use of drugs and medication is aimed at three categories of symptoms,to improve brain functioning and cognition, to treat behavioral symptoms, and for pain management.Although dementia is not reversible, doctors will look at whether or not the decline in mental functioning is the result of other conditions which are treatable. This could include conditions such as: deficiency in vitamin B and folic acid, decreased supply of oxygen, thyroid problems, infections, anemia,depression and heart conditions.
When these conditions are not present, and the onset of symptoms is due to primary dementia,the doctor may prescribed medication that is FDA approved for dementia and Alzheimer\’s, and/or medication that is prescribed ‘off-label’ to treat dementia,and dementia related secondary symptoms.
Four medicines classified as acetylcholinesterase inhibitors have been approved by the FDA for dementia by Alzheimer\’s and include: Tacrine (Cognex®), donepezil (Aricept®), galantamine (Razadyne®), and rivastigmine (Exelon®).In clinical studies, donepezil, rivastigmine, and galantamine have been shown to mildly slow the rate of cognitive decline and improve activities of daily living (ADLs) and behavior in mild-to-moderate Alzheimer disease for a period of 6-18 months.
Of these four acetylcholinesterase inhibitors, donepezil is the most prescribed and has shown to be the most effective but side-effects occur in approximately 17 percent of patients with the 5-10mg dosages. Donepezil is expected to delay the onset of AD for about one year in people suffering from mild cognitive impairment (MCI). Rivastigmine was also effective but side-effects occurred in approximately 50 percent of patients for the 6-12mg dosages, with 25 percent needing to be taken off the drug. It is also approved for Parkinson\’s disease dementia by the FDA.
Memantine (Namenda) is a drug of a different class and works best in patients with moderate to severe Alzheimer\’s. However, the addition of memantine to the above mentioned acetylcholinesterase inhibitors being given to mild to moderate Alzheimer\’s patients was no more effective than placebo.
Depression, agitation, paranoia, and anxiety are common symptoms associated with dementia and Alzheimer\’s. Doctors may prescribe anti-depressants and anti-anxiety medication as well as anti-psychotics.
Dementia patients have many of the same physical ailments as non-dementia seniors to include chronic, persistent pain. Approximately 25 to 50 percent of seniors experience chronic pain so it must be reasoned that statistics for dementia patients must be similar. Chronic pain can contribute to depression, aggression, and poor cognition and should not be overlooked in dementia patients.
Therapy and Caregiver Services
Nonpharmacalogical therapy methods may be directed for dementia patients through music therapy (for mental stimulation), behavioral therapy (for depression), and psycho motor therapy (for agitation). Other mental stimulation therapies may include: simple games, picture observation, reading to patients, and other techniques. Physical exercise also benefits patients. Trained caregivers may initiate and participate in stimulation therapies. Having empathetic, attentive caregivers well trained in addressing the wants and needs of dementia patients is an important part of the overall treatment regimen for dementia patients. Advice, tips, and information for better caregiving for dementia patients may be found online.