Dementia: symptoms, forms and causes

Dementia: symptoms, forms and causes

Dementia is a disease that usually occurs in old age. It is associated with severe impairments of mental performance and essentially limits the ability of those affected to lead an independent life. The causes of dementia are very diverse, and the disease manifests itself in numerous different symptoms. Today, more than 50 other forms of dementia are known, with around two-thirds of the cases being due to the most well-known form, Alzheimer’s dementia. In Germany alone, over 1.5 million cases of dementia are known. In this article, you will learn about the causes of dementia, and in addition to the typical symptoms and diagnostics, you will learn more about the course dementia and how to deal with it.

What is dementia?

The term “dementia” does not describe a clearly defined disease but rather a complex of different symptoms that can have many other causes. What all forms of dementia have in common is a disease-related, acquired reduction in mental performance, which is expressed in memory loss, speech disorders, a limited ability to form judgments and sometimes also interpersonal behavioural disorders.

 

Causes of primary and secondary dementia

In most cases, patients develop primary dementia, the cause of which lies in the increasing death of nerve cells in the brain. As a result, the performance of the higher brain functions can become increasingly poor and, in later stages, no longer occur. As a result, those affected can hardly cope with their everyday life without comprehensive help and care.

Secondary dementia is understood to mean symptoms typical of dementia that cannot be explained by an independent breakdown of nerve cells but have other causes. This can be, for example, chronic inflammatory diseases of the nervous system, such as multiple sclerosis (MS) or AIDS. Traumatic brain injuries, brain tumours, chronic alcoholism ( Korsakoff syndrome ), thyroid diseases or pronounced vitamin deficiencies can also lead to a secondary form of dementia. However, secondary dementia occurs much less frequently than the primary form, with a proportion of only around ten per cent.

Common forms of dementia

A uniform definition of dementia is difficult to achieve because the causes and characteristics of the various forms are very different. Despite the large number of types of dementia, the vast majority of sufferers can be assigned to a few common forms of dementia:

  • The undoubtedly best-known form, dementia of the Alzheimer’s type, accounts for about 65 per cent of the diseases.
  • Vascular dementia and Lewy body dementia follow with around 10 to 15 per cent each.
  • Around every fifth affected person has a mixed form of Alzheimer’s dementia and vascular dementia.

The most common forms of dementia are presented below.

 

Alzheimer’s dementia

The exact causes of Alzheimer’s dementia have not yet been clarified. Still, it is already known that changes occur in a protein, which is then increasingly deposited in the brain’s nerve cells. These altered proteins cause the cells to change shape and lose function until they finally disintegrate.

The result of these decay processes is a significant shrinkage of the brain, so it can lose up to 20 per cent of its size in severe cases.

In addition to a severe loss of memory, Alzheimer’s dementia also leads to a loss of cognitive and social skills. The course gradually increases and can be divided into three clinical stages, each lasting about three years.

  • Stage 1: memory loss and forgetfulness (amnesia)
  • Stage 2: Loss of practical motor skills such as tying shoes, etc. (apraxia), incomprehensible speech (sensory aphasia )
  • Stage 3: Loss of concern (apathy), loss of continence, loss of appetite

What is the difference between Alzheimer’s and Dementia?

Alzheimer’s and dementia are not different diseases; rather,d Alzheimer’s is a form of dementia. Since the term dementia primarily describes a clinical picture, i.e. the joint occurrence of specific symptoms, the symptoms are very similar in most forms of dementia. Therefore, the signs of Alzheimer’s dementia do not differ from those of other forms. On the other hand, the different variants have very different causes. Alzheimer’s is one of the types of dementia that is triggered by protein deposits, while this process plays no role in other forms of dementia.

vascular dementia

The cause of vascular dementia is circulatory disorders in the brain, which mainly affect the small vessels. The brain can suffer considerable damage if the supply is insufficient since the nerve cells receive too little oxygen, which is transported with the blood. As a result, they lose their function and die.

Either there are diseases of the vessels themselves, which restrict the blood transport, or the vessels become blocked by a blood clot, disturbs the blood flow. Atherosclerosis can occur in the ship, which is understood to be an excessive accumulation of cholesterol and other fats in the wall layer. As a result, the vessels narrow and blood flow is significantly restricted.

The risk factors for vascular dementia are the same as those leading to atherosclerosis. In particular, these are smoking, lack of exercise, poor blood lipid levels without medication, diabetes mellitus and high blood pressure.

Lewy body dementia

Like Alzheimer’s disease, Lewy body dementia, also known as Lewy body dementia (LBD), is caused by protein deposits in the brain, known as Lewy bodies. The symptoms are similar to those of Alzheimer’s dementia, but the therapy is different, which is why precise differentiation is essential. Lewy bodies also occur elsewhere in the brain and differ in shape from the protein deposits typical of Alzheimer’s.

The Lewy bodies also play a significant role in the development of Parkinson’s disease, which is why Parkinson ”s-like symptoms often occur over time, and Parkinson‘s disease can also develop. In neuroscience, it is even assumed that Lewy body dementia and Parkinson’s disease could be two different forms of the same disease. The main difference is that in Lewy body dementia, the changes typical of dementia appear long before the Parkinson-like symptoms. Conversely, Parkinson’s disease often leads to so-called Parkinson’s dementia, although the symptoms of dementia only appear later.

It should be emphasized in particular that progressive memory disorders occur in Lewy body dementia. However, there can be significant fluctuations in mental abilities and attention, so that phases of awareness alternate with phases in which those affected do not know that they are ill. While women develop dementia more frequently than men, more men than women are affected by Lewy body dementia and Parkinson’s disease.

 

Fronto-temporal dementia

Frontotemporal dementia tends to affect younger people around the age of 50, while the other known forms of dementia only appear at an older age on average. It is named after the location of its expression in the brain, as it primarily affects the frontal lobe (lobus frontalis) and the temporal lobe (lobus temporalis), leading to cell loss.

Since these places in the brain only play a subordinate role in memory, the ability to remember is retained mainly in contrast to almost all other forms of dementia. However, because part of the consciousness is anchored in the affected areas of the brain, those affected typically suffer from a change in personality and impaired processing of emotions. Many patients also experience a progressive loss of language skills (aphasia).

alcohol dementia

Excessive alcohol consumption can lead to significant memory loss, which is why Korsakoff syndrome, a brain disorder with other manifestations, is also considered a type of dementia. The cause is a pronounced deficiency of vitamin B1, which leads to what is known as Wernicke encephalopathy. This brain damage is caused by chronic alcohol abuse and often occurs after only a few years of alcoholism.

In addition to damage to the nerve cells, the connections between the individual brain cells are loosened, leading to massive cell loss. Those affected can only remember the past with difficulty or not at all and can no longer remember new information. Therefore, alcohol dementia is also referred to as amnestic syndrome.

What are the symptoms of dementia?

Dementia begins insidiously and is initially only noticeable subliminally. The first signs of incipient dementia are unusual forgetfulness and orientation problems in previously familiar surroundings. These symptoms worsen over time, and new ones appear, such as speech disorders.

Inevitable disorientation can be seen in the facial expressions of those affected. They often react with a delay and lose control of their facial expressions, resulting in reduced motor skills. It is, therefore, often difficult to correctly interpret the feelings of people with dementia. They usually appear mentally absent and appear as if they are daydreaming. Increasing tiredness is also one of the first signs of dementia. Increased irritability and moodiness are added.

Some of the typical dementia symptoms are listed below:

  • forgetfulness
  • confusion
  • decreasing concentration
  • disorientation
  • mood swings
  • sleep disorders
  • fatigue
  • word-finding disorders
  • nocturnal restlessness

 

How do you recognize the early stages of dementia?

Because of the insidious onset, it is not always easy to identify dementia in its early stages. A medical examination is advisable if you notice changes such as increasing forgetfulness that go beyond the usual extent. Frequent misplacing of objects, new writing, and language weaknesses are also alarming signals.

Diagnosis: investigations in dementia

If dementia is suspected, examinations using imaging methods such as computed tomography (CT) or magnetic resonance imaging (MRI) can show the condition of the brain even in the early stages and enable a good differentiation of the possible causes. Neurophysiological tests should also allow more precise localization of the damage in the brain by testing different brain functions assigned to specific areas in the brain.

Unfortunately, by the time signs of dementia appear, the destruction of the brain cells is usually already well-advanced and unstoppable. Therefore, neuroscientists are working with different approaches to improve early detection. Although dementia cannot be cured, it can be delayed as long as possible by starting treatment early.

Complex procedures such as positron emission tomography (PET) and CSF diagnostics are currently used in the diagnosis of Alzheimer’s dementia. However, these procedures have the disadvantage that they are either costly (PET) or painful (CSF diagnostics).

The latest research results are very encouraging and give great hope of detecting the disease when it is still asymptomatic and thus identifying people who have an increased risk of Alzheimer’s. Specific proteins that play a vital role in the development of Alzheimer’s could be detected in the blood with a simple and inexpensive test. In the future, this blood test could even be available as a dementia test, i.e., as a screening procedure in preventive medical check-ups and enable early therapy.

The watch test – a simple and quick test

A classic first test for dementia is the watch test – a straightforward test that follows a fixed pattern. It does not replace imaging or laboratory diagnostics but can be helpful for an initial assessment. It only takes a few minutes and consists of a single task.

The test person is given a piece of paper and a pen and is asked to mark the hours on a standard clock with twelve dashes. She is then given different times, and her task is to draw during these times with an hour-and-minute hand.

The doctor takes notes on various aspects, for example: In what order does the person proceed? How much time does she need? Are there any problems? Points are then awarded according to a specific pattern, and an initial assessment is made possible. With the watch test, several relevant skills can be tested simultaneously, such as memory, memory, visual orientation and planning ability. Of course, the test does not provide a reliable diagnosis, but it should always be seen as a first indication of dementia.

 

How does dementia progress?

The course differs individually, but all those affected go through three stages characterized by specific symptoms. These stages are described in the table below.

What therapy options are available?

In principle, dementia cannot be cured. Therefore, stopping or slowing down the progression of the disease is already considered a success. The aim of therapy is primarily to alleviate the disease’s symptoms and improve the quality of life.

In addition to drug therapy, the focus here is primarily on psychosocial treatments. Therapeutic measures in the psychological and social area are intended to help maintain mental abilities for as long as possible, to learn how to cope with everyday life under challenging conditions and, in particular, to maintain or improve well-being. Cognitive methods such as memory, attention and concentration training are also said to help slow down the development of dementia.

Psychotherapy and self-help groups are also helpful, especially at the beginning of the illness, as they can offer those affected valuable help in accepting their illness. In addition, they often open up new perspectives on how a fulfilled and joyous life can still be possible with a diagnosis of dementia.

Drugs to treat people with dementia

The primary goal of drug treatment is to relieve symptoms. Side effects of the disease, such as sleep disorders, restlessness or depression, can be alleviated with appropriate medication. Antidepressants, antipsychotics, and tranquillizers are used to treat it. However, their use is often associated with side effects and should be carefully considered.

A causal drug treatment of dementia is not yet possible. Nevertheless, medications are available that positively affect individual major disorders in brain metabolism so that they can significantly slow down the progression of the disease. These so-called anti-dementia drugs are intended to counteract the loss of memory and cognitive functions.

You can choose between acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine or galantamine) and NMDA receptor antagonists (e.g. memantine). Often, only a combination of different active ingredients brings success. Unfortunately, while some of those affected benefit significantly from these drugs, they do not work for others.

 

Recent developments: the dementia flatshare

In recent years, there have been increasing efforts to bring dementia patients together and enable them to live together in so-called dementia-shared flats. These are reminiscent of a classic flat share that is popular with students. However, dementia patients are also cared for by qualified nursing staff and are thus able to lead a more independent life than in a classic retirement home.

Life in the shared flats is more relaxed; the residents decide together about their daily routine and can withdraw simultaneously if they feel the need to do so. In addition, the residents can contribute according to their abilities and interests, so the risk of loneliness is significantly reduced. You will receive a structured and self-determined daily routine and be supported in coping with your everyday life wherever necessary. Living together in a shared flat is usually found to be very enriching by the residents and can have a positive influence on the course of the disease.

life expectancy and the dying process

Life expectancy from the time of diagnosis is usually two to ten years. The process of dying from dementia is often preceded by a long process of saying goodbye, which is also difficult for the relatives since they are recognized less and less by the sick person and at some point, they are no longer recognized at all.

A common cause of death in dementia patients is pneumonia because, in the late stages of bed confinement, there is a high susceptibility to infections. Impending death can usually be recognized days or hours in advance. Patients appear sleepy and weak, and pale and cool skin are outward signs of impending death. In some cases, those affected experience a brief moment of clarity just before death, often appearing even more content and happier than during the years of the illness.

Is dementia hereditary?

Although there is a genetic predisposition to dementia in some families, in reality, heredity plays a minimal role. In the case of Alzheimer’s dementia, in particular, age is the decisive risk factor; genetic causes can only be proven in one per cent.

However, there could also be a genetic influence in age-related Alzheimer’s dementia. Changing specific genes is highly likely to lead to an increased disease risk, even if an outbreak does not occur in all cases.

 

How can you prevent dementia?

Since genetic causes only play a role in a tiny proportion of people with dementia, there are many ways of influencing the risk of developing dementia. Some of the known risk factors can be influenced well:

  • Stress
  • diabetes and high blood pressure
  • Smoking
  • alcohol consumption
  • unhealthy diet
  • overweight
  • Medication for incontinence, sleep disorders and depression (tip: regular dose adjustments as far as possible)
  • Acid blockers (for example , omeprazole , pantoprazole )
  • Hearing loss (tip: early use of a hearing aid)
  • unstable personality and depression
  • loneliness
  • air pollution

 

 

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