Patient's Complete Guide to Dementia

Overview of Dementia

Dementia is one of the leading conditions of the world, which affects the cognitive functions of the brain. Alzheimer disease is the most common cause of it.

Signs and Symptoms of Dementia

Dementia (Zehani Bigar/ ذہنی بگاڑ ) is a form of memory loss that affects the cognitive functioning such as language skills, visual perception, problem-solving, self-management, and the ability to focus and pay attention.
The severity of dementia ranges from the mildest stage (start to affect the brain) to the severe stage when the person relies on the other person for basic activities of life.
Dementia is a symptom of other brain diseases or neurocognitive disorders. The cause of this problem varies from one person to another, but the most common one is Alzheimer disease in older people. Other conditions are Lewy body dementia, frontotemporal disorders, and vascular dementia.

Prevalence of Dementia

Dementia is more common as people grow older over the age of 65 years. It is not a normal part of aging. Many people with dementia survive at the age of 90s and beyond. Frontotemporal disorders are a common dementia type that mainly affects the middle-aged than older adults.
In a developing country like Pakistan, dementia is a 6th popular disease in the world. In 2017, around 12.5 million people over the age of 60 years suffered from this disease. This figure will increase up to 40 million by 2050.

Types of Dementia

Because dementia is a symptom of various neurological disorders. That’s why its symptoms can vary according to the patient’s condition. But common problems associated with dementia are as follows:

  • Memory problem
  • Difficult to concentrate
  • Difficulty in Communication
  • Reasoning, judgment, and problem solving
  • Visual perception (changes in vision)

Some common signs that may identify the dementia include:

  • Lost in a familiar neighbourhood
  • Saying unusual words that refer to familiar objects
  • Unable to remember the name of a close family member or friend
  • Forgetting old memories
  • Not being able to achieve tasks independently

Causes of Dementia

Dementia is categorized into two groups based on which part of the brain is affected.

  • Cortical Dementias- This type of dementia results from the impairment in the outer layer of the brain is called the cerebral cortex. They cause memory loss. Sometimes, affected people do not remember words or have difficulty understanding language. Major conditions associated with this type are Alzheimer's and Creutzfeldt-Jakob disease.
  • Subcortical Dementias- People with this type of dementia cause impairment in the brain beneath the cortex. In this condition, typically delay in thinking and ability to start activities, but, they do not have memory and language problems. Parkinson's disease, Huntington's disease, and HIV are diseases of these types of dementia.

In some cases of dementia, it affects both parts of the brain.

Risk Factors of Dementia

Dementia is caused by disruption or loss of nerve cells and their connections in the brain. The affected part of the brain is damaged by injury, stroke or brain tumours. Majorly different people react differently due to dementia and cause different symptoms.
On the other hand, some neurodegenerative diseases are the reason for dementia such as Alzheimer disease. If there are any reactions of medications and vitamin deficiencies that appear dementia-like symptoms,  they can be treated.

What Causes Dementia?

The causes of dementia are categorized into two stages of dementia that is reversible or irreversible dementia. The irreversible cause is a progressive stage of dementia and cannot be treated, but managed only.   These causes are further linked with different neurological conditions are given below:

  • Reversible Dementia

Reversible causes of dementia result from the disruptions of brain cells, particularly in the cerebral cortex (the part of the brain which controls memory, perception, consciousness, and language). This type of dementia can be cured or reversed with proper treatment. Following are the conditions that produce the dementia-like symptoms.

  • Infections and immune disorders such as multiple sclerosis attacks the nerve cells and cause temporary dementia
  • Metabolic problems and endocrine abnormalities like thyroid problems, low blood sugar (hypoglycemia), too little or too much sodium or calcium, or problems absorbing vitamin B-12 can produce dementia-like symptoms as well as other personality changes.
  • Nutritional deficiencies are another factor that may develop dementia. For example dehydration, thiamin (vitamin B-1), vitamins B-6 and B-12, copper and vitamin E deficiencies.
  • Medication adverse effects also develop dementia-like symptoms
  • Subdural hematomas refer to the bleeding between the surface of the brain and the covering over the brain. It is more likely to occur in elderly patients.
  • Exposure to heavy metals, such as lead, and other poisons, such as pesticides, as well as a recreational drug or heavy alcohol use, can lead to symptoms of dementia.
  • Brain tumours rarely cause dementia from the damage of nerve cells.
  • Anoxia is a condition in which insufficient oxygen transfers to the brain tissues or organs which ultimately causes the symptoms of dementia.
  • Normal-pressure hydrocephalus begins due to the enlargement of ventricles in the brain. This can also cause walking problems, urinary difficulty and memory loss.
  • Irreversible Dementia

In this type, symptoms of dementia are not reversed due to genetic alterations. There is no treatment of this, but only the manageable measures are used to improve the conditions. Of which, Alzheimer disease is the most common cause of irreversible dementia caused by the gene mutations of the brain. But other genetic factors tend to produce various kinds of dementia.
Vascular Dementia- Vascular dementia is caused by the damaged blood vessels to the brain. These vessels cause damage due to the deposition of fats on the walls of the brain, damage of fibre in the white matter of the brain or strokes etc.
The main signs of vascular dementia include difficulties with problem-solving, slowed thinking, focus and organization. Other symptoms are slurred speech, decreased cognitive abilities, confusion etc. It can develop due to a wide range of conditions, but the most common cause of this type is Alzheimer disease.
Lewy-Body Dementia- This type shows their effects when abnormal balloonlike clumps of protein accumulate in the brain. It is one of the common types of progressive dementia in which Alzheimer's disease and Parkinson's disease are also the main causes of it.

Most Common signs and symptoms include:

  • Sleeping hallucinations
  • Visual hallucinations
  • Problems with focus and attention
  • The uncoordinated or slow movement
  • Tremors and rigidity (parkinsonism).

Other Causes of Dementia

Frontotemporal Dementia- This condition is caused by the breakdown (degeneration) of nerve cells and their connections in the frontal and temporal lobes of the brain.  These areas are generally linked with personality, behaviour and language. Due to this, it produces difficulty in behaviour, personality, thinking, judgment, and language and movement.
Mixed Dementia- This is caused by more than one type of dementia such as a combination of Alzheimer's disease, vascular dementia and Lewy body dementia. It mostly affects people over the age of 80 years.

Almost 5% of dementia is caused by other neurological diseases, such as HIV infection, progressive supra-nuclear palsy, or alcohol-related brain damage. These diseases are more likely to produce dementia in younger individuals.

Prevention

Factors that increase the risk of dementia include:

  • Age mostly affects people above 65 years or older
  • People had a family history of dementia, such as parents or siblings etc.
  • Ethnicity is another factor that increases the chance of dementia. For example, older African Americans are twice as prone to dementia than white people.
  • People having nutritional deficiency may stimulate dementia.
  • High blood pressure, high cholesterol, and smoking may also develop dementia
  • Traumatic brain injury due to some accident or any other condition.

Diagnosis

Certain steps that help to prevent dementia are below:

  • Avoid smoking
  • Stop drinking alcohol
  • Reducing recreational drug abuse
  • Participating in programs of  mentally stimulating, memory-training activities
  • Keep the people physically and socially active
  • Eating a healthy diet
  • Maintaining a regular exercise routine
  • Getting enough sleep
  • Manage stress
  • Managing health problems such as high cholesterol, diabetes, and high blood pressure

Treatment of Dementia | When to Consult a Doctor

Diagnosing dementia and its type is very difficult and challenging. Most doctors evaluate the patient's conditions on the basis of symptoms, medical history. As there is no specific test for dementia but identify the sign through imaging tests of the brain. These tests help to check the memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes and other areas.

Following are the imaging tests to identify the abnormalities in the brain.

  • Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI) - These scans are used to check any stroke, bleeding, tumour or hydrocephalus.
  • PET Scans- These tests can show patterns of brain activity whether it is working properly or not. For example, identify the hallmark of Alzheimer's disease, the amyloid protein.

Other tests of finding the biomarker of dementia are as follows:

  • Blood Tests- The blood tests are used to perform the physical problems that affect the brain such as vitamin B12 deficiency or underactive thyroid gland. For some cases, the spinal fluid is under examination for the infection, inflammation or markers of degenerative diseases.
  • Cognitive and Neuropsychological Tests- To measure the cognitive functions such as thinking skills, language skills and attention.
  • Psychiatric Evaluation- A physiatrist determines the state of the patient whether depression or any other complications develop symptoms of dementia.

Healthcare Providers

Consult with Best Doctors for Dementia

Prof. Dr. Shahzad Shams, Neurosurgeon
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Assoc. Prof. Dr. Syed Shahzad Hussain, Neurosurgeon
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Prof. Dr. Muhammad Athar Javed, Neurologist
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Prof. Dr. Nazir Ahmad, Neurosurgeon
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Dr. Saeed Ahmad Bajwa, Neurosurgeon
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Dr. Anjum Habib Vohra, Neurosurgeon
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Dr. Asim Mahmood, Neurosurgeon
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Dr. Asim Mahmood

Dr. Amer Ikram, Neurologist
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Dr. Amer Ikram

Dr. Aamir Aziz, Neurosurgeon
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Dr. Aamir Aziz

Dr. Muhammad Khurrum Ishaque, Neurosurgeon
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Speciality for Dementia

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