Dementia

Dementia

Dementia is the progressive decline in cognitive function due to damage or disease in the body beyond what might be expected from normal aging.

Although dementia is far more common in the geriatric population, it may occur in any stage of adulthood. This age cutoff is defining, as similar sets of symptoms due to organic brain dysfunction are given different names in populations younger than adulthood.

Dementia is a non-specific illness syndrome (set of symptoms) in which affected areas of cognition may be memory, attention, language, and problem solving. Higher mental functions are affected first in the process. Especially in the later stages of the condition, affected persons may be disoriented in time (not knowing what day of the week, day of the month, month, or even what year it is), in place (not knowing where they are), and in person (not knowing who they are or others around them).

For the mind to keep pace with an ever changing world as we age, memory must preserve the tiny strands of links between yesteryears, yesterday, today and project reasonably into the future, even if it is shrinking. It must situate us within a time and personality frame that must correlate with the moment, at least not too far away.

With aging comes cognitive decline which is often termed innocently "cognitive aging", a subtle attempt to bundle it with the aging process. When memory fails substantially, the various reproducible trait and behavior that define who we are dissolves into a widening well of emptiness. While over 50% of elderly people say their memory is worse than when they were younger, on the average only 8% (1% at 60 years to 35% at 90 years will development dementia. Alzheimer's dementia will account for about 60%. This age is deceptive because new techniques for brain imaging has shown that the physical features dementia commences long before the first symptoms are noticed; a signal that preventive measures may be more useful long before the disease becomes evident.

Etiology:

While the elderly are particularly at risk, medical knowledge regarding the precise cause is still in infancy, an important reason why effective therapy is also unavailable, because "you can't catch what you can't find".

Decades ago, the prevailing hypothesis was that there was a deficiency in a chemical (Acetylcholine) utilized by nervous tissues to transmit impulses and communicate between each other. Many of the symptoms, notably the learning difficulties were explained by the lack of Acetylcholine. While drugs that prevent degradation of Acetylcholine (Anti-cholinesterase) compress the majority of available treatment options, their inability to offer effective respite to many patients, meant other crucial mechanisms were at play.

A more recent additional explanation is based on the deposition of a protein called Beta-amyloid which progressively induces nervous tissue destruction and the subsequent cognitive and memory decline. Other important factors that may contribute include the excessive amounts of the by-product of calorie combustion (Reactive Oxygen species) that can damage biological tissues and episodes of poor blood supply to the brain seen during Stroke (Cerebro-Vascular Accidents).

Early Diagnosis:

It is true that there is there a general lack of information about dementia which significantly contributes to the delay in diagnosis. Early assessment in cases of suspected dementia is vital because it may help establish the presence of a medical condition, create an avenue to access treatment and help care-givers prepare for their role. Also early diagnosis of dementia is critical for legal and financial planning. The most common reasons for delays were lack of information about dementia, belief that symptoms were normal aging, not knowing which physician to ask, and being overwhelmed with the situation.

Prevention:

Primary prevention essentially entails interventions that are carried out to prevent the occurrence of a disorder. A lot of preventive measures have been evaluated. On top is the need for to modify the risk of chronic medical disorders e.g. Hypertension, Diabetes Mellitus and Stroke with prompt medical treatment which includes; Anti-hypertensive medication, Aspirin (Acetylsalicylate) and anticoagulants such as Warfarin. Other medication includes vitamin C (500 mg) and Vitamin E (400 units) daily for at least three years was were associated with a risk of Alzheimer's Diseases.

Lifestyle practices which involves;

  • adequate exercise.
  • weight control.
  • abstinence from cigarette smoking.
  • moderate alcohol consumption (250 - 500 ml of wine per day)

And a healthy balance diet that encourages a more efficient metabolism. Increased total fat intake and deficiency of omega 3 fatty acid rich in marine protein, have been linked to dementia).

The relationship between education and subsequent development of dementia have been explored and there is a positive correlation which might be explained by innate ability i.e. those possessing more innate intelligence might progress further in formal education and might be less likely to develop dementia. Occupational exposure to pesticides and fumigants are also associated with dementia.

Treatment:

Except for the treatable types of dementia, there is no cure to this illness, although scientists are progressing in making a type of medication that will slow down the process. Cholinesterase inhibitors are often used early in the disease course. Cognitive and behavioral interventions may also be appropriate. Educating and providing emotional support to the caregiver (or carer) is of importance as well.

The main method to prevent dementia is to live an active life, both mentally and physically. It appears that the regular moderate consumption of alcohol (beer, wine, or distilled spirits) may reduce risk.