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- amjmed.com - Dementia
- download pdf - Dementia - diagnosis and treatment interventions - NCBI
- ncbi.nlm.nih.gov - Dementia treatment versus prevention
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Can dementia be a symptom of another disease? Yes, it can. What is dementia? What are its types and causes?
The term dementia comes from Latin. Translated it means "unthinking, unreasonable, insane, insane". Nowadays we use this term to refer to an acquired intellectual disorder.
This disease is usually found in older adults. Rarely, it can be detected at a younger age or even in children.
Dementia can be diagnosed from the age of 3. Early psychomotor development is complete at this age. An inborn intellectual disorder with clinical manifestations before the age of 3 is called idiocy or retardation.
Dementia affects approximately 5% of people over the age of 65. By the age of 90, almost half of people have dementia.
Two types of dementia are distinguished according to the first signs of dementia:
- Presenile dementia (onset before the age of 65).
- senile dementia (after the age of 65)
The clinical manifestation of dementia is the so-called dementia syndrome. In this article you will find its signs and symptoms.
Dementia syndrome is characterised as a gradual deterioration of cognitive function.
Cognitive functions are controlled by the brain and allow us to carry out normal daily activities.
Using cognitive function:
- orient ourselves in time and space
- communicate with other people
- understand what others are saying to us
- we can write, read and count
- understand different logical constructions
- we can even think abstractly and use our imagination to make judgements
- we can plan more complex and complicated tasks
Cognitive functions include :
How many types of dementia are there?
Dementia is classified according to several criteria. Here are the most common types of dementia according to different criteria.
According to the location of the brain lesion :
- Cortical (cortical) dementia, e.g. Alzheimer's dementia - These are mainly manifested by impaired memory, learning, judgement, logical and abstract thinking, apraxia (impaired learned movements, e.g. when dressing), acalculia (impaired counting), agnosia (impaired perception of objects while retaining sight) and aphasia (impaired speech).
- Subcortical (subcortical) dementia, e.g. Huntington's disease - This type of dementia has a mild memory impairment, especially in the recall of older memories. Psychomotor slowing without acalculia, aphasia and apraxia predominates. From the onset of the disease, there is a marked impairment in executive functions, planning, motivation, attention and muscle tone.
According to the course, dementia is divided into:
- smoothly progressive (Alzheimer's dementia)
- rapidly progressive (vascular dementia)
- stationary dementia (after accidents)
According to the degree of severity we divide into:
- dementia of moderate severity
- moderate dementia
- severe dementia
What causes brain degeneration?
One of the possible causes of dementia is an innate predisposition to degeneration of cells and intercellular connections. The gradual death of nerve cells and their connections leads to atrophy of the cortical or subcortical brain centres.
Dementias with this mechanism of onset are called primary neurodegenerative dementias. They account for up to 60% of all dementias.
The best known example isAlzheimer's disease It is a familial dementia that is an autosomal dominant disease caused by mutations in up to three genes (on chromosomes 21, 14 and 1).
Parkinson's diseaseis also a known inherited disease. It is a mutation of the gene for parkin (protein) or ubiquitin C-hydrolase. Both have a protective function in the brain. A malfunction of their gene leads to faster and easier cell death.
However, a defective gene alone is not enough. In addition to a genetic predisposition, a trigger factor is needed for the clinical manifestation of dementia. This may be another organic disease, a change in the environment, a difficult social situation or an emotionally challenging period.
Other primary degenerative dementias include :
- Dementia with Lewy bodies
- frontotemporal dementia
- Huntington's disease dementia
All of the above dementias are proteinopathies. The cause of neurodegeneration is the deposition of a specific type of pathological protein. High levels of pathological protein in the brain are neurotoxic. It causes aseptic (non-infectious) inflammation that damages nerve cells in its surroundings.
Such pathological proteins are beta-amyloid, tau-protein, alpha-synuclein and TDP-43 (transactive response DNA binding protein 43 kDa).
Dementia as a symptom of another disease
Cognitive decline can also be a symptom of another disease. These are mainly chronic diseases. It can affect the brain, other organs or the whole body. These dementias are referred to as secondary dementias. They account for about 5-10% of all dementias.
Examples of diseases that lead to secondary dementia:
1. Metabolic diseases :
- Wilson's disease
- Acute intermittent porphyria
- metachromatic leukodystrophy
- uremic encephalopathy
- hepatic encephalopathy
2. Endocrine diseases :
- hypothyroidism, thyrotoxicosis
- parathyroid dysfunction
- adrenal dysfunction, e.g. Addison's disease, Cushing's syndrome
3. Infectious diseases :
- Lyme disease
- progressive multifocal leukoencephalopathy (JCV)
- herpetic encephalitis
4. Pulmonary and haematological diseases :
- chronic obstructive pulmonary disease
- heart failure
5. Anaemia, pulmonary anaemia, thoracic anaemia
6. Other medical conditions :
- Alcohol intoxication
- normotensive hydrocephalus
- oncological diseases
A blood-filled brain = a functional brain
The better blooded our blood vessels are, the better blooded our brain is. Poorly blooded brain tissue has an insufficient supply of oxygen. This leads to degeneration of nerve cells.
Vascular dementia is the second largest group of dementias. It is caused by impaired blood supply to the brain.
This type of dementia can be caused by cardiovascular disease, including high blood pressure, atherosclerosis of the blood vessels, obesity, hypercholesterolaemia, lower limb ischaemia or myocardial infarction.
Dementia has many other symptoms.
The symptoms of dementia are twofold. It is primarily a cognitive disorder. In addition, there are non-cognitive deficits (called neuropsychiatric), physical symptoms and symptoms of functional impairment of the patient.
- gradual loss of memory
- impaired thinking
- impaired judgement
- poor orientation in space, time, disorientation by person
- speech impairment
- inability to learn new things
- cognitive impairment
- inability to perform complex motor tasks
- inability to name familiar objects
Neuropsychiatric symptoms :
- apathy and disinterest
- insomnia or sleep rhythm disturbances
- rudeness in social behaviour
- inappropriate motor manifestations
Physical symptoms :
- urine leakage
- weight loss, food refusal
- loss of muscle mass
- extrapyramidal symptoms - tremor, rigidity, gait disturbance, etc.
Patient's functionality :
- difficulty with complex tasks, e.g. driving, work habits
- inability to perform household chores
- problems with personal hygiene, which requires gradual steps
- limitations in normal daily activities (eating, dressing, grooming...)
- impaired communication, expression of needs and thoughts
- independent movement is almost impossible
Motor symptoms are typical of e.g. Parkinson's disease. A set of symptoms is present:
- hypokinesia (restriction of range of movement) and associated manifestations of bradykinesia (slowing of movement) and akinesia (impaired initiation of movement)
- rigidity (stiffness of muscles and joints)
- resting tremor
- postural disturbances
Observe your relatives. The first stages of dementia often escape attention
Dementia has a multi-stage course.
The first stage
It is usually inconspicuous to the patient and those around them.
There are headaches, dizziness, mild intellectual decline, slowing of thinking, mild memory impairment.
Minor errors, such as errors in counting and handling money, begin.
Difficulties with reading or speech are also common. Repeating heard words and sounds instead of forming your own words is called echolalia.
In the first stage, motor symptoms are not yet present. Psychological disturbances such as depression, restlessness and nervousness may occur.
This is characterised by a more pronounced memory impairment. This stage lasts 1-3 years. Dementia is most often diagnosed in this period.
Short-term memory is affected. Forgetting various everyday events is typical.
The patient has difficulty remembering where he has been, what he has done, what he had for lunch. He may forget where he has put away various objects. He feels he is losing them. He may put them away himself in unusual places.
Orientation in space and time is impaired. People with dementia often get lost even in familiar places. After such an experience they tend to be very agitated and confused. This exacerbates anxiety and depression.
The third stage
This is characterised by a very rapid progression of cognitive impairment. Patients begin to require complete care from another person.
In this stage, long-term memory is affected. Patients do not remember their date of birth, address. They do not recognise familiar places, people, family, partner, children. They talk out of turn and often stray to illogical things with their thoughts.
Terminal stage of dementia
Characterised by complete immobility, incontinence, screaming, aggressive seizures and inappropriate behaviour. The patient often handles their body or secretions such as urine or faeces inappropriately.
A very common cause of death is aspiration pneumonia or pneumonia. This condition is difficult to treat.
Prevention and treatment of dementia
Dementia is an incurable disease. It is an irreversible condition.
Treatment consists more in relieving the symptoms and slowing down the progression of degeneration.
Pharmacological treatment includes two types of drugs:
- So-called cognitive agents - Drugs in this group are intended for the symptomatic treatment of cognitive deficits. Their effect is to slow the progression of the disease. These include cholinesterase inhibitors, NMDA receptor antagonists, memantine and ginkgo biloba extract.
- Secondary treatment involves taking drugs to help manage the neuropsychiatric symptoms of dementia (e.g. depression).
- Non-pharmacological treatments include aromatherapy, music therapy, getting a pet, educating caregivers on proper care or psychological support for the family.
Prevention of dementia starts at a young age. Dementia can be prevented by a healthy lifestyle. Diet, especially fish with a high fatty acid content, is important.
Another aid in preventing dementia is coffee. Its protective effect has even been confirmed in several scientific studies.
Another type of dementia prevention is regular brain training. Various fun tasks, puzzles, Sudoku and the like are popular.
Don't underestimate good physical fitness either. In studies, regular physical exercise had an even better protective effect than doing crossword puzzles.