Dementia is the name of a syndrome, that with time leads to the deterioration in cognitive abilities. Dementia is an umbrella term that describes a range of disorders, they affect memory, thinking, comprehension, calculation, and judgment. These impairments may come with changes in mood, emotional control, behavior, and motivation. It is the seventh leading cause of death among all diseases worldwide, and a major cause of disability among the elderly.
There is no cure for Dementia, therefore treatment and prevention stands as the primary shield to fight the onset of cognitive decline. The World Health Organization (WHO) has indicated some of the following key facts about Dementia:
9.9 million people develop Dementia each year
Individuals suffering from Dementia are set to increase to 75 million in 2030, and 132 Million in 2050
The overall costs of Dementia are estimated to be US818 Billion, with the cost of caring for individuals with Dementia to rise to US$ 2 trillion
The costs of caring for dementia have a much more significant impact on lower income countries, which leads to a disproportionate increase in cases in these countries.
There is a need for 40 million new health and social care workers, and 18 million additional workers global, in or der to have an effective coverage for neccesary health services
Most cases of Dementia (around 60%) live in low and middle income countries. Most of the new cases of Dementia (around 71%) are expected to occur in these countries
Types and Causes
Alzheimer's disease: This is the most common cause of dementia. Although not all causes of Alzheimer's disease are known, experts do know that a small percentage are related to mutations of three genes, which can be passed down from parent to child. Alzheimer's disease patients have plaques and tangles in their brains. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein. It's thought that these clumps damage healthy neurons and the fibers connecting them.
Vascular dementia: This type of dementia is caused by damage to the vessels that supply blood to your brain. Blood vessel problems can cause strokes or affect the brain in other ways, such as by damaging the fibers in the white matter of the brain. The most common signs of vascular dementia include difficulties with problem-solving, slowed thinking, and loss of focus and organization. These tend to be more noticeable than memory loss.
Lewy body dementia: Lewy bodies are abnormal balloonlike clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer's disease, and Parkinson's disease. This is one of the more common types of progressive dementia. Common signs and symptoms include acting out one's dreams in sleep, seeing things that aren't there (visual hallucinations), and problems with focus and attention. Other signs include uncoordinated or slow movement, tremors, and rigidity (parkinsonism).
Frontotemporal dementia: This is a group of diseases characterized by the breakdown of nerve cells and their connections in the frontal and temporal lobes of the brain. These are the areas generally associated with personality, behavior, and language. Common symptoms affect behavior, personality, thinking, judgment, and language, and movement.
Mixed dementia: Autopsy studies of the brains of people 80 and older who had dementia indicate that many had a combination of several causes, such as Alzheimer's disease, vascular dementia, and Lewy body dementia. Studies are ongoing to determine how having mixed dementia affects symptoms and treatments.
Common Comorbidities with Dementia:
Dementia however can also be caused by other disorders, or can occur concurrently with another disorder, some of the main ones are:
Congestive heart failure
Chronic skin ulcers
These are typically mild symptoms, of dementia, and can be missed or overlooked due to the gradual onset of the symptoms.
The main symptoms of the early stage are:
Losing track of time
Getting lost in familiar locations can look like “wandering” as well
Trouble handling money
Taking longer to complete normal daily tasks
As the disease progresses, the symptoms get more severe. Symptoms here are many and are harder to ignore. They may need help eating, getting dressed, and using the toilet.
Main symptoms of the moderate stage:
Forgetting events, people’s names (including friends and family)
Confusion and disorientation even at familiar places (such as getting lost at home)
Repetitive or impulsive behavior
Delusions, which is believing things that are irrational and untrue about the world
Paranoia and suspicion of carers or family members
Speech and language problems, with difficulties in communicating with others
Difficulty with tasks that involve spatial abilities such as measuring distance
Needing help with personal hygiene and daily living tasks
By this stage, the individual suffering from Dementia will be almost completely dependent on others to be able to perform daily tasks. They would not be able to respond to their immediate surroundings, speak and communicate their needs, and control physical movement.
The main symptoms of the Late-stage are:
Difficulty eating, moving, or changing position without assistance
Difficulty controlling urine and bowel movement
Loss of speech
Problems with short-term and long-term memory
Unaware of time and place
Behavior changes such as aggression
The first step to diagnosing any mental health or other physically related conditions is to exclude any other possible physical conditions.
A diagnosis requires a qualified professional to examine the individual. Only trained healthcare providers can diagnose and/or treat any mental health condition, and others that are specifically trained to diagnose and treat these conditions (such as a psychologist, psychiatrist, neurologist, geriatric psychiatrists).
There are a number of ways to diagnose these conditions, and no single test can determine the presence of the condition or disease. Therefore doctors will review and evaluate a person’s medical history, symptoms, conduct evaluations, brain scans, and lab tests. Some of these are as follows:
Cognitive and Neuropsychological tests: These are tests that can evaluate one’s thinking ability, and test a person’s memory, reasoning, judgment, language skills, and attention
Neurological Evaluation: tests that are used to evaluate language ability, visual perception, attention, problem-solving, movement, senses, balance, reflexes, and other areas.
Brain scans: Some scans that can be done are a CT scan, MRI scan, and PET scans
Various lab tests that can detect physical problems that affect overall brain function, which could indicate signs of Alzheimer’s disease or Dementia
The psychiatric evaluation may uncover patterns of loss of skills and functions. The evaluation can also determine what an individual is able and unable to do when it comes to known impairments with dementia and Alzheimer’s disease
Dementia’s symptoms can be managed and improved with proper treatment, medications, lifestyle changes, and different approaches to therapies. As Dementia is not a curable syndrome, these methods play a significant role in the overall wellbeing and outlook of the individuals suffering from it.
Medication directly aimed at the Dementia are:
Cholinesterase Inhibitors: Medications that work on increasing the level activity involved in memory and judgement.
Generic brand names for those medications include:
- Galantamine (Razadyne)
- Donepezil (Aricept)
- Rivastigmine (Exelon)
Memantine: Medications that work on regulating brain functions such as learning and memory. It can go under the generic brand name of Namenda
Medications that treat symptoms that may not be directly attributed to Dementia or Alzheimer's, however would mitigated symptoms related to comorbid disorders.
These medications can involve:
- Antipsychotic Medications - mitigate symptoms of aggression, frustration, delusions, and hallucinations
- Anxiolytics - Medications that help mitigate anxiety
- Antidepressants - A class of medications aimed to reduce the symptoms of depression
Therapies: Multiple forms of therapies are available to help tackle a few of the symptoms and behavior problems.
The evidence-based approach aimed at dementia is known as Cognitive Stimulation Therapy
Cognitive Stimulation Therapy (CST): An evidence based treatment for invidivuals that suffer with mild to moderate dementia. There groups typically involve bi-weekly sessions that aim to engage people with dementia, while providing a learning environment tailored to meet their needs. CST has been found to improive general cognitive functioning, language comprehension and production, and quality of life. CST has shown an improvement in the quality of life of both the individuals suffering from Dementia, as well as their carers.
Healthy diet and lifestyle: Research suggests that developing a consistently healthy diet, adequate sleep, and exercise plan can play a big factor in mitigating symptoms and improving the quality of life. Guidelines by the WHO recommend this to reduce the risk of cognitive decline and dementia.
World Health Organization (WHO) and Dementia
The WHO, in partnership with Member States, and Non-state actors, has organized efforts aimed at the prevention of Dementia, and the creation of the support needed by the individuals and their carers. The goal is to improve the health and well-being of those affected by dementia.
This is being done through multiple interventions organized by the WHO. These interventions include the following:
The endorsement of a comprehensive plan called “Global Action Plan on the public response to dementia 2017-2025”
Launch of the “Global Dementia Observatory (GDO)”, which is an international surveillance platform for sharing information on dementia, policies, and research
The launch of “GDO Knowledge Exchange Platform”, serves to complement the GDO, and contains key information on tackling Dementia through multiple domains, such as public health plans, awareness initiatives, information on risk factors, treatment, career support, key knowledge, and information on dementia, and research
Development of a guide for countries to initialize a plan for Dementia in their country which includes tools that help preparation and implementation of a country-wide plan to tackle it
Development of “guidelines on risks reduction of cognitive decline and dementia”. Which provides recommendations and interventions to reduce risk factors of dementia on a country-wide level. This was coupled with the launch of the mDementia Programme, which is the use of wireless applications and devices to complement and support medical and public health practices.
Development of skills and training program for carers of people with dementia named “iSupport”. Centers on providing the skills and training required of being a caregiver, and improving the quality of life of those caring for people with dementia.
When put together, all of these interventions aim to tackle Dementia on a holistic level, with milestone goals set in place by the year 2025. The WHO acknowledges that without a cure for Dementia, these goals are set to reduce the onset of Dementia in the global population, and ease the overall burden it is causing worldwide.
These milestones require the cooperation of multiple levels of government, the private sector, the scientific community, and social care systems
By the year 2025, the WHO has implemented multiple global targets to achieve these milestones, which are as follows:
The development of frameworks and strategies for dementia in countries worldwide
A minimum of one functioning public awareness campaign on dementia in all countries
A minimum of one dementia-friendly initiative, which must be highly inclusive of people living with dementia in each country
A minimum 50% of the estimated number of people with dementia to be diagnosed by 2025
Provide support and training programmes for carers and family members of dementia
Routine collection of core dementia indicators through health and social systems every 2 years
Doubeling the output of global research efforts on Dementia
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM–5). American Psychiatric Association, 2013.