Dementia is a term used to describe decreased intellectual functioning that interferes with everyday functions. It affects, fully or in part, two or more cognitive capabilities of the individual, such as language, memory, perception, reasoning or judgment.
It is sometimes incorrectly referred to as “senility” or “senile dementia”, because people who have it commonly are advanced in age. But, experts point out that using the term senile dementia is inaccurate. Dementia can affect people of any age. Some people in their 30’s and 40’s are diagnosed with it.
In general terms, dementia usually occurs at an advanced age, becoming more frequent past the age of 65. Aging is, indeed, one of the most significant risk factors. It is important to understand that dementia is actually the symptom; not the disease itself. In almost all cases, it results from the degeneration of various areas of the brain and is irreversible. The functions and capabilities that are lost cannot be recovered.
There are some instances of dementia-like symptoms that, if detected early, can be reversed. These include brain injuries, tumors, changes in glucose, calcium or sodium levels (in which cases, dementia is considered to be of metabolic origin), or low levels of vitamin B12 in the blood. While these are included in the popular press as forms of dementia, it is more appropriate to use the term only in cases that are non-reversible.
Among the medical conditions that can cause dementia are:
- Huntington’s Disease: a disorder in which certain parts of the brain degenerate. It is a disease that is transmitted from parents to children.
- Brain injury: any trauma can damage brain tissue permanently. Examples are the type of concussions that occur when playing contact sports like football, rugby and boxing.
- Multiple sclerosis: An autoimmune disease that affects the brain and spinal cord.
- Parkinson’s Disease: A condition in which the areas of the brain cells that control movement and coordination breakdown. The disease causes tremors and difficulty in moving or walking.
- Progressive supra-nuclear palsy: A disorder that causes difficulty in movement due to damage to the neurons.
- Infections such as AIDS, syphilis or Lyme disease.
Evaluate your symptoms
If you believe that you or a loved one has dementia, an evaluation of symptoms should include all aspects of the individual’s mental functions. In general terms, emotional or personality behavior, language, memory, perception and thought or judgment can and will be affected.
Prior to the formal presentation of severe symptoms, your loved one will commonly have a condition known as Mild Cognitive Impairment or MCI. MCI is a term adopted by medical professionals to categorize the symptoms when judgment and mental capabilities have declined, but it is premature to make a diagnosis of a dementia disease (like Alzheimer’s). Part of this is due to the fact that the actual diagnosis is complicated without invasive procedures such as spinal fluid taps. In most cases, a diagnosis is a “clinical diagnosis”, meaning that the physician renders an opinion based on several factors including the individual’s performance on tests and their medical history.
When it is dementia, as the disorder gets worse, the symptoms will also become aggravated. The following conditions will become pronounced:
- Difficulty remembering events or recent conversations; mental agility is diminished.
- Loss of social skills and changes in personality, leading to inappropriate and, sometimes, aggressive behavior.
- Problems in communication, due to the inability of the patient to recall the names of familiar objects. Add to this a decreased sense of orientation resulting from their inability to locate objects.
- Increased difficulty in memorization or in the performance of activities that require thinking.
- A loss of judgment as demonstrated by their inability to recognize risky or dangerous actions. A classic example is leaving the stove on even though they are not cooking or in the kitchen.
- Changes in sleep patterns, which increase the risk of hallucinations, delusions; these symptoms may even lead to depression
In the most severe cases, people with dementia are no longer able to perform basic activities, such as eating, bathing or dressing. They may be unable to recognize close family members or understand language.
Prevention
Most psychiatric diseases lack specific preventive measures. In the case of dementia, it is essential to maintain a healthy diet and engage regularly in exercise to maintain physical well being.
In addition, it is important to control other conditions that can increase your risk factors, such as diabetes. Finally, experts recommend that you control blood pressure and avoid smoking.
Causes of Dementia
There are several causes, but the most common are:
- Alzheimer’s Disease: This is the most common form, representing from 60 to 80 percent of all cases. It usually affects the parts of the brain that are responsible for thought, memory and language.
- Vascular Dementia: This is the second most common cause and typically occurs after a stroke. The diminished blood flow to the brain causes brain damage.
Diagnosis
To make a diagnosis, your doctor will perform the following tests:
- A complete physical examination, reviewing, above all, the health of the nervous system.
- A detailed review of clinical history and symptoms.
- An examination of the mental capability to determine if diminished capacity exists.
Treatments
Sadly there are no cures for dementia. The medications that are approved by the FDA have shown limited value and, at best, ameliorate the symptoms for a short period of time. The pharmaceutical industry has invested billions in pursuit of a cure, so far with few promising results. Drugs that show promise in early clinical trials have, in many cases, failed in more exhaustive later-stage trials. Even if a cure were to be discovered today, the process for approving pharmaceutical products is so prolonged that it would not be available commercially during the lifetime of anyone currently diagnosed.
Regardless, there may be an opportunity for the dementia patient to participate in a clinical trial. While it’s unlikely that it will improve the long-term outcome for your loved one, they may find a sense of purpose in using their condition to help others.
At this point, it’s not about the cure. It’s about the care. We cannot change the individual with dementia, but we can do a lot to make their experience better and more positive. We can modify their care environment and we can make changes in the way we interact with them. Certain organizations, like Dementia Friendly Orange County, www.dfoc.org, are working on improving the environment in retail businesses. Increased understanding on the part of all will reduce our frustration and make the caregiving process more fulfilling.
About the Author:
Lorenzo Mejia and his wife, Mary Lynn Ryerson, are the owners of Acorn, a caregiver registry located in Chapel Hill.
They founded Acorn based on their experiences caring for his mom, who suffered with Alzheimer’s Disease. In 2013, he became a Qualified Dementia Care Specialist. In 2014, the Alzheimer’s Foundation named him the Dementia Care Professional of the Year in the United States.
Lorenzo is the founder of Dementia Friendly Orange County an effort to make local businesses more accommodating to people with dementia.
Lorenzo speaks often on dementia and the challenges associated with caring for loved ones. He has been interviewed by ABC News and National Public Radio. He is an advisor to Orange County’s OC-CARES Dementia Capable Community Project.
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