What is dementia?
Dementia is a condition characterized by a chronic decline in
mental abilities, especially memory. The higher functions of man
include memory, orientation in time and place, intelligence,
reasoning, speech, self care etc. Dementia implies global
reduction in higher functions. Memory is usually the first to be
lost but loss of memory alone is amnesia. When memory is lost and
he can’t recognize relations or look after his daily habits then
the person is demented. The affected person may have problems
doing things he used to do. He may become confused when given too
many things to do at the same time. He may also become more
aggressive. Dementia also requires the illness to be chronic. If a
person is old, has fever and then is confused that is not
dementia.
Is dementia related to age?
Dementia is not a normal part of the aging process. It may be
caused by many disease conditions and can affect the young as well
as old but certainly is commoner in older persons.
What causes dementia?
The two commonest diseases causing dementia are vascular disease
of brain (less blood supply to brain) and a degenerative disorder
called Alzheimer’s disease. Several other rare degenerative
diseases can also cause dementia. Perhaps more important are
conditions that cause reversible forms of dementia:
Reactions to medications such as those given for the treatment
of hypertension, arthritis and certain neurological problems.
Emotional distress caused by major life changes such as
retirement, divorce or loss of someone dear.
Metabolic disturbances because of kidney or liver failure,
pancreatic diseases or blood electrolyte imbalances.
Endocrinal abnormalities such as hypothyroidism or adrenal gland
abnormalities.
A blood clot on the surface of the brain exerting pressure and
causing a state of confusion.
Diseases such as brain tumours, nutritional deficiencies,
infections and problems of vision and hearing that may lead to
conditions similar to dementia. Among infections an important
recent cause is HIV disease and the human variant of Mad Cow
disease.
What are the symptoms?
Symptoms of dementia are short-term memory loss, inability to
think through problems, inability to complete complex tasks
without detailed instructions and confusion. The person may have
difficulty in concentrating for a long time and may show
inappropriate or bizarre behaviour. He may get disoriented about
time, people and places and may neglect personal safety, hygiene
and nutrition. He may keep forgetting what he did recently whether
he has eaten or not etc. Memory consists of 3 types immediate
memory (remembering a phone number) short term memory and long
term memory of past events. The last one is rarely lost so just
because a person remembers what happened 20 years ago does not
mean his memory is good. What he remembers of yesterday or today
is more important.
How is the condition diagnosed?
The first step is to confirm the presence of dementia. This is
done by examination and by asking questions about the day, date
and month or subtracting one number from the other, telling
something and checking after 5 minutes if that could be recalled.
The next step is to look for the causes of dementia given in the
beginning by careful examination. A MRI or CT Scan will tell if
the patient has diseases like tumour, stroke, clot etc. or may
suggest degenerative disease by showing atrophy of the brain.
Nowadays a test for HIV disease and syphilis should be done.
Deficiency of thyroid function (hypothyroid) and deficiency of
some vitamins especially B12 and Folate should be checked. Lastly
one should be careful of Pseudodementia.
What is Pseudodementia?
This is a condition that looks like dementia but is actually due
to psychologic problem like depression. The patient is depressed
so he does not look after his clothes and when asked anything will
say “ I don’t know”, suggesting he has poor memory and
orientation. This repeated “I don’t know” is an important pointer.
A patient of Alzheimer disease if asked the name of a month or
year will always give an answer eg. Jan 1968 but a depressed
person just keeps saying “I don’t know”, “I can’t remember” etc.
Pseudodementia may form upto 10% of causes referred for dementia.
How is dementia treated? Treatment includes a combination of medications, behavioural
strategies and environmental interventions. A person with dementia
should be under the care of a neurologist and a psychiatrist. Care
should be taken to prevent deterioration of the condition by
controlling the blood pressure and monitoring and treating high
blood cholesterol and diabetes. All treatable causes of dementia
outlined before should be looked for and treated.
Drugs may be prescribed to treat behavioural problems such as
anxiety, depression, agitation or problems related to sleep.
A healthy, well balanced diet may help in maintaining an overall
good health. Family members and friends may assist such people in
their physical activities. They may assist in keeping them
informed about the things happening around them by talking to them
and giving them a patient hearing. It should be seen that their
room is well lit and a proper temperature is maintained to avoid
inconvenience to the person. Certain bold colours may be used to
denote important areas in the room. Efforts should be directed
towards providing the maximum ease and comfort to the person so
that behavioural problems are not aggravated.
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