Dementia: what dementia is, when to worry, and how you can help others

Dementia is a clinical syndrome caused by various diseases and brain injuries. World wide, 47.5 million people I have dementia. Given the dramatic increase in the geriatric population, the number of people with dementia worldwide is expected to double every 20 years, reaching 135.5 million by 2050. Alzheimer’s and Related Disorders Association of IndiaApproximately 5 million people in India have dementia.

Anant (renamed), an 80-year-old retired District Judge, came to our Institute after 18 months of increasingly forgetful memory. He misplaced frequently used items such as keys, mobile phones, and pens. He then continued to search for these items. He was also starting to get lost in and out of the house. He was frequently found trying to find his way around his neighborhood. (His son then had him wear his GPS armband.) His social engagement was shrinking, as was his vocabulary. He also had severe mood swings, becoming more irritable and aggressive over time.

They consulted me after he became paranoid and began to think his family was “trying to catch him”. I was sick.

clinical findings

The most common cause of dementia is Alzheimer’s disease.it is involved in Up to 70% of dementia diagnosesThe tragic combination of Alzheimer’s disease symptoms has a severe and resource-intensive impact on patients, families, friends, and caregivers.

Early symptoms include listlessness, difficulty remembering names and words, difficulty retaining new information, disorientation in unfamiliar surroundings, and decreased social engagement. More atypical symptoms include impairment in recognizing visually presented objects (visual agnosia) despite normal visual field, visual acuity, and color vision. Also, some people have difficulty finding words (aphasia).

As the disease progresses, there is marked memory loss and other cognitive deficits such as reduced vocabulary and less complex speech patterns. This may be accompanied by mood swings, apathy, decreased social skills, and the appearance of psychotic phenomena. Advanced disease is characterized by monosyllabic speech, psychotic symptoms, behavioral disturbances, loss of bladder and bowel control, and reduced mobility.

Dementia assessment

Doctors use neuroimaging and neuropsychological tests to diagnose dementia on clinical grounds. The first and most important step is obtaining an individual’s comprehensive medical history from a reliable informant. A trusted informant is one who knows the individual well. It’s usually a family member. Informants themselves can be affected by mental states such as depression and denial, so talking to multiple informants to confirm or clarify an individual’s account can be helpful.

Years of slowly progressive dementia with insidious onset may indicate dementia of the Alzheimer’s type. Rapidly progressing dementia over several months may indicate dementia due to prion disease. Instead of determining when symptoms first appeared, it is useful to determine when an individual was last well. Informants often minimize early symptoms by attributing them to “normal aging.”

Dementia affects cognition, the mental processes used to acquire knowledge and instill an awareness of our environment. These mental processes also facilitate interaction with the environment. They include perception, complex attention, judgment, memory, language, imagination, social cognition, organization, and learning.

Evaluation of dementia revolves around conducting a cognitive assessment. Common tools for this include the Mini Mental State Examination (MMSE), the Modified Mini Mental State Examination (3MS), and the Montreal Cognitive Assessment (MoCA). Such neuropsychological tests help distinguish dementia from mild cognitive syndrome and/or normal aging. The severity of dementia is ‘mild’, ‘moderate’ or ‘severe’ based on the MMSE score and is informed by the degree of impairment of the individual.

In most cases, further scrutiny using laboratory studies and brain imaging will be required. These include metabolic panels, liver tests, blood counts, thyroid tests, vitamin B12 and folic acid tests. Upon request of clinical presentation and medical history, physicians may request additional tests such as heavy metal screens, HIV testing, syphilis serology, toxicology, electrocardiogram, computed tomography (CT scan), magnetic resonance imaging (MRI), and chest radiography. You may be asked to be tested. .

There are currently no genetic or biomarker tests available for diagnosing dementia.

dementia prevention

of identified by WHO Preventing Alzheimer’s disease is a key component of strategies to combat the global dementia epidemic.Economic analysis found it delays disease onset by even a year Can reduce prevalence by 11%five years later could be halved.

Prevention programs typically focus on lifestyle risk factors such as sedentary behavior, unhealthy diet, smoking and excessive alcohol consumption, as well as mental health and cardiovascular disease risks.

of Gothenburg Longitudinal Study and the Honolulu Asia Aging Study Both show a strong relationship between hypertension in middle age and dementia in later life. Aggressive management of vascular risk factors (such as keeping systolic blood pressure below 160 mmHg), high cholesterol, diabetes and obesity greatly help prevent dementia.

current smoker 50% higher risk The incidence of dementia is higher in people who have never smoked. (It is known that quitting smoking reduces the risk of dementia to the level of nonsmokers.)

Regular exercise can help offset cardiovascular risk as well as wider health risks. Exercise improves brain perfusion, has anti-inflammatory properties, improves synaptic function and stimulates the growth of new brain cells in the hippocampus. Exercise also has social and cognitive components that broadly protect mental health. .

Moreover, there is a strong association between depression in later life and the incidence of sporadic dementia. Depression makes him nearly twice as likely to develop dementia. The detrimental effects of depression on memory, sleep, and social functioning are well established. Treatment of depression in people with established cognitive impairment is extremely important.

Higher education and occupational attainment are consistently implicated in preventing the development of dementia later in life. One recent study found that those with higher education had a 40% lower risk. has been reported. The protective effect of education may be due to longer learning periods, which stimulate the development of larger or more complex neural networks.

Cognitive reserve theory hypothesizes that these brain reserves accumulate through learning, compensate for underlying dementia pathology, and delay the onset of clinical symptoms.

dementia care

The first pillar of care is to manage key aspects of the disease and reverse its effects or slow its progression in the brain. to manage functional symptoms.

The other two pillars include providing systematic, evidence-based supportive care to patients and caregivers.

The optimal dementia care team includes psychiatrists, occupational therapists, physical therapists, nurses, psychologists, and social workers.

Nonpharmacologic interventions form the first line of treatment, except in emergencies. However, over time, medications are often necessary and even an integral part of symptom management.

Cognitive symptoms associated with dementia are treated with drugs called cholinesterase inhibitors. Acetylcholine is a neurotransmitter hypothesized to be important in cognition. Two enzymes, acetylcholinesterase and butyrylcholinesterase, break down acetylcholine. Cholinesterase inhibitors therefore increase the concentration of acetylcholine in the brain. They provide moderate and temporary stabilization of the disease process. However, they do not reverse or stop the denaturation process.

These drugs lead to notable but temporary improvement in symptoms 10-15% of people with dementiaSymptom improvement lasts 6 to 12 months.

Despite the modest immediate benefits associated with these drugs, some additional benefits may be seen in those on long-term treatment. Donepezil and Memantine in Moderate to Severe Alzheimer’s Disease In the (aka DOMINO) study, researchers looked at the effects of continued symptomatic treatment beyond the stage of moderate-to-severe dementia. The group that discontinued symptomatic therapy experienced more rapid cognitive decline, worse functional outcomes, Admitted to care soonerThis study found that cholinesterase inhibitors should not stop Because it reached the stage of severe dementia.

Behavioral and psychological symptoms of dementia include depression, psychosis, agitation, aggression, sleep disturbance, wandering, apathy, and various socially inappropriate behaviors. Together, they promote loss of independence, increase caregiver responsibility, and lead to early placement in nursing care.Non-pharmacological interventions are used to address these problem behaviors.

Neuropsychiatric symptoms of dementia respond moderately to aromatherapy, bright light therapy, music therapy, controlled multisensory stimulation, animal-assisted therapy, physical therapy, occupational therapy, and speech therapy.

Future trends

of A Finnish Elderly Intervention Study to Prevent Cognitive Impairment and Disability (aka FINGER) trial was an effort to understand secondary prevention of dementia. Researchers recruited people aged 60-77 without dementia but with a high dementia risk score (based on age, gender, education, blood pressure, BMI, cholesterol levels and physical activity) and mild cognitive impairment. bottom.

This trial selected a very high-risk population for dementia and tested a multidomain intervention that included changes in nutrition, physical activity, education, and cognitive training. Cognitive outcomes in the intervention group improved by 25-150% compared to controls who received health advice alone.

Future studies aim to demonstrate the benefits of such interventions on time to dementia onset, a key public health outcome. Although controlling risk factors may have great societal benefits, disease-modifying therapies are still needed to reduce the global burden of dementia.

Also, public perceptions of Alzheimer’s disease and other related dementias need to be culturally shifted to fully reap the benefits of prevention and treatment strategies. By moving from dementia to a brain health paradigm, cognitive decline is downplayed, people take more responsibility towards prevention, and comprehensive solutions to maintain functional independence. society is more broadly encouraged to adopt

Let’s rethink dementia care in terms of brain health centers, not in terms of memory clinics.

Dr. Alok Kulkarni is a Senior Geriatric Psychiatrist and Neurologist at the Manas Institute of Mental Health and Neuroscience, Hubli.