Dementia

A person can be suspected to have dementia if he/she exhibits the following symptoms:

• A progressive loss of memory, which may start as simple forgetfulness and gradually increase to an extent where the person cannot recollect vital information, such as his/her name or address.
• Problems in performing basic tasks, such as grooming, dressing, and eating, that he/she could previously complete with ease.
• Difficulty establishing new memories and learning new things.
• Loss of ability to communicate effectively; the patient may struggle to remember even simple words.
• The patient is often confused and disoriented.
• Other psychological symptoms, such as anxiety, depression, inappropriate behavior, paranoia, and hallucinations, may also be present.

There are many causes of dementia that result in various neurological disorders, including:

• Dementia of Alzheimer’s Disease: This is the most common type of dementia, accounting for 70-80% of all cases. Patients with Alzheimer’s disease exhibit brain abnormalities, such as the deposition of beta-amyloid proteins or plaques and tangles, which damage healthy neurons and are thought to cause symptoms. Additionally, there is a loss of connection between neurons that transmit messages between different parts of the brain and from the brain to muscles and organs in the body.
• Fronto-temporal Dementia: This type of dementia results from the degeneration of nerve cells in the brain’s frontal and temporal lobes, leading to personality changes, mood alterations, and abnormal behavior.
• Vascular Dementia: This occurs when the blood supply to the brain is compromised by a stroke, injury, or abnormal blood pressure, damaging neurons and resulting in memory problems and cognitive decline.
• Lewy-body Dementia: Lewy bodies are abnormal clumps of protein found in the brain associated with neurological diseases like Alzheimer’s and Parkinson’s disease. This type of dementia is characterized by stiffness, rigidity in the body, and slow, uncoordinated movements.
• Other Brain Disorders: Certain neurological conditions, such as traumatic brain injury, Huntington’s disease, and Creutzfeldt-Jakob disease, may also cause dementia symptoms like memory loss and speech difficulties.
• Mixed Dementia: This type occurs due to an overlap of different causes.
• Progressive Dementia: All types of dementia described above are progressive and often begin with mild symptoms. There is currently no possibility of a complete cure for these types of dementia.
• Reversible Type Dementia: These types of dementia can improve if the underlying causative factors are addressed. They may arise from nutritional deficiencies, infections, medication effects, hormonal imbalances, brain tumors, hydrocephalus, excess fluid buildup in the brain, or poisoning. Correcting these causative agents usually helps improve the symptoms.

Certain factors are known to increase the risk of dementia, such as:

• Age: The risk of dementia increases with age, particularly after 65 years. However, it is not a part of the normal aging process, which is a common misconception.
• Family history: The likelihood of developing dementia is higher if a close family member has been diagnosed due to shared genetic factors.
• Chronic illness or diseases: Comorbid conditions such as diabetes and hypertension can elevate the risk of dementia.
• Nutritional deficiencies: A diet lacking in vitamin B complex may increase the risk of dementia.
• Alcohol abuse: Excessive consumption of alcohol is associated with a higher risk of dementia.
• Medications: Certain medications, including antidepressants like amitriptyline, anti-allergy medications like diphenhydramine, benzodiazepines, anticholinergics, and opioids, may increase the risk of dementia.

To evaluate a person with memory loss, the doctor takes a detailed history about the onset of symptoms, notes family history, and evaluates the patient's neurological and psychological condition with physical and cognitive assessments. Certain supporting lab tests and imaging studies may be required to establish the cause of dementia.

Lab Tests: Laboratory tests to evaluate dementia include:

• Thyroid profile total
• Vitamin B-12
• Vitamin D (25-OH)
• Complete blood count (CBC)
• Erythrocyte sedimentation rate
• Protein electrophoresis CSF

These tests check for infectious conditions, autoimmune conditions, or nutritional deficiencies, as these are other potential causes of dementia. Depending on the test results, further detailed tests may be recommended to confirm the findings.

Imaging Studies: Imaging studies useful to study the structural changes to the brain and surrounding vasculature include:

• CT scan (Head)
• MRI brain
• MR angiography brain
• CT angiography brain

Others: Additional evaluations may include:

• EEG (Electro-Encephalograph)
• Electrocardiography (ECG)
• Echocardiography

With timely preventive health check-ups, one can spot and address risk factors for certain diseases that might arise with old age. Read more on the need for preventive health check-ups for the elderly.

Certain types of dementia cannot be entirely prevented. However, making healthy lifestyle choices can help prevent dementia that originates from a poor lifestyle. These lifestyle choices include:

• Consuming a balanced diet rich in vitamins and minerals.
• Regularly exercising for an active physical and social life.
• Engaging in brain-stimulating exercises, such as solving puzzles and reading.
• Avoiding heavy smoking and excessive alcohol consumption.
• Taking proper treatment for comorbid conditions like diabetes, hypertension, thyroid issues, and anxiety.
• Establishing a sleep schedule for adequate and sound sleep.

The treatment for dementia mainly consists of supportive care and treating the causative factors wherever possible. Medical management consists of the following:

Medicines to Improve Cognitive Functions

The common types of medications prescribed to patients with dementia to improve their cognitive symptoms include:

• Acetylcholinesterase inhibitors: These drugs prevent the breakdown of acetylcholinesterase enzymes, helping to manage symptoms but not affecting disease progression. Examples include Donepezil, Galantamine, and Rivastigmine.
• Nerve-protecting medicine: This class of drugs nourishes nerve cells, protects them from damage, and improves their survival. An example is Citicoline.
• N-methyl-D-aspartate (NMDA) agonists: These drugs decrease glutamate activity, controlling symptoms. Memantine belongs to this class.
• Antioxidant drugs: These medications improve dementia symptoms by combating free radicals associated with memory decline. Popular options include Coenzyme Q10, Ginkgo biloba, and Saint John’s Wort.
• Nootropic drugs: This category includes piracetam, which targets α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptors, playing a key role in signal transmission in the brain. It may help decrease cognitive impairment and enhance mental acuity.
• Ibuprofen: A cyclooxygenase (COX) inhibitor that relieves pain, decreases inflammation, and reduces fever. It lowers nitric oxide production, protects neurons from glutamate toxicity, and decreases proinflammatory cytokine production, thereby controlling dementia symptoms.
• Statins: This class of drugs aids in treating certain types of dementia caused by small blockages in blood vessels supplying the brain. Statins may reduce these blockages and improve symptoms.

Medicines to Calm Anxiety and Improve Sleep

Patients with dementia often experience anxiety, irritability, depression, and sleep disturbances. Anti-anxiety or antidepressant medications are prescribed to alleviate these symptoms.

Other Medicines for Reversible Causes of Dementia

• Supplements: Nutritional deficiencies can cause dementia. Correcting these with vitamin supplements such as Polybion SF Syrup and Meg-B12 Capsules may help reverse dementia.
• Antidiabetics & antihypertensives: Treating diabetes with oral hypoglycemic drugs or insulin and hypertension with antihypertensives is essential if dementia is a complication of these comorbidities.
• Antibiotics & anti-inflammatory drugs: Any infection or inflammatory condition in the body must be treated with appropriate antibiotics and anti-inflammatory medications if dementia results from infection or inflammation.

It is important to ensure safety and quality of life for patients suffering from dementia. Caring for a relative or loved one who is suffering from dementia can be challenging and often tiresome. Here are a few things that can help with home care for dementia patients:

• Encourage the person to maintain a diary or calendar to note down important things or days, which will help them remember.
• Always keep the atmosphere at home pleasant, positive, and caring. Never make the patient feel that they are a burden.
• Ensure that the patient has access to important data, such as identity documents, home address, important telephone numbers, etc., at all times. This can help in situations where the patient loses their way home or is unable to remember their identity or whereabouts.
• People with dementia are often at an increased risk of falls due to concurrent motor issues. Hence, ensure that their surroundings are well-lit, spacious, and free of obstacles.
• Do not allow a patient with dementia to drive or operate heavy machinery.

Dementia is a progressive condition that can worsen over time. The treatments currently available are known to slow the progression of the disease but cannot entirely stop it. As dementia gradually worsens, it can lead to the following complications:

• Safety issues: Patients with dementia are at an increased risk of injuries while performing activities such as walking, cooking, and cleaning.
• Personal hygiene: In the later stages, patients may struggle with basic hygiene tasks, including brushing, bathing, grooming, and using the bathroom.
• Nutritional challenges: With advanced dementia, individuals may forget to eat or lose interest in food, leading to various malnutrition-related problems.
• Aspiration or choking: Difficulty swallowing can result in aspiration or choking, potentially causing pneumonia.

• Exercise and Yoga: Performing light exercises can help enhance mood, manage anxiety in patients with dementia, and maintain their physical activity status. These light exercises can include home-based aerobic routines, dancing, lifting light weights, and yoga practices such as Pranayama.
• Physiotherapy and Occupational Therapy: Certain modifications suggested by physiotherapists or occupational therapists may need to be implemented in a patient’s home or work environment to enhance safety and prevent injuries due to falls.
• Massage Therapy and Aromatherapy: Massage therapy and aromatherapy induce relaxation and may be beneficial for patients with dementia.
• Ayurveda: Dementia is referred to as Smrutibuddhirhass in Ayurveda. Panchkarma and medicinal herbs like Shankhpushpi, Guduchi, Brahmi, Ashwagandha, and Shatavari may be useful in treating dementia.

Often, receiving a diagnosis of dementia can be a life-altering and challenging situation for patients and their caregivers. Coming to terms with the diagnosis can invoke feelings of anxiety, depression, anger, rage, and guilt. However, it is important to remember that a diagnosis of dementia does not necessarily mean the end of life. It is possible to live a fulfilling life even after being diagnosed with dementia.

Ensure that the person understands the diagnosis and its health implications.

• Motivate the patient to stay socially active, such as going to a movie or taking a walk in a park.
• Engage them in community activities like attending functions or help them join a support group.
• Encourage them to spend time with friends and family.

Love, understanding, patience, and reassurance are the cornerstones of living with a loved one who has dementia.