Dementia is a condition caused by brain disease. It is typically chronic or unremitting in nature. It disturbs several functions including memory, thinking, calculation, judgment, language as well as learning capacity. However, consciousness is still clear. The function abnormality comes with worsening in social manners, inspiration or emotional direction. Dementia happens in a great number of disturbing the brain (WHO, 7).
The most common form of dementia is the Alzheimer’s disease that comprises the sixty to seventy percent of dementia cases. Other forms of dementia are vascular dementia and dementia with Lewy bodies. Dementia also occurs in mixed forms since the border between subtypes are not very distinguishable (WHO, 7).
The effects of dementia are different in every individual but the problems associated to dementia can be seen in stages called as early stage, middle stage and the late stage. There are periods given to each stage as a guide but the deterioration of the situation can happen in different pace (WHO, 8).
The prevalence of dementia increases noticeably by age. Three to eleven percent of the people older than 65 has dementia while 25 to 47% of people older than 85 has incurred dementia (USPSTF, 1).
Stages of Dementia
As mentioned earlier, dementia is divided into stages named as the early stage, mid stage, late stage and the end stage.
During the early stage, there are obvious symptoms in a number of parts. It includes lack of memory of fresh events and poorer ability in mental mathematics. The early stage also comprises trouble in doing difficult tasks like supervising finances, setting up dinner for visitors or even managing bills. A patient can also forget his own past during this stage that can lead to being reserved or temperamental particularly in mentally and socially demanding circumstances (GHC, 2).
When the so-called mid stage occurred, the memory gaps and absentmindedness are more obvious, and the patient starts to require assistance with his daily activities. At this period, the patient may be incapable to remember his personal address and phone number. Confusion regarding locations and dates are intense. Mental mathematics is also very challenging to the patient. He might also be unable to select appropriate clothing for the weather or occasion. Nevertheless, at this stage, the patient is still able to eat and use toilet normally and still remember family members (GHC, 2).
At the late stage, memory persists to deteriorate, behavioral changes occur and the patient require far-reaching assistance on a daily basis. Individuals might lose consciousness of current occurrences and of their environment. The person can be capable to remember his name although may experience trouble with his history. Moreover, the patient can discern recognizable and strange faces but have problem recalling the name of a husband or wife (GHC, 2).
Furthermore, patient during the late stage require assistance for putting attire properly because he may commit mistakes like having pajamas during a hot day, or wearing shoes on the wrong feet. Restless nights and sleeping on daytime can be experienced due to abnormality in sleeping pattern. The use of toilet will also be a problem. The use of toiletries will be confusing for the patient but the bigger problem is the lack of control in bowels and bladders. The late stage will show major behavioral and personality alterations such as delusions and suspiciousness, compulsiveness and rhythmic activities. It is common for patient to wander around and be lost.
The final stage of dementia comprises of patients being able to speak but might require helping out with the majority of personal care such as eating as well as toilet using. They lose the capability to react to situations and keep on a discussion. They also lose the skill to sit without help, to smile or even to hold up their heads and to direct their movement because their muscles become rigid, swallowing becomes abnormal and they lose control on their reflexes (GHC, 2).
Causes and Symptoms of Dementia
There are several different diseases that cause dementia. However, the reason behind the development of these diseases is unknown in the majority of their occurrences. The most widespread form of dementia is the Alzheimer’s disease characterized by pathological alterations in the brain that causes memory loss, thinking problems, and speaking disability and behavioral changes that will result to an entire functional disability. It is the most frequent type of dementia for the elderly (Alzheimer’s Association, 131).
Alzheimer’s disease causes a regular turning down of cognitive. Alzheimer’s disease is due to two irregularities inside the brain. These are the neurofibrillary tangles and amyloid plaques. The protein termed as tau made up the bundles of twisted filaments that made the neurofibrillary tangles. The beta amyloid proteins form a bundle that clumps together as plaques. Both the tangles and the plaques prevent interactions among nerve cells that cause them to expire (Alzheimer’s Association, 131). Other symptoms of Alzheimer’s disease are social withdrawal, anxiety and paranoia. The disease has slow beginning with enduring deterioration, and it is not caused by any identifiable neurologic, medical or psychiatric circumstances.
Vascular dementia is a brain disease caused by damage to the brain blood vessels. This disease can be brought by occurrence of single or several strokes. When there are evidences of blood vessel disease inside the brain and broken cognitive functions, vascular dementia is detected and it impedes the everyday ability of the patient. The symptoms of vascular dementia start immediately after the occurrence of stroke, or it may start slowly as the disease in the blood vessel deteriorates. The symptoms are different based on the size and location of the brain injury.
The disease may influence one or more cognitive functions. Vascular dementia can be mistaken as Alzheimer’s disease. Moreover, the combination of the two diseases is very common.
Vascular dementia’s symptom involves a laboratory confirmation of cerebrovascular state or focal neurological signs. Patients have white-matter alteration on imaging and generally have a stepwise deterioration.
Another form of dementia is the Lewy body disease. It is characterized by the occurrence of Lewy bodies inside the brain. They are abnormal and unwanted clumps of the alpha-synuclein protein build up inside the nerve cells. The abnormal clumps occur in particular areas of the brain which alters the behavior, movement and thinking of the person who has the disease. Great fluctuations in thinking and attention occur to the patient of this disease, and the condition can go from typical ability to rigorous confusion in just a short time. Another symptom is visual hallucinations. The Lewy body disease overlaps with Parkinson’s disease dementia, Dementia with Lewy bodies, and Parkinson’s disease. Lewy body dementia’s symptoms are irregular cognitive activities, regular visual hallucinations.
Frontotemporal dementia is a continual development of damage inside the brain’s frontal/temporal lobes. Symptoms show during the age of 50s to 60s. The frontal damage affects the behavior and the personality of the affected person while the temporal damage affects the language ability of the person. People with frontotemporal dementia frequently face problems in preserving proper social actions and conducts. Patients could be offensive, ignore usual tasks, be obsessive, and be violent and impulsive.
Treatment for Dementia’s psychological and behavioral Symptoms
The behavioral and psychological symptoms of Dementia (BPSD) is defined by the International Psychogeriatric Association (IPA) as a distressed opinion, thinking, temper or manners that regularly arise from patients with dementia (GHC, 16).
The psychological symptoms are typically and mostly evaluated based on the consultations with patients and their family. The psychological symptoms can be nervousness, depressive temper and delusions (GHC, 16).
Behavioral symptoms are typically recognized based on studying the patient. The symptoms could be physical violence, screaming, agitation, protest, wandering, sexual unshyness, cursing and stalking. It is important to make the family members aware about the symptoms of dementia and that these symptoms are not permanent (GHC, 16).
Treatment must include assessment of the impact of BPSD. It is important to know if the treatment should be focused on patient or caregiver if the housing of the patient will be jeopardized.
While some dementias are curable, curing diseases such as Alzheimer’s have mostly been unsuccessful. However, symptoms of such disease can be managed by some drugs. The majority of the drugs for dementia are employed to cure symptoms in Alzheimer’s. Cholinesterase inhibitors are some examples. The inhibitors could be rivastigmine and donepezile. The activity of the cholinergic brain system increases with the use of the said drugs to stabilize and improve the condition of the patient (NIH, 22).
Another type of medication is NMDA receptor agonists that have the ability to stop the deterioration of the patient’s ability to learn and remember. The NMDA regulates the neurotransmitter activity. Nevertheless, the two types of drugs cannot reverse the progression of dementia (NIH, 22).
- Drugs for supervising the Dementia Lewy Body aim to relieve the symptoms of inflexibility, delusions, and deliriums of patients. Conversely, numerous of the means for curing the symptoms like antipsychotics can actually worsen the mental health of the patient and can aggravate physical warning signs (NIH, 22).
- For the Frontotemporal diseases, there are no drugs allowed to cure or prevent its symptoms. Drugs use for treating Alzheimer’s and Parkinson’s can aid some problems in behavior connected to this disease (NIA, 22).
- For the Parkinson’s disease dementia (PDD), cholinesterase inhibitors are also employed to improve the cognitive condition of the patient. The U.S. Food and Drug Administration allowed rivastigmine to cure PDD’s symptoms (NIH, 22).
At present, there is no existing treatment for the general dementias brought by neurodegeneration such as Alzheimer’s disease, Lewy body dementia as well as frontotemporal disorders. Nevertheless, a number of types of dementia are curable. For the affected individuals to be able to live a normal life again, a deeper understanding of dementia and their treatment analysis is needed. Research activities done by National Institute of Health (NIH) do not stop to search and construct a better dementia approaches for the development of treatments and practices for these diseases.
Alzheimer's Association. “Alzheimer's disease facts and figures.” Alzheimers Dement. 8(2012):131-168.
Group Health Cooperative. Dementia and Cognitive Impairment Diagnosis and Treatment Guideline. Guideline Oversight Group, 2013.
NIH. The Dementias: Hope for Research. National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging (NIA). Web. 2012. www.nia.nih.gov/alzheimers
U.S. Preventive Services Task Force (USPSTF). Screening for dementia: recommendations and rationale. USPSTF web. 2003.
http://www.uspreventiveservicestaskforce.org/3rduspstf/dementia/dementrr.htm. Published 2003.
World Health Organization. Dementia: A Public Health Priority. Switzerland: WHO Press, 2012.