Dementia

Dementia isn’t a specific disease. Instead, dementia describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning.

Though dementia generally involves memory loss, memory loss has different causes. So memory loss alone doesn’t mean you have dementia.

Alzheimer’s disease is the most common cause of progressive dementia in older adults, but there are a number of causes of dementia. Depending on the cause, some dementia symptoms can be reversed.

What Causes Dementia?

The most common causes of dementia include:

• Degenerative neurological diseases. These include Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and some types of multiple sclerosis. These diseases get worse over time.
• Vascular disorders. These are disorders that affect the blood circulation in your brain.
• Traumatic brain injuries caused by car accidents, falls, concussions, etc.
• Infections of the central nervous system. These include meningitis, HIV, and Creutzfeldt-Jakob disease.
• Long-time alcohol or drug use
• Certain types of hydrocephalus, a buildup of fluid in the brain

 

Types of Dementia

Types of dementias that progress and aren’t reversible include:

• Alzheimer’s disease. In people age 65 and older, Alzheimer’s disease is the most common cause of dementia.

Although the cause of Alzheimer’s disease isn’t known, plaques and tangles are often found in the brains of people with Alzheimer’s. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein.

Certain genetic factors might make it more likely that people will develop Alzheimer’s.

• Vascular dementia. This second most common type of dementia occurs as a result of damage to the vessels that supply blood to your brain. Blood vessel problems can be caused by stroke or other blood vessel conditions.
• Lewy body dementia. Lewy bodies are abnormal clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer’s disease, and Parkinson’s disease. This is one of the more common types of progressive dementia.
• Frontotemporal dementia. This is a group of diseases characterized by the breakdown (degeneration) of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior, and language.
• Mixed dementia. Autopsy studies of the brains of people 80 and older who had dementia indicate that many had a combination of Alzheimer’s disease, vascular dementia, and Lewy body dementia. Studies are ongoing to determine how having mixed dementia affects symptoms and treatments.

• Huntington’s disease. Caused by a genetic mutation, this disease causes certain nerve cells in your brain and spinal cord to waste away. Signs and symptoms, including a severe decline in thinking (cognitive) skills, usually appear around age 30 or 40.
• Traumatic brain injury. This condition is caused by repetitive head trauma, such as experienced by boxers, football players or soldiers.

Depending on the part of the brain that’s injured, this condition can cause dementia signs and symptoms, such as depression, explosiveness, memory loss, uncoordinated movement and impaired speech, as well as slow movement, tremors, and rigidity (parkinsonism). Symptoms might not appear until years after the trauma.

• Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without known risk factors. This condition might be due to an abnormal form of a protein. Creutzfeldt-Jakob disease can be inherited or caused by exposure to diseased brain or nervous system tissue. Signs and symptoms of this fatal condition usually appear around age 60.
• Parkinson’s disease. Many people with Parkinson’s disease eventually develop dementia symptoms (Parkinson’s disease dementia).

 

Diagnosis & Treatment

Diagnosis

Diagnosing dementia and determining what type it is can be challenging. A diagnosis of dementia requires that at least two core mental functions be impaired enough to interfere with daily living. They are the memory, language skills, ability to focus and pay attention, ability to reason and problem-solve, and visual perception.

Your psychiatrist in Pitampura, Rohini, Shalimar Bagh, Delhi will review your medical history and symptoms and conduct a physical examination. He or she will likely ask someone close to you about your symptoms, as well.

No single test can diagnose dementia, so psychiatrist in Delhi are likely to run a number of tests that can help pinpoint the problem.

Cognitive and neuropsychological tests

Best psychiatrist in Delhi will evaluate your thinking (cognitive) function. A number of tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention.

Neurological evaluation

Psychiatrist in Shalimar Bagh, Delhi evaluate your memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes and other areas.

Brain Scans

• CT or MRI. These scans can check for evidence of stroke or bleeding or tumor or hydrocephalus.
• PET scans. These can show patterns of brain activity and if the amyloid protein, a hallmark of Alzheimer’s disease, has been deposited in the brain.

Laboratory tests

Simple blood tests can detect physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. Sometimes the spinal fluid is examined for infection, inflammation or markers of some degenerative diseases.

Psychiatric evaluation

A mental health professional can determine whether depression or another mental health condition is contributing to your symptoms.

Treatment

Most types of dementia can’t be cured, but there are ways to manage your symptoms.

Medications

The following are used to temporarily improve dementia symptoms.

• Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.

Although primarily used to treat Alzheimer’s disease, these medications might also be prescribed for other dementias, including vascular dementia, Parkinson’s disease dementia, and Lewy body dementia.

Side effects can include nausea, vomiting, and diarrhea.

• Memantine. Memantine (Namenda) works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory. In some cases, memantine is prescribed with a cholinesterase inhibitor.

A common side effect of memantine is dizziness.

• Other medications. Your doctor might prescribe medications to treat other symptoms or conditions, such as depression, sleep disturbances or agitation.

Therapies

Several dementia symptoms and behavior problems might be treated initially using nondrug approaches, such as:

• Occupational therapy. An occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior, and prepare you for the dementia progression.
• Modifying the environment. Reducing clutter and noise can make it easier for someone with dementia to focus and function. You might need to hide objects that can threaten safety, such as knives and car keys. Monitoring systems can alert you if the person with dementia wanders.
• Modifying tasks. Break tasks into easier steps and focus on success, not a failure. Structure and routine also help reduce confusion in people with dementia.

Clinical trials

Dementia symptoms and behavior problems will progress over time. Caregivers might try the following suggestions:

• Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don’t rush the response. Present one idea or instruction at a time. Use gestures and cues, such as pointing to objects.
• Encourage exercise. Exercise benefits everyone, including people with dementia. The main benefits of exercise include improved strength and cardiovascular health. There is growing evidence that exercise also protects the brain from dementia, especially when combined with a healthy diet and treatment for risk factors for cardiovascular disease.

Some research also shows physical activity might slow the progression of impaired thinking in people with Alzheimer’s disease. And it can lessen symptoms of depression.

• Encourage activity. Plan activities the person with dementia enjoys and can do. Dancing, painting, gardening, cooking, singing, and others can be fun, can help you connect with your loved one, and can help your loved one focus on what he or she can still do.
• Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup, and active family members. Leave nightlights on in the bedroom, hall, and bathroom to prevent disorientation.

Limiting caffeine, discouraging napping and offering opportunities for exercise during the day might ease nighttime restlessness.

• Encourage keeping a calendar. A calendar might help your loved one remember upcoming events, daily activities, and medication schedules. Consider sharing a calendar with your loved one.
• Plan for the future. Develop a plan with your loved one while he or she is able to participate that identifies goals for future care. Support groups, legal advisers, family members and others might be able to help.

You’ll need to consider financial and legal issues, safety and daily living concerns, and long-term care options.

Alternative medicine

Several dietary supplements, herbal remedies, and therapies have been studied for people with dementia. Some may be beneficial.

Use caution when considering taking dietary supplements, vitamins or herbal remedies, especially if you’re taking other medications. These remedies aren’t regulated, and claims about their benefits aren’t always based on scientific research.

Some alternative medicines for Alzheimer’s disease and other forms of dementia that have been studied include:

• Vitamin E. Evidence for taking vitamin E to slow Alzheimer disease is soft. Doctors warn against taking large doses of vitamin E because it may have a higher risk of mortality, especially in people with heart disease.
• Omega-3 fatty acids. There is some evidence that eating fish three times a week might lower your risk of dementia.

However, in clinical studies, omega-3 fatty acids haven’t significantly slowed cognitive decline in mild to moderate Alzheimer’s disease. More research is needed.

• Ginkgo. Although ginkgo is considered safe, study results have been inconsistent in determining whether ginkgo helps people with dementia.

Other therapies

The following techniques may help reduce agitation and promote relaxation in people with dementia.

• Music therapy, which involves listening to soothing music
• Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia
• Aromatherapy, which uses fragrant plant oils
• Massage therapy
• Art therapy, which involves creating art, focusing on the process rather than the outcome

Contact Dr. Prashant Goyal, psychiatrist in Rohini, Pitampura, Shalimar Bagh, for better treatment of dementia.