What is dementia?

What is dementia?

Dementia is defined as an acquired decrease in mental abilities in at least two areas (for example: memory and speech, memory and perception, spatial orientation and perception, etc.) and worsens over time. Dementia is a syndrome, ie a set of symptoms (disorders noticed by the patient himself) and signs (what the doctor finds during the examination), which occurs in about 150 different diseases. About 5% of people after the age of 60 suffer from some kind of dementia, and with every 5 years of life, this frequency (prevalence) doubles. Dementias are the diseases that burden caregivers the most and are the most financially demanding (obvious and hidden costs) diseases. Determining the cause of dementia is of great importance for treatment and requires a detailed clinical examination and additional examinations. The most common dementias are Alzheimer’s disease (about 60%), vascular dementia (about 15%), dementia with Lewy bodies (about 10%), frontotemporal dementia (5-10%), while all other causes are only about 5%.

How does dementia manifest itself?
Dementia is manifested by various disorders in memory, speech, attention, perception, thinking, behavior, mood, etc. Manifestations of dementia are classified into three groups: cognitive manifestations (memory disorders, speech, spatial orientation, etc.), behavioral changes and psychological symptoms (anxiety, suspicion, hallucinations, fears, mood swings, etc.) and impaired daily activities. inability to perform professional, household and recreational activities). The first and third groups of disorders are present constantly, and the second occurs either constantly or occasionally at some stage of the disease.

The most common manifestations are as follows:
Memory disorders are initially easier to forget (for example, forgetting dates, days of the week, names of people, etc.) and interfere first with complex professional activities and later with daily home and recreational activities.

There may be difficulties in finding words and later understanding other people’s speech.

Attention deficit disorder occurs in terms of deconcentration and inability to maintain longer and divided attention.

Disorientation in space often occurs, which first manifests itself in an unknown, and then in a familiar environment.

The ability to perform various tasks and solve problems, first difficult professional activities, and later everyday activities, has been reduced.

Various mood swings are possible, such as apathy or depression or irritability, as well as behavioral changes such as passivity, lack of interest, distrust, suspicion, aggression, leaving home and more.

In the final phase of dementia, patients are bedridden, do not communicate, do not control urination and stool, and become susceptible to infections.

A very important question is: Is all forgetfulness the beginning of dementia?
Forgetfulness is not always a sign of illness, and if it does not worsen for at least six months and does not lead to disturbances in the profession and daily work, it is most likely not initial dementia.

If forgetfulness worsens and leads to problems, a medical examination is needed. Dementia can also begin with the appearance of behavioral changes that are not typical for the person in question and that become noticeable to the environment. Sometimes speech, orientation, movement control, attention, thinking and other brain functions appear first.

The examination consists of neurological and psychiatric examination, neuropsychological tests, appropriate laboratory blood tests, brain scanners or magnetic resonance imaging of the brain and other analyzes as needed.

It is very important to determine the type of dementia due to the specific therapy to be used.

What are the causes of dementia?
Dementia occurs as a consequence of various brain diseases, but also diseases that affect other organs and tissues (about 150 of them) that lead to the loss of nerve cells (neurons), and as these cells are practically not restored, most of these diseases worsen over time. three mentioned domains of dementia (cognition, behavior, activities of everyday life).

The two most common forms of dementia are Alzheimer’s disease and vascular dementia.

Alzheimer’s disease is the most common cause of dementia and accounts for more than half of these diseases.

The exact cause of Alzheimer’s disease is not known, and the basis of the disease is the accumulation of amyloid beta protein in the brain, which prevents the transfer of information between nerve cells, for which acetylcholine is especially responsible. Due to that, there is a progressive deterioration of nerve cells, which is most pronounced in the temporal lobes, on their inner side (hippocampus), which leads to memory difficulties. The process of neuronal decay spreads over time in both the parietal and frontal lobes, which leads to disorders of other brain functions.

In typical cases, Alzheimer’s disease begins with memory impairment, difficulty finding words or mood swings. After at least 6 months, problems are noticed in everyday activities, unlike ordinary forgetfulness, which does not get worse. As the disease progresses, other problems can develop, such as personality changes, mood and behavior changes, thinking disorders, and more.

The most significant risk factors for vascular dementia are older age, high blood pressure (greater than 120/80), smoking and high cholesterol, especially “bad” cholesterol, severe or repeated brain injuries, hereditary factors, lower levels of intellectual activity. stimulation) etc.

Other brain diseases that can lead to dementia are: Parkinson’s disease, inflammation of the brain, brain tumors, Huntington’s disease, normotensive hydrocephalus and others.

What are the options for preventing and treating dementia?
So far, no measures are known that would certainly protect against the development of dementia, but numerous studies are underway in this direction. They showed that proper nutrition at a young age and middle age reduces the occurrence of dementia by about 30% (the so-called Mediterranean type of diet) while moderate regular physical activity reduces the risk of dementia by another 30%. Of course, there are various other factors that may or may not be influenced.

Alzheimer’s disease is of unknown cause. There are medications that can possibly slow the progression of the disease, affect the behavior of these patients and to some extent improve intellectual functioning. Administration of cholinesterase inhibitors (donepezyl, rivastigmine, galantamine) increases the level of acetylcholine in the brain and has a beneficial effect on memory and behavior. NMDA glutamate receptor antagonists (memantine) are another group of drugs that alleviate disorders and possibly slow the progression of the disease. New generation neuroleptics are relatively successful in alleviating behavioral disorders without significant side effects.

Patients with vascular dementia should seek professional help to prevent new strokes and treat existing conditions.

Text author:
Prof. Dr. Dragan Pavlović