Understanding dementia

Dementia is a general term used to indicate that a person has developed difficulties with reasoning, judgment, and memory. People who have dementia usually have some memory loss and difficulty with at least one other area, such as speaking or writing coherently (or understanding what is said or written), recognizing familiar surroundings, planning and carrying out multi-step tasks.

Dr. Ian Shyaka

For one to be considered dementia, these changes must be severe enough to interfere with a person’s independence and daily activities.

Dementia can be caused by several different brain disorders. The most common cause is Alzheimer disease, which is associated with the death of nerve cells (neurons) in important parts of the brain. Alzheimer disease accounts for 60 to 80 percent of all cases of dementia.

Vascular dementia in which one has lost or damaged areas of brain because of reduced blood flow and this can happen when the blood vessels in the brain get clogged with blood clots or fatty deposits. This form of dementia is more common among people who have had strokes or are at risk for strokes, especially those with longstanding high blood pressure and diabetes.

Other causes of dementia include; formation of abnormal protein structures called lewy bodies within the brain cells (Dementia with Lewy bodies), Parkinson disease dementia. Dementia can also be caused by cumulative damage to the brain, which can occur in people with chronic alcoholism or repeated head injuries (e.g., among former professional boxers, football players or rugby players).

Many persons at more advanced old age (85 and greater) have more than one cause of dementia, for example, Alzheimer disease and vascular dementia.

Who is at risk?

Each form of dementia has its own risk factors, but most forms have several risk factors in common.

The biggest risk factor for dementia is age: dementia is uncommon in people younger than 60 years old.

Some forms of dementia have a heritable component, meaning that they tend to run in families. Having a close family member with Alzheimer disease increases your chances of developing it. People with a first-degree relative, such as a parent or sibling, with Alzheimer disease have a 10 to 30 percent chance of developing the disorder. The risk is higher if the family member developed Alzheimer disease at a younger age (less than 70 years old) and is lower if the family member did not get Alzheimer disease until late in life.

Some evidence shows that high blood pressure, smoking, and diabetes may be risk factors for dementia. Lifestyle factors have also been implicated in dementia; hence people who remain physically active, socially connected, and mentally engaged seem less likely to develop dementia later than people who do not do these things.

Symptoms of dementia

Each form of dementia can cause difficulty with memory, language, reasoning, and judgment, but the symptoms are often slightly different. These differences are usually noticeable only to skilled healthcare providers who have experience working with people with dementia.

The earliest symptoms of dementia (usually secondary to Alzheimer disease) are gradual and often subtle. Many people and their families first notice difficulty remembering recent events or information. Other changes can include; confusion, difficulties with language (e.g., not being able to find the right words for things), difficulty with concentration and reasoning, problems with complex tasks like paying bills, getting lost in a familiar place.

As the disease progresses, a person’s ability to think clearly continues to decline, hence their personality and behavior deteriorate and one can experience challenges such as; increased anger or hostility and at times some people become very passive, hallucinations and/or delusions, disorientation, needing help with basic tasks (eating, bathing, dressing), incontinence (leaking urine or feces)

The number of symptoms and speed with which symptoms progress can vary widely from one person to the next. In some people, severe dementia occurs within five years of the diagnosis; for others, the process can take more than 10 years.

It is important to know that not all memory loss problems are due to dementia as normal age-related changes usually cause minor difficulties in short term memory and a slowed ability to learn and process information. These changes are usually mild and do not worsen greatly over time in normal aging, nor do they usually interfere with a person’s day-to-day functioning.

The diagnosis of dementia is usually made by interacting with the person and speaking with his or her family members and gathering information of the person’s problem. Memory and other cognitive (thinking) tests to assess the person’s degree of difficulty with different types of problems and the results of these tests monitored over time can be done in some settings.

Brain scans (either CT or MRI) are usually performed in people with dementia to rule out other problems. Blood tests may also be performed to see if a chemical or hormonal imbalance or vitamin deficiency is contributing to the person’s difficulties.

Dealing with dementia

The treatment for dementia depends in part on the type of dementia. People with vascular dementia should focus on getting their blood pressure and cholesterol under control to reduce the risk of further damage to the brain such as stopping smoking. People with dementia with parkinsonism, sometimes need medications used to manage Parkinson disease.

Although there is currently no cure for Alzheimer disease, there are a number of medications that may help to control some of the symptoms of Alzheimer disease. These include medications to manage memory as well as behavioral problems.

A major issue for caregivers of people with dementia is being sure the person stays safe. Because many people with dementia do not realize that their mental functioning is impaired, they try to continue their day to day activities as usual. This can lead to physical danger, and caregivers must help to avoid situations that can threaten the safety of the patient or others such as driving, falling, and cooking.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital.