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Yumna Fatima Dar
Jul 31, 2023

Shadows of Memories: Understanding the Enigma of Dementia

Written By Yumna Fatima Dar


1.1 Introduction

Dementia is a clinical syndrome characterized by a significant loss of cognitive and emotional abilities, involving a decline in memory, thinking, and reasoning abilities, that interferes with daily functioning and quality of life. Dementia is not a disease in its own right and is not a natural part of ageing rather its symptoms are caused by different neurological diseases that affect the brain such as “Alzheimer’s disease”. It occurs primarily late in life; the prevalence is about 1 % at the age of 60 years and doubles every five years, to reach 30-50 % by the age of 85.1

Fig 1 Temporal Trend of Dementia incidence in different age groups.2



1.2 Article Structure at a Glance

This article intends to explore the different forms, underlying causes, and the impact of dementia on the affected people and their caregivers. Moreover, this article will shed light on the early signs and symptoms that often serve as crucial indicators for timely diagnosis as well as the diagnostic processes used to identify dementia. This article will explore the existing treatment and management options available.


2.1 Types of Dementia

Various neurodegenerative disorders and factors contribute to the development of dementia through a progressive and irreversible loss of nerve cells and brain functioning.3 Different types of Dementia are associated with particular types of brain cell damage in specific region of the brain. Types of Dementia include:


1) Alzheimer’s Disease:

Alzheimer ’s disease is the most common cause of Dementia diagnosis. It is caused by changes in the brain, including abnormal buildups of proteins known as amyloid plaques and tau tangles. Plaques are clumps of a protein called beta-amyloid. Tangles are fibrous masses made up of tau protein. It is believed that these clumps damage healthy brain cells and the fibers connecting them.4

Fig 2 Major Pathological Hallmarks of Alzheimer’s Disease5


2) Vascular Dementia

Vascular Dementia is a form of dementia caused by damage to the blood vessels that supply blood containing oxygen and nutrients to the brain. Damage to these Blood vessels can cause stroke or affect the brain in other ways, by damaging the fibers in the white matter of the brain. The most common symptoms of vascular dementia include problems with problem-solving, slowed thinking, and loss of focus and organization and these symptoms tend to be more noticeable than memory loss.6

Fig 3 Cerebo Vascular Occlusion7

3) Lewy Body Dementia

Lewy Body Dementia is a form of dementia caused by abnormal deposits of the protein alpha-synuclein, called Lewy bodies.8 Lewy bodies are balloon like clumps of protein. Common symptoms of this type of Dementia include visual hallucinations, uncoordinated movement, tremors, muscle rigidity and stiffness, known as parkinsonism. It primarily affects a person’s motor skills.


Fig 4 Aggregates of Lewy Bodies within the Brain10


4) Frontotemporal Dementia

Frontotemporal dementia (FTD) refers to a group of disorders caused by progressive nerve cell loss in the brain's frontal lobes or its temporal lobes. The nerve cell damage caused by frontotemporal dementia leads to loss of function in brain regions, which variably cause deterioration in behavior, personality and difficulty with producing or comprehending language.11


Fig 5 Brain regions affected by Frontotemporal Dementia12

5) Mixed Dementia

Mixed dementia’ is a condition in which a person has more than one type of dementia. Alzheimer’s disease and vascular dementia is the most common type of mixed dementia.13

6) Reversible Dementia (pseudo-dementia)

Many factors can cause symptoms that mimic Alzheimer disease. These symptoms are known as reversible dementias. Unlike Alzheimer disease, they can be cured with proper treatment. Some factors that may lead to reversible dementias include depression, Poor eating habits, neuro Syphilis, hypothyroidism, normal pressure hydrocephalus and Lyme disease.14

3.1 Signs and Symptoms of Dementia

The general signs and symptoms of dementia include Experiencing memory loss, poor judgment, Difficulty speaking, understanding and expressing thoughts, or reading and writing. Symptoms also include Repeating questions, Taking longer to complete normal daily tasks and Losing interest in normal daily activities or events. Affected people may hallucinate and experience delusions and paranoia as well as act impulsively. 15

3.2 Impact of Dementia on Patients

Dementia affects cognitive function and memory as its impact on patients can be profound and wide-ranging, affecting various aspects of their lives including:

  1. Cognitive Decline: Dementia causes a gradual decline in cognitive abilities, such as memory, attention, reasoning, and problem-solving which is why patients may struggle with everyday tasks and lose the ability to recognize familiar people or places.

  2. Emotional Changes: Patients with dementia often experience mood swings, anxiety, depression, and irritability.

  3. Loss of Independence: Patients of dementia may find it increasingly challenging to perform daily activities such as dressing, bathing, cooking, and managing finances independently.

  4. Communication Difficulties: Dementia can affect language skills, making it challenging for patients to express themselves or comprehend what others are saying.

  5. Disturbances in Sleep Patterns: Dementia can disrupt sleep patterns, leading to insomnia or increased daytime sleepiness, which can further affect cognitive function and overall health.

Fig 6 Adverse Impacts of Dementia on Patients16


3.3 Impact of Dementia on Caregivers

  1. Physical Strain: The physical demands of caregiving, including lifting, assisting with mobility, and managing incontinence, can lead to physical strain for caregivers.

  2. Financial Burden: Dementia care can be expensive due to medical costs, home modifications, and professional assistance, placing a financial strain on the care giver.

  3. Social Isolation: Caring for a person with dementia may limit the caregiver's ability to engage in social activities.

  4. Mental Health Difficulties: Caregivers are at a higher risk of developing mental health issues like depression and anxiety.

  5. Coping with Challenging Behaviors: As dementia progresses, individuals may display challenging behaviors like agitation, aggression, or hallucinations. These behaviors can be difficult for caregivers to manage and understand.

Fig 7 Caregiver and a Patient affected by Dementia17


4.1 Existing Diagnostic Procedures of Dementia


  1. Cognitive and neurological tests are used to evaluate thinking and physical functioning, by assessing problem solving, language skills, and reflexes.

  2. Brain scans. These tests can identify strokes, tumors, and other problems that can cause dementia. The most common scans include Computed tomography (CT), Magnetic resonance imaging (MRI), and Positron emission tomography (PET).

  3. Cerebrospinal fluid (CSF) tests. CSF is a clear fluid that surrounds the brain and the spinal cord, providing protection, insulation, and nutrients. Doctors collect CSF by performing a lumbar puncture and then Measuring the levels of proteins or other substances in CSF to help diagnose different types of dementia.18

Conclusion:

Raising awareness on dementia is of paramount importance in our society today. This debilitating condition affects millions of individuals and their caregivers worldwide. By increasing public understanding and knowledge about dementia, we can work towards creating a more compassionate and supportive environment for those living with the condition and their families. Raising awareness can help to dispel myths and misconceptions surrounding dementia, reducing stigma and discrimination. Moreover, increased awareness can lead to early detection and diagnosis, enabling individuals to access appropriate care and support at the onset of symptoms. Education on dementia equips caregivers, healthcare professionals, and communities with the necessary tools and resources to provide better care and support for those affected. By emphasizing the importance of raising awareness on dementia, we can advocate for increased research funding, driving advancements in treatment and care. Through collective efforts, we can work towards finding effective interventions and, ultimately, a cure for dementia.


References


12- https://www.buoyhealth.com/learn/frontotemporal-dementia


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