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Dementia

By HopeQure

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16 Jan 2018

Dementia is a syndrome that affects various cognitive functions of the brain. The term syndrome basically means a collection of different symptoms and signs that group together and present in different ways. Therefore, the signs and symptoms of dementia will differ from other cognitive disorders.

Dementia includes disturbances in various areas of functioning including1,2,:

  • Deficits in memory: Like keeping track of a conversation at a given moment, remembering a grocery list, etc.
  • Deficits in learning: Difficulty in retaining new material, issues in applying what is learnt, etc.
  • Communication difficulties: Issues manifest in the form of significant difficulties in understanding written and spoken language.
  • Issues in organizational skills: For example difficulties in organizing important documents
  • Issues in executive functions: Resuming tasks after interruptions, planning a meal etc
  • Deficits in recognition: Failure in recognizing family relatives, or close friends, etc.
  • Disorientation: Includes difficulty in pointing out what time of the day or day of the week it is.
  • Mood and behaviour changes: Symptoms include general apathy towards family and close ones, verbal or physical aggression incidents, depressed mood, significant anxiety, etc.

These symptoms present in various ways and need careful evaluation. An important area of evaluation is determining the effect of these issues on a person’s everyday functioning. Dementia can cause significant challenges in leading a normal life for the patient and their family because of its pervasive effects.

Assessing dementia requires in depth information of symptom development as well as neurocognitive assessments. Trained professionals such as neurologists, psychiatrists and clinical psychologists can conduct diagnostic interviews and plan management plans for dementia.

Types of Dementia

There are different conditions that can cause dementia. These underlying conditions are therefore considered different clinical presentations of dementia1,2,3.

  • Dementia in Alzheimer’s disease: Alzheimer’s disease is caused due to the accumulation of certain proteins in the brain that interfere with nerve cell functions. Dementia caused by Alzheimer’s disease presents very gradually and continues to progress over years. Its symptoms include memory loss, language issues, and disorientation.
  • Vascular Dementia: Vascular dementia is possible after brain episodes called strokes. Strokes cause damage and injury to specific brain areas and surfaces. This can lead to the development of cognitive impairments. Due to this, dementia symptoms such significant decline in attention and executive functions may develop in the aftermath of such episodes.
  • Dementia due to Parkinson’s disease: Parkinson’s disease is caused by issues in certain proteins in the brain. It can cause damage to different brain areas and lead to cognitive decline.
  • Dementia due to traumatic brain injury: Impact of brain injuries can cause neuro-cognitive issues such as disorientation, confusion, memeory loss, changes in walking, etc.

Other probable causes of dementia include HIV infection, substance use and other medical disorders.

Treatment of Dementia

Currently available treatments for dementia can improve or at best, delay cognitive decline but cannot reverse the degeneration of brain cells3. Nonetheless, timely and effective management of dementia is widely recommended. The following are some treatment approaches that target dementia symptoms3,4:

  • Pharmacological Treatment: Depending on what type of dementia a person presents with, medical professionals such as psychiatrists can prescribe different medications. These medications aim at improving memory, concentration and thinking to some extent. In addition, behavioural symptoms like agitation, depression, etc can also be managed to some levels.
  • Psychotherapy: Psychotherapeutic approaches are often applied to managing behavioural and emotional symptoms of dementia. Cognitive behavioural therapy has been found to have significant benefits in treating depressive symptom in dementia. Interpersonal therapy is also opted for in assisting individuals and their family members deal with behavioural issues such as aggression.
  • Behavioural interventions: Various behavioural interventions are applied in managing symptoms such as apathy, and verbal & physical agitation. Interventions include systematic recording of behaviour, and identifying possible triggers such as in the A(Antecedent)-B (Behaviour)-C (Consequence) method. The analysis provides productive information related to behaviours from the patient’s perspective. For example, a patient may report feeling restless or annoyed (Behaviour) only when they are about to meet unknown people or have to see a visitor leave (A). This then leads them to get distressed (Consequence).
  • Cognitive Stimulation: Cognitive stimulation involves activities and exercises that help improve memory, attention, concentration and language abilities. Tasks include exercises with numbers, colours, use of art projects (drawing, painting for example), etc.

Various efforts are underway at improving existing modules of treatment of dementia as well as developing additional approaches. An important consideration in the treatment procedures is now given to caregiver factors whereby distress and emotional impact caused to the close family members is also focused on.

References:

1. American Psychiatric Association. (2013). Neurocognitive disorders. In Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: Author.

2. World Health Organization (1993). Organic, including symptomatic, mental disorders. In International classification of diseases-Classification of mental and behavioural disorders (5th ed.). Geneva: Author

3. Nufflield Council on Bioethics. (2009). Dementia: Ethical issues. Retrieved from http://nuffieldbioethics.org/wp-content/uploads/2014/07/Dementia-report-Oct-09.pdf

4. Overshott, R. & Burns, A. (2005). Treatment of dementia. J Neural Neurosurg Psychiatry, 76, 53-59. doi:10.1136/jnnp.2005.082537

Dementia

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