Dementia

What is dementia?

Dementia is not a specific disorder but a syndrome that includes a wide range of symptoms caused due to the damage of brain tissues and cells. Due to this damage, people are affected with neurodegenartive disorders such as Alzheimer'sorParkinson's. The symptoms include memory loss, mood changes, difficulty in thinking and reasoning, problem solving and language which severely inhibit the person's ability to perform everyday activities.

Dementia is progressive; that is, the condition will gradually worsen with time, eventually leading to death.

Note: According to the “Dementia India Report”, it is estimated that over 3.7 million people are affected by dementia in our country. This number is expected to double by 2030.

What is not dementia

  • As people age, they may have memory problems. Physical illness or a mental illness such as depression may also affect memory and this is not a sign of dementia.
  • A person with dementia will have problems with at least two brain functions (memory loss and impaired judgment or language) and may not be able to manage daily tasks independentenly.

Types of dementia

There are many types of dementia; each is named after the disease or condition that causes it.

  1. Alzheimer's disease is the most common type of dementia. Alzheimer's disease usually progresses slowly over seven to ten years. The cognitive functions of the brain slowly decline, and eventually, parts of the brain that control memory, language, judgment, and spatial abilities stop functioning.

  2. Lewy body dementia: Lewy bodies are abnormal clumps of protein that are found in the brain. A person affected by this type of dementia often has a condition called Rapid Eye Movement (REM), sleep behavior disorder where the person acts out his or her dreams.

  3. Frontotemporal dementia: This type of dementia usually occurs at a slightly younger age (40 to 65 years) when compared to other types. The nerve cells begin to degenerate in the frontal and temporal lobes of the brain, the areas associated with personality, behavior, and language. Symptoms include inappropriate behavior, language, problems with thinking and concentration, and movement.

  4. Vascular dementia: This type of dementia is caused when there is a brain damage due to reduced or blocked blood flow in blood vessels leading to the brain. Brain damage can be caused by stroke, infection of a heart valve (endocarditis) or other vascular (blood vessels) conditions.

What are the symptoms of dementia?

Most of the time, we fail to recognize the early signs of dementia in the elderly due to lack of awareness about the condition. Hence, there is a significant delay in seeking professional help, and by that time, the person's condition would have aggravated.

Dementia symptoms may vary depending on the cause and the area of the brain that is affected. Each person may experience different symptoms and the difficulties caused due to these symptoms may vary from one person to another. 

Dementia symptoms include the following:

  • Memory loss: The elderly parent may have difficulty in remembering recent events and activities. They may remember what happened many years ago but they can forget the most recent activity, such as where they went in the morning. They may fail to recognize their near and dear ones, and can be confused with the events happening in their surroundings.

  • Language and communication: They may have difficulty in finding the right words to describe things and express their thoughts and feelings. They may also forget the meanings of words they hear.

  • Sense of direction:They may fail to recognize places they were once familiar with and forget the route to reach that place. For example, they may visit the park and then forget the route to return home.

  • Daily tasks: They may have difficulty in doing daily tasks like cleaning, organizing things, cooking, gardening, managing finances, etc. They may struggle to take care of their personal hygiene (bathing, washing hands, dressing up neatly).

  • Reasoning: They may have difficulty in thinking and responding to a situation or a conversation in a logical manner. For example, when someone enquires what they had for breakfast, they may not tell about breakfast but may start speaking about some other incident.

  • Loss of interest: They may lose interest in activities or hobbies that they enjoyed doing earlier. They may not like to interact with others, go out of the house, or attend social gatherings like weddings, religious functions, etc. 

  • Change in mood: They may have sudden mood changes, which could affect their behavior; sometimes they can become aggressive and abusive.

  • Repetition: They may repeat a particular task again, thinking that they did not do it earlier (example, shaving, taking medication, asking for breakfast again even though they had it earlier) They may also repeat the same questions that they had asked earlier, even after you have answered them.

  • Adaptation: Because of their failing memory, and difficulty in doing daily activities, they may prefer to have a routine and do not like to try new things.

Some types of dementia cause specific symptoms:

  • Dementia with Lewy bodies: The person has detailed visual hallucinations and may fall frequently

  • Frontotemporal dementia: Personality changes or unusual behavior. The person may not show any concern  for others, and may be rude or harsh while speaking.

  • Vascular dementia: The person may have delirium, or confusion caused due to a new or worsening illness.

How is dementia diagnosed?

There is no single test to diagnose the early signs of dementia. However, doctors diagnose the condition based on medical history, behavioral changes, and laboratory tests. Doctors look for at least two symptoms that significantly disrupt a person's ability to carry on with daily life activities. 

An early diagnosis can help the person understand their condition, prepare and plan for the future with the help of family members, and also manage daily tasks as much as possible.

Some of the tests include:

  • Cognitive and neurophysical tests: Cognitive functions are evaluated by conducting tests on memory, orientation, reasoning, judgment, and language.

  • Neurological evaluation:  Doctors check movement, sense, balance, and reflex.

  • Brain scan: A Computerized Tomography (CT) scan or magnetic resonance imaging (MRI) scan is conducted to check if the person has had a stroke or internal bleeding to rule out the possibility of a tumor.

  • Psychiatric evaluation: A mental health expert may check if depression or any other psychological condition is causing the symptoms.

Getting treatment for dementia

Dementia cannot be treated or cured because diseases that cause dementia are progressive, that is the condition deteriorates with time. However, doctors can help the person manage his or her symptoms. Other conditions such as depression or anxiety that could co-exist with dementia may need treatment. 

Doctors and family members need to focus on activities that the person is still able to perform and encourage the person to continue doing them. The most important type of treatment is love, support and care from family members.

Can dementia be prevented?

Although it is observed that it is not possible to prevent dementia, some steps may help to delay the onset of dementia, however, more research is being conducted on this topic.

Some ways that could be beneficial in maintaining a healthy lifestyle:

  • Keep your mind active with mentally stimulating activities like playing word games, Sudoku, solving puzzles, memory training, or learning a new language.

  • Be physically active by exercising regularly and maintaining a healthy diet.

  • Be active by getting involved in social activities like volunteering for a social cause, joining a hobby class or spending time with friends or like-minded people.

  • Have a structured routine for daily activities.

  • Quit smoking and alcohol.

Caring for someone with dementia

When a person is diagnosed with dementia, it can be devastating for the person and for their family members. People with dementia need a great amount of support and reassurance in the early stages, so that life can be made easier and manageable to the extent possible.

To be able to take care of the family member, you can follow some of these suggestions. However, you may want to adapt them according to the person's condition and situation. You must also understand that dementia is progressive and the symptoms will worsen with time.

  • Communication: When speaking to your loved one, maintain eye contact. Speak slowly and clearly in simple sentences and speak about one idea at a time.

  • Exercise: Encourage the person to do simple exercises and maintain physical wellbeing, reduce symptoms of depression, retain motor skills and for a calming effect.

  • Games and activities: Encourage the person to participate in games and thinking activities. Using cognitive skills can help slow down the degeneration of brain cells.

  • Routine: Establish a proper routine for daily activities so that the person is not disturbed with irregular eating or sleeping time. Try to accommodate behavior changes because the person may change their habits over time.

  • Future: During the early stages of dementia, encourage the person to plan for the future and make decisions on matters such as finances, property, long-term care plan, safety and daily living concerns.

Caring for the caregiver

Caring for a loved one with dementia can be stressful, frustrating, physically and emotionally draining. You may quite often have mixed feelings of anger, guilt, sadness, self-pity, anxiety and helplessness. But to be able to sail through this tough phase, you may want to take care of your physical health and psychological wellbeing.

  • Learn as much as you can about the disease so that you can understand the patient's problems better, and manage the situation in a better way.

  • Speak to doctors and counselors and discuss your concerns.

  • Seek the help of friends and family members when needed.

  • Take care of your physical, emotional and spiritual health.

  • Take some time out for yourself and do things that you are interested in.

  • Join a support group to share your experiences and seek support from other caregivers who are dealing with the same situation. You can also provide support to other caregivers.