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Dementia

Definition

Dementia is the disorder where there is a decline of cognitive functions such as perception, judgment, attention, memory, performance of complex executive functioning and speech, due to either treatable medical conditions or chronic degenerative disorder of the brain. There may be changes in personality and hallucinations. Dementia is more common in older people, but can also occur at younger ages. Alzheimer’s disease is the most common form of dementia followed by vascular dementia, Parkinson disease, and dementia of Lewy’s body. These chronic degenerative disorders are not curable.

There are several reversible causes of dementia. Cerebral tumors can cause psycho-affective changes and gognitive symptoms. If the brain swelling that accompanies a tumor is reduced through medication, then cognitive symptoms can improve. Nutritional deficiencies, infections and head injuries can also cause cognitive symptoms that can be improved with proper therapy.

Other aggravating reasons of Dementia, apart from age, are:

  • Down Syndrome
  • Diabetes
  • High cholesterol
  • Atherosclerosis
  • Smoking
  • Family history of the disease

Other causes of dementia

Dementia can still be triggered by a specific problem or medical condition such as:

  • Reaction to medications
  • Metabolic diseases and vitamins deficiency
  • Endocrinopathies
  • Infections like HIV
  • Poisonings from lead, heavy metals, alcohol
  • Brain tumors
  • Anoxia (reduced oxygen supply to the brain),
  • Heart and respiratory diseases
  • traumatic brain injury

Mild dementia is characterized by:

  • Difficulty remembering names, although the figures are identified.
  • Repetition of the same question that was just before being asked.
  • Difficulty in finding the right words to communicate.
  • Difficulty on tasks, such as remembering how to take medications correctly.
  • Logical gaps in crisis.

The moderate state of dementia is characterized by:

  • Difficulty in naming common objects.
  • Difficulty in expressing needs and desires.
  • Tendency to getting lost when they are away from home.
  • Changes in personality and behavior.
  • Failure to identify the children.
  • Disorientation in time and space.

Severe dementia is characterized by:

  • Difficulty in functioning and use of the relevant device or tool such as the kitchen or the car.
  • Shortness of self-provision as in personal hygiene and dressing.
  • Difficulty eating, swallowing, walking and sitting.
  • Failure to recognize and communicate with intimate family members.
  • Hallucinations or delusional thoughts.

The most common types of dementia are:

Alzheimer’s Disease

About half of all cases are due to dementia of Alzheimer’s type. There is accumulation and deposition of neurofibrilary formations and particles within and around the cerebral nerve cells causing nerve cells to not function properly and be destroyed. It has also been found a substance-neurotransmitter decrease, called acetylcholine, which serves as the messenger in communication between nerve cells. Patients with Alzheimer;s disease can live for 8-10 years on average after they are diagnosed but can live even for up to 20 years.

Vascular dementia

It is the second most common cause of dementia. Atherosclerosis, cholesterol deposition of plaques in blood vessels, high blood pressure and diabetes contribute to destruction of small vessels in the brain. Eventually the vessels either block, or bleed leading to multiple micro-strokes and gradual deterioration of mental functions.

Parkinson’s disorder

This is a neurological disorder characterized by tremors, stiffness, slow walking. In about 10-20% of sufferers a form of cognitive decline coexist. Most of the patients are usually older people who exhibit the signs of Parkinson’s disease after them being over 65.

Lewy Body Disorder

Lewy Body disorder has characteristics of both Parkinson’s disorder and Alzheimer’s disease. The dementia of Lewy body can affect thinking, attention and memory similarly to Alzheimer’s disease. The person may have hallucinations and stiffness of body as well as slow walking just like in Parkinson disorder.

Fronto-Temporal Dementia

It is characterized by degeneration of nerve cells in the frontal and temporal cerebral cortex that control judgment and social behavior. Patients with fronto-temporal dementia have difficulty in interacting normally with other people and keeping their social skills. It is estimated that a rate of 2-20% of all dementia types accounts for the this particular type. Because there is often a family history of this particular dementia, portion of aetiology is attributed to the genetic factor.

Patients with dementia may benefit from medication and cognitive exercise. While there is no solution for the complete reversal of most forms of dementia, treatment may improve the symptoms and slow the progression of the disease. Treatment may even delay the need for the patient to be hospitalized or in nursing homes. This consists of a combination of psychotherapeautic and psychosocial interventions along with medication.

  • Medication can help the quality of life and to relieve the burden of caregivers.
  • Rewarding positive behaviors and ignoring inappropriate-clumsy behavior can help in growing and maintaining social skills.
  • Keeping the patient busy with tasks to grown the cognitive functions can help in the early stages of dementia. This could be done with memory aiding practices or keeping notes.
  • Psychotherapy  and psychosocial approaches can help improve quality of life and to: 
  1. Maximize the functionality
  2. Improve thought functioning
  3. Improve mood
  4. Improve behavior

Examples of psychosocial approaches

  • Supportive psychotherapy in order self re assurance be provided and issues of loss and mourning be discussed.
  • Healing memories (Reminiscence therapy) for improving mood and behaviour.
  • Art and music therapy to improve the functionality and the mood.
  • Occupational therapy to assess and improve the level of functionality.

Acetylcholinesterase inhibitors

Acetylcholinesterase inhibitors are drugs that act in the brain nerve cells in such a way as to prevent decline of a neurochemical substance, naturally circulating in the brain, called acetylcholine . Acetylcholine is thought to be responsible for cognitive functions, thus, by saving its concentartion, we suspend the decline of memory and other cognitive functions.

The most well-known acetylcholinesterase inhibitors is Donepezil (Aricept), takrine (Cognex) and rivastigmine (Hexelon).

Common side effects are:

  • Gastric discomfort
  • Diarrhea
  • Nausea
  • Dizziness
  • Drowsiness

A recent a cholinesterase inhibitor with a dual action (additional effects on Nicotinic Receptors believed to be associated with cognitive functions and memory) is galantamine (Reminyl).

NMDA receptor antagonist

A drug called memantine (Ebixa) often combined with acetylcholinesterase inhibitor. There are studies that show increased cognitive functions with this combination in relation to the exclusive use of one of the two drugs.

CAUTION the anti-dementia medicines use has practical meaning when administered the earliest possible after the disorder gets diagnosed, preferably when dementia is at its light stage. Therefore, early diagnosis and treatment is important to slow down the disease progression.

Frequently, prescribing psychiatric drugs of other categories, such as anxiolytics, antidepressants and antipsychotics in response to mental conditions like anxiety disorders, sleep disturbances, hallucinations and delusional thoughts often encountered in demented patients, is common practice.

“Για την ψυχή που νοσεί φάρμακο είναι ο λόγος”

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Contact Psychiatrist-Psychotherapist Karanikas Evangelos

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