Let’s Talk About Dementia
What is Dementia?
Dementia can be simply defined as the loss of mental function that is severe enough to interfere with a person’s daily functioning. Symptoms also might include changes in personality, mood, and behavior.
Dementia itself is not a disease, but rather a group of symptoms that accompanies certain conditions or diseases.
Dementia can be either reversible or irreversible, depending upon what is causing it. Some reversible causing include vitamin or electrolyte imbalances, depression and drug use. It is very important for dementia to be evaluated thoroughly in order for an accurate cause to be determined. It is estimated that about 20% of dementia cases are believed to be reversible.
Reversible and Irreversible Causes of Dementia
There are more than 50 conditions that can cause or mimic dementia.
Alzheiemer’s disease is one of the most common irreversible causes of dementia. Other causes of irreversible illnesses resulting in dementia include vascular dementia, Parkinson’s disease, Huntington’s disease, brain tumors, AIDS, neurosyphillis.
In some types of dementia treatment can improve mental functioning and sometimes the effects can even be reversible. This is why it is vitally important to report any cognitive changes to a doctor as early as possible.
Reversible Dementia
Reversible dementias are often easier to diagnose than irreversible causes because they are often accompanied by other obvious symptoms. In the following conditions or situations, however, dementia may be the primary or even the only, symptom. Proper treatment can improve and even restore cognitive functioning.
Delirium
Delirium causes changes in mental functioning that can closely resemble dementia but there are two key differences:
~Speed of onset. The mental changes in delirium often develop quickly, often in a matter of hours. In contrast, dementia evolves over months or years.
~Level of consciousness. In delirium, consciousness is either clouded or fluctuates between drowsiness and alertness. Dementia doesn’t affect the level of consciousness.
Delirium is considered a medical emergency, in part because it’s often the main expression of a life-threatening illness. (but not always) For example, elderly people are susceptible to delirium after surgery or it can also result due to severe dehydration.
Toxic Reaction to Drugs
Medications are common culprits in mental decline. With aging, the liver becomes less efficient at metabolizing drugs, and the kidneys eliminate them from the body more slowly. As a result, drugs tend to accumulate in the body. Elderly people in poor health and taking several medications are especially vulnerable.
The list of drugs that can cause a dementia-like effect is long and includes:
~antidepressants ~anticonvulsants
~antihistamines ~corticosteroids
~anti-Parkinsons drugs ~narcotics
~anti-anxiety drugs ~sedatives
~cardiovascular drugs
Depression
People sometimes manifest dementia-like symptoms, forgetfulness, disorientation, inattentiveness, and slowed responses, when they are depressed. This so-called pseudo dementia can masquerade the depression that often accompanies Alzheimer’s disease but there are subtle differences.
~Pseudodementia. In pseudodementia, the depressed mood begins before there is any mental decline. Typically, the person complains about memory loss or lack of concentration, looks sad or worried, and speaks in a flat tone
~Depression. In Alzheimer’s-related depression, the mental decline comes first, and the person usually tries to conceal memory problems, rather than call attention to them
Vitamin B12 Deficiency
Dementia could be a symptom of pernicious anemia, a rare condition caused by low levels of vitamin B12. In people with pernicious anemia, the bone marrow produces red blood cells that are both larger and less numerous than normal
In older people, the first symptoms of pernicious anemia often include confusion, slowness, irritability, and apathy. Other symptoms include
-yellowish skin -headaches
-fatigue -numbness or tingling of hands and/or feet
-shortness of breath -trouble keeping balance
Hydrocephalus
Hydrocephalus (water on the brain) is an excess of cerebrospinal fluid around the brain. The fluid is secreted by ventricles (cavities in the center of the brain). It circulates around the spinal cord and is absorbed by veins on the external surface of the brain.
In addition to dementia, people with this condition frequently lose bladder control and walk in a slow, hesitant manner, as if their feet are stuck to the floor. A surgically implanted tube (a shunt) can drain the fluid from the brain to the jugular vein or to the abdomen brings rapid improvement, provided treatment is started soon after the symptoms appear.
Tumors
Brain tumors may be malignant and therefore capable of surrounding tissues, or they are benign.
Brain tumors can interfere with cognitive functioning and cause personality changes. Depending on their location, they can trigger other symptoms, such as headaches, seizures, or vomiting.
The first symptom of slow-growing brain tumors frequently resemble dementia, especially in older people.
Subdural Hematomas
Hematomas are blood clots caused by bruising. When they are located in the subdural area, between the brain surface and the thin membrane that covers it, they can cause symptoms that mimic dementia. Such subdural hematomas can also be life-threatening, causing coma and death. Most subdural hematomas are caused by severe head trauma. However, in older adults they can be acquired following very minor (in comparision) head injuries.
As blood oozes into the closed space, the hematoma enlarges and begins to interfere with brain function. Removing the clot within weeks of the injury may restore mental function. However, the symptoms often evolve so slowly that diagnosis is delayed for months.
Thyroid Disease
An overproduction of thyroid hormones (hyperthyroid) is commonly caused by Graves’ disease, while an underproduction (hypothyroid) usually results from Hashimoto’s thyroiditis. Both disorders can cause dementia-like symptoms.
~Hyperthyroidism. To diagnose hyperthyroidism, physicians use a simple blood test that measures levels of thyroid hormones. Surgically removing the thyroid or destroying it with radioactive iodine usually can correct the cognitive problems.
~Hypothyroidism. This is diagnosed by measuring the level of thyroid-stimulating hormone circulating in the blood. Physicians usually recommend thyroid hormone replacement, but this treatment doesn’t always reverse the dementia.
Alcoholism
An irreversible state of confusion and amnesia in alcoholics, Wernicke-Korsakoff syndrome, results from thiamine deficiency due to long-term malnutrition. But consuming excessive amounts of alcohol for a decade or more can also cause impaired thinking that resembles dementia.
In demenita due to alcoholism, memory, orientation, and attention deteriorate, although verbal skills are not always severely impacted. In this type of dementia, abstinence may partly restore mental functioning.
Irreversible Dementias
Although there are many causes of irreversible dementia, the following are the most common.
Alzheimer’s disease
Alzheimer’s disease is distinguished from other dementias at autopsy by the presence of sticky plaques and fibrillary tangles within neurons. Although such lesions may be present in any aging brain, in people with Alzheimer’s disease these lesions tend to be more numerous and accumulate in areas of the brain involved with learning and memory.
The hallmark symptom of Alzheimer’s is difficulty in recalling new information. As the disease progresses, the following may occur:
~Memory loss: This may be severe enough to disrupt daily life (for example the person may get lost in a very familiar neighborhood)
~Cognitive decline: The individual may also experience decline in cognitive ability (finding it hard to make decisions, solve problems or make good judgement)
~Mood or personality changes: An individual with Alzheimer’s may undergo significant changes in mood and personality (such as becoming more irritable, hostile or apathetic)
Alzheimer’s is very debilitating and death usually occurs within 3 to 9 years after it is diagnosed. And while there are several drugs approved for use with Alzheimer’s, but they only slightly alleviate symptoms.
Vascular Dementia
Some cognitive problems stem from insufficient blood flow to portions of the brain. The decrease in blood flow is often the result of atherosclerosis (an accumulation of fatty deposits on artery walls) in the blood vessels that feed the brain. The resulting interruption of blood flow creates areas of dead tissue.
These events, which in fact are small strokes, often go unnoticed. But the cumulative damage can lead eventually to large areas being impacted, causing confusion, impaired thinking, slurred speech, and paralysis.
People with vascular dementia usually have one or more of these following risk factors:
~hyptertension
~cardiovascular disease
~diabetes
~a history of stroke
The classic symptom of vascular dementia is an abrupt mental change, sometimes accompanied by paralysis or slurred speech. The mental deterioration proceeds in a “stairstep” pattern
~Stairstep pattern: a person suffers a sudden cognitive decline, the decline levels off, and then new strokes cause another sudden decline.
Degenerative Diseases
Most dementias are caused by degenerative diseases, conditions whose deterioration cannot be stopped. Alzheimer’s disease is the degenerative disease that is most often responsible for dementia, accounting for more than 50% of cases. Frontotemporal lobar degeneration, Parkinson’s disease and Huntington’s account for approximately 25% of all dementias.
Frontotemporal Lobar Degneration
This group of diseases, formerly called Pick’s disease, is characterized by atrophy of the front part of the brain, including the frontal and temporal lobes. It is often confused with Alzheimer’s disease because the symptoms are sometimes identical. Some experts believe it may be the second most common dementia.
The cause of frontotemporal lobar degeneration is unknown but some variants can run in families, and it is sometimes associated with gene mutations. People with frontotemporal lobal degeneration exhibit symptoms such as:
~prominient aphasia
~loss of inhibition
~loss of emotional responses such as fear
~compulsively putting objects in their mouths
Parkinson’s disease
This is a movement disorder resulting from a deficiency of dopamine, a neurotransmitter involved in coordinating muscle activity as well as memory function.
Its hallmarks include tremors, rigid limbs, and difficulty starting and stopping movement. Mild cognitive problems are common early on in the disease and dementia occurs in 30 to 80% of total cases.
Drugs that increase dopamine transmission, such as levodopa (Sinemet) help to control the physical symptoms of Parkinson’s but they do not help mental function.
Huntington’s disease
Huntington’s disease is a rare inherited disorder characterized by an abnormal gene on chromosome 4. Its symptoms include involuntary writhing movements and dementia, and they begin between the ages of 20 and 40.
Mental disturbances may occur before or after the physical issues appear and people are often difficult to provide care for because their irritability, aggressiveness and erratic behavior. The medications used to control the movement and mood disorders do not stop the disease from progressing.
Creutzfeldt-Jakob disease
This is a rare and progressive form of dementia caused by a type of infectious agent called a prion. The initial symptoms include fatigue and subtle changes in behavior. Typically the disease progress to movement problems, seizures, coma and usually death within a year from onset.
AIDS Dementia
This form of dementia occurs in people who have AIDS. The resulting dementia can develop rapidly, sometimes in a matter of weeks and consists of forgetfulness, inattentiveness and difficulty thinking.
Neurosyphilis
This condition is now rare because syphilis is treated more effectively and it rarely progresses to this point. However, it used to be about 30% of patients admitted to mental hospitals were suffering from neurosyphilis. Luckily the development of penicillin has helped to stop this disease from progressing to that level, for the most part.
Dementia is a devastating symptom to experience, both for the patient and their family. Throughout my career in the geriatric field dementia has been my passion. I have been fascinated by it and I focused my education and own research on the topic. I feel fortunate to have such a great education and to have so much professional and now personal experience with it.
If any of you have a situation or question that you would like to discuss please feel free to contact me via commenting here on this blog post or connecting via Facebook or email (thrivegcm@gmail.com).
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