Let's learn more about dementia. Could your loved ones have this condition?

Do you sometimes forget little things? Like where your keys are, or someone's name. It can be normal. But for some people, this forgetfulness becomes so severe that they can't even do everyday tasks. That's when we need to talk about a condition called dementia.

Simply put, dementia is not a single specific disease. It is an umbrella term that can cover a range of mental impairments. We call dementia when a person's previously good mental function gradually declines to the point where it becomes so severe that it interferes with daily life. To be diagnosed with dementia, a person must have at least two of the following:

• Memory
• Reasoning
• Language
• Coordination
• Mood
• Behavior

Are dementia and Alzheimer's disease the same thing? Or are they two?

Many people think that dementia and Alzheimer's disease are two different things. Actually, dementia is a big umbrella, as I mentioned earlier. Alzheimer's disease is the main cause of dementia under that umbrella. That is, not everyone with Alzheimer's disease has dementia, but not everyone with dementia has Alzheimer's disease. There may be other causes.

Who gets dementia? How common is it?

Dementia usually develops as we age. Have you ever seen our grandparents lose their memory? Between 5% and 8% of people over the age of 65 have some form of dementia. This number doubles every five years. Imagine, by the age of 85, perhaps one in two people will have dementia.

Does memory loss always mean dementia?

Now you may be thinking, 'Oh, I forget things too, so do I have dementia too?' Don't be afraid. Just because you have lost your memory doesn't mean you have dementia. It's normal to have some forgetfulness as some of the neurons in our brain die as we age. But it doesn't interfere with our daily activities.

Dementia is not about forgetting where you put your keys. Someone with dementia can also forget what to do with a key. That's the difference. Dementia is not a normal part of getting older.

Are there different types of dementia?

Dementia can be divided into three main categories:

1. Primary Dementia: In this, dementia is the main disease.

2. Secondary Dementia: Dementia caused by another disease.

3. Reversible dementia-like symptoms: Some diseases or conditions can cause dementia-like symptoms, but these symptoms go away when they are treated.

Types of Primary Dementia

• Alzheimer's disease: This is the most common type. Two types of abnormal proteins, Tau proteins and Amyloid proteins, accumulate in the brain. These disrupt communication between nerve cells in the brain, and the cells begin to die. At first, things like short-term memory loss, confusion, and behavioral changes occur. Later, things like difficulty speaking, forgetting old things, and difficulty walking occur. It mostly affects older people. If someone in your family has it, you are more likely to develop it. Between 60% and 80% of people with dementia have it.
• Vascular dementia: This is the second most common. It is caused by blockage or damage to the blood vessels that carry blood to the brain (e.g., stroke, atherosclerosis). Symptoms include memory problems, confusion, difficulty concentrating, and difficulty completing tasks. It can come on suddenly (after a large stroke) or gradually (after several small strokes). People with high blood pressure, diabetes, and high cholesterol are at higher risk.
• Lewy body dementia: In this, protein clumps called Lewy bodies accumulate in the nerve cells of the brain. These damage the nerve cells. Symptoms include problems with body movement and balance, changes in sleep patterns, memory loss, difficulty planning and solving problems, and visual hallucinations .
• Frontotemporal dementia (FTD): This is caused by damage to the frontal and temporal lobes of the brain. It can cause social behavior, personality changes, loss of language skills (speech, understanding, forgetting the meaning of common words), or problems with motor coordination. This is a type of dementia that usually affects people between the ages of 45 and 64, meaning it develops at a younger age.
• Mixed dementia: This is a combination of two or more types of dementia. The most common type is Alzheimer's disease and vascular dementia. It is most common in people over 80 years of age. It can be difficult to recognize because only one type of dementia is clearly visible. Symptoms tend to progress more quickly in these people than in people with only one type.

Secondary Dementia (Dementia caused by other diseases and conditions)

• Huntington's disease: This is a brain disorder caused by a genetic defect. It causes problems with body movement control, thinking, decision-making, memory, and personality changes.
• Parkinson's disease: Many people with Parkinson's disease develop dementia in the later stages. There are problems with thinking, memory, hallucinations, depression, and difficulty speaking.
• Wernicke-Korsakoff syndrome: This is a brain disorder that occurs when there is a severe deficiency of thiamine (vitamin B1). Bleeding can occur in areas of the brain involved in memory. It is often caused by excessive alcohol consumption.
• Traumatic brain injury: This condition can be caused by repeated blows to the head. Symptoms such as memory loss and behavioral changes may appear years later.

Reversible dementia-like symptoms

Sometimes it looks like dementia, but it could actually be a symptom of another illness. The best part is, once it's treated, the dementia-like symptoms will go away!

• Side effects of certain medications: Some medications, such as sleeping pills and tranquilizers, can cause memory problems.
• Vitamin deficiencies: Especially when vitamin B12 is low.
• Thyroid problems (Hypothyroidism).
• Infections: Things like urinary tract infections (UTIs), especially in older people.
• Normal pressure hydrocephalus (NPH): A buildup of cerebrospinal fluid (CSF). This can be treated with a surgical shunt.

What are the symptoms of dementia?

In the early stages, you may see symptoms like:

• Forgetting recent events and information.
• Repeating/asking things that have been said and questions that have been asked.
• Frequently used items are missing or in strange places.
• Lack of understanding of month, year, and time.
• It's hard to find the right words.
• A change in mood, behavior, or preferences.

As the condition worsens, symptoms such as:

• Memory and decision-making ability decline further.
• It's getting harder to speak, to find the right words.
• Even simple everyday tasks like brushing your teeth, making a coffee, using the TV remote, and paying bills become difficult.
• Rational thinking, behavior, and problem-solving skills decrease.
• Sleep patterns change.
• Anxiety, frustration, confusion, restlessness, doubt, sadness, and depression increase.
• Needing help with daily tasks (getting dressed, bathing, eating)
• You are hallucinating things that are not really there.

What are the causes of dementia?

Simply put, dementia is caused by damage to your brain. This damage prevents the nerve cells in your brain from communicating with each other. Sometimes, blood flow to the brain is reduced, starving it of oxygen and nutrients, and brain tissue can die.

How is dementia diagnosed?

Diagnosing dementia can be a bit tricky because the symptoms are similar to many other illnesses. Your doctor will do the following:

• I'm asking about your symptoms.
• I'm asking about your old illness.
• I'll look at the medication you're currently taking.
• I wonder if anyone in the family has had dementia.

In addition, blood tests, brain scans (imaging tests) such as `(Computed tomography - CT)`, `(Magnetic resonance imaging - MRI)`, and possibly `(FDG-PET scan)`, and neurocognitive tests that measure your thinking ability may be done. You may also need the help of a psychiatrist.

Is there a treatment for dementia?

Here, we need to understand the terms 'treatable', 'reversible', and 'fully curable'.

Many types of dementia have medications to help control symptoms. However, most types of dementia cannot be completely cured or reversed. Treatments only provide some relief.

However, as mentioned earlier, some conditions that mimic dementia (e.g., vitamin deficiencies, side effects of certain medications, thyroid problems) can be treated and completely cured.

For incurable types of dementia (e.g. Alzheimer's disease, vascular dementia), there are medications to control memory loss and behavioral problems. For example, cholinesterase inhibitors (such as donepezil (Aricept®) and rivastigmine (Exelon®)) and NMDA receptor antagonist memantine (Namenda®) are used. Newer medications such as the anti-amyloid antibody aducanumab (Aduhelm®) are also available. Although these medications cannot completely stop the disease, they can slow down the rate at which it gets worse.

Complications caused by dementia

Some of the complications that can occur due to dementia are:

• Lack of water and malnutrition.
• Bed sores (pressure ulcers).
• Injuries and fractures due to falls.
• Strokes.
• Pneumonia and aspiration pneumonia.
• Sepsis (spread of an infection throughout the body).

What is life like with dementia?

Being diagnosed with dementia is a very sad thing. However, how long you can live with this condition varies from person to person. Some people live for about 8 years with a common type of dementia, such as Alzheimer's disease, while others live for up to 20 years. The most important thing is to maintain the patient's quality of life. Researchers are still researching this disease and ways to control it.

Can dementia be prevented?

Although dementia cannot be completely prevented, a healthy lifestyle can reduce the risk of developing some types of dementia.

• Quit smoking.
• Follow a good diet (e.g. Mediterranean diet - more vegetables, fruits, fish, grains, olive oil, less red meat).
• Exercise. At least 30 minutes most days of the week.
• Keep your brain active. Solve puzzles, play word games. These can delay the onset of dementia.
• Be social. Talk and socialize with others.

Factors that increase the risk of developing dementia

• Age: The main factor. The risk increases with age. It affects people over 65 years of age the most.
• Family history: If your parents or siblings have it, you are at higher risk of developing it too.
• Down syndrome: People with Down syndrome are at risk of developing Alzheimer's disease early in middle age.
• Poor heart health: High cholesterol levels, high blood pressure, atherosclerosis, or smoking increase your risk of dementia. These health problems, like diabetes, affect your blood vessels. Damaged blood vessels can reduce blood flow and lead to strokes.
• Serious head injury (Brain injury): If you have suffered a serious head injury, you are at higher risk of developing dementia.

When do you need to see a doctor?

See a doctor if you or someone in your family notices any of these changes:

• Changes in your memory.
• Changes in your mental functioning.
• Changes in your ability to perform daily tasks.
• Changes in your behavior.
• Changes in your personality.

What happens when dementia becomes severe?

Unfortunately, many types of dementia get worse over time. When the brain doesn't get the nutrients and oxygen it needs, or when "junk" like abnormal proteins blocks communication between nerve cells in the brain, brain tissue begins to die.

Alzheimer's disease and other types of dementia usually start with memory loss and minor lapses in decision-making – something you can live with for a while. As brain function deteriorates further, vital functions begin to be affected. These include breathing, digestion, heart rate, and sleep.

In the final stages of dementia, the body is unable to perform the tasks needed to keep itself alive. Due to brain damage and muscle weakness, even simple, necessary movements are impossible. Without help, people are unable to speak, walk, control their bladder and bowels, eat, chew, or swallow food.

When you can't take care of yourself, move around, get enough water and food, and even feel depressed, you're more likely to get other illnesses. Pneumonia is a common illness among people with dementia. A weakened body may not be able to fight off infections or benefit from medications. The patient's pain and discomfort can be greater than treatment options that can only provide short-term relief.

At this time, many families are choosing hospice care for the end of life. Hospice care provides comfort and focuses on quality of life rather than prolonging life. Many people who die from dementia-related conditions do not have this information on their death certificates. This is because the complication they died from – for example, pneumonia – is listed instead. Another reason may be that many people are not officially diagnosed with dementia before they die.

Are there stages of dementia?

Although there is no specific classification of dementia, there are three stages of the most common type, Alzheimer's disease. These characteristics are common to many types of dementia.

Early stage (Mild Stage)

During this time, they can still do things on their own. They may drive, go to work, and socialize. Some changes occur that may not be noticeable to the person with Alzheimer's disease, but close friends and family may notice.

The difficulties can be like this:

• After introducing someone, they forget their name.
• Several items are missing or misplaced.
• It's always hard to find the right words.
• Difficulty planning, organizing, managing, or completing tasks.
• I always forget what I read.

Moderate Stage

People in the middle stages of Alzheimer's disease can stay in this stage for years. They can participate in daily activities with help. The symptoms are now clear.

The difficulties can be like this:

• I'm confused about what year/time it is and where it is.
• Forgetting events, unable to remember personal details (phone number, address, school attended).
• Changes in personality, mood, and behavior, for example, becoming suspicious, seeing hallucinations, and repeating the same things over and over again.
• Day/night sleep patterns change.
• Difficulty controlling urine and/or stool.
• Wearing clothes that are inappropriate for the time or occasion.
• Walking around and getting lost.

Severe Stage

People in the late stages of Alzheimer's disease cannot speak, are unaware of what is happening around them, and cannot control their body movements.

The difficulties can be like this:

• It's hard to speak, maybe only a few words or phrases.
• It's hard to walk.
• It's hard to swallow.
• Easily susceptible to infections, especially pneumonia.
• They need care 24 hours a day.

Early diagnosis of dementia can help you and your family come together to make plans for a meaningful life. It can also help you put your legal, financial, and health plans and wishes in order. Your medical team, doctors, social workers, hospice workers, and religious leaders are ready to provide education, support, and care for you or your loved one. Also, ask your team about dementia support groups in your area. Support groups can be a great place to share care tips, find comfort, and know that you are not alone.

Finally, things you need to remember

Dementia is a serious condition. However, it is important to be aware of it early. This will help you and your family make the necessary plans, and take care of legal, financial and health matters. Your medical team, social workers and others are all ready to help you. Caring for someone with dementia is not easy, so never hesitate to ask for help and support. Remember, you are not alone.

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