Dementia is a serious decline of global brain functioning in a previously unimpaired individual that surpasses what would be expected due to the normal process of aging. Dementia can be unchanging, as the result of a severe brain injury or progressive which can lead to a long-term decline caused by disease or damage to the body. While dementia is more common among older adults, it can occur before the age of 65, which is called “early onset dementia.”
Dementia is not a single disorder or disease. Rather, it is a group of symptoms that can be caused by the effects of genetic diseases, illnesses, medications, hormonal imbalances, and other conditions. The symptoms caused by dementia are severe enough that they affect the ability to think so much so that they affect activities of daily living. Most people who are diagnosed with dementia generally have memory loss, but memory loss alone isn’t an indicator of dementia.
It’s important to note that dementia is not simply a problem with memory; dementia reduces our ability to learn, retain past experiences, reason, along with loss of patterns of thinking, feeling, and acting. Other mental and behavioral problems may affect people who have dementia which can complicate quality of life. Some people with dementia may act inappropriately, neglect themselves, lack inhibitions, wander away from safety, and act aggressively toward others.
Dementia exists when there are problems with two or more functions of the brain, which include memory loss, impaired judgment, language and communication difficulties, and the loss of the ability to perform several daily activities. These symptoms generally must be present for six months or longer before a diagnosis of dementia is made. Shorter periods of cognitive dysfunction is called delirium.
There are different classes of dementia based upon the reason behind the disorder, and some classes are reversible while others are permanent. Some cases of dementia can be reversed with treatment.
Dementia is caused by damage to brain cells that leads to improper communication between cells in the brain. These damaged brain cells cannot communicate properly, which changes behaviors, emotions, and thinking. The human brain is composed of different regions that are responsible for specific functions and when cells in these areas are damaged, the normal functions of that area of the brain are compromised. Different types of dementia have a correlation with the areas of the brain that have been damaged. Alzheimer’s disease comprises between 60-80% of dementia diagnoses, while vascular dementia, caused by a stroke, is the second most common form of dementia. There are well over 50 other types of dementia, some of which can be reversed or slowed, which makes prompt diagnosis and treatment very important.
In later stages of dementia, people may not know what day of the week it is or even what year it is. They may not know where they are. In the latest stages, they may not even know who they are any longer.
Dementia is a heartbreaking disorder.
Statistics
The occurrence of dementia varies by type of dementia and age at diagnosis. The prevalence of dementia increases radically from the age of sixty – estimates are that between 1-2% of people at 65 years of age have some form of dementia, by 85 years of age that number is closer to 30%.
Co-Occurring Disorders
As dementia is not one disease, rather a group of diseases, syndromes, and other conditions, there are a number of co-occurring disorders. Not an inclusive list, the following are the most common forms of dementia:
- Alcoholism
- Alzheimer’s disease
- Cardiovascular disease
- Creutzfeldt-Jakob disease
- HIV/AIDS
- Huntington’s disease
- Normal pressure hydrocephalus
- Wernicke-Korsakoff syndrome
Causes
There exist well over 50 types of dementia – some reversible – that are caused by a variety of sources. The most common causes for dementia are listed below.
Genetic: A family history, especially if a close relative has dementia, can put you at a greater risk for developing dementia. Many genetic conditions can also lead to dementia as part of their process. Some of the most common include:
- Alzheimer’s disease – the most common form of dementia, Alzheimer’s disease is responsible for 60-80% cases of dementia. Alzheimer’s disease is marked by three broad stages: mild, moderate and severe, each with hallmark symptoms and interventions. Alzheimer’s disease is a progressive disorder, meaning that the symptoms become more pronounced as the disease develops.
- Huntington’s disease – this genetic and degenerative brain disorder leads to a notable decline in reasoning ability and cognitive skills. Huntington’s is also noted to cause abnormal and involuntary movements, irritability, personality changes, depression, and changes in behavior.
- Parkinson’s disease – a disorder with variable but progressive symptoms, many people experience dementia during later stages of the disease.
Biological: the strongest prognostic factor for developing dementia is advancing age. Advanced age increases the chances for developing cerebrovascular, cardiovascular, and neurodegenerative diseases.
- Vascular dementia – the brain is an organ that, like the rest of the body relies heavily on the delivery of oxygen and other nutrients by the circulating blood. When a clot forms and lodges in a part of the brain, that area gets deprived of oxygen. Vascular dementia can occur after a stroke and lead to problems in the area that was deprived of oxygen. Symptoms include inability to plan for events that require many steps and impairment in judgment and memory.
- Normal pressure hydrocephalus – sometimes the cerebrospinal fluid, the fluid that encases the brain and the spinal cord is unable to properly drain from the brain leading to a build-up in cerebrospinal fluid and pressure within the brain. Surgeons can place a shunt to drain the excess fluid from the brain. Normal pressure hydrocephalus can cause impaired movement and memory loss.
- Lewy-Body dementia – symptoms of dementia with Lewy Bodies are similar to those of Alzheimer’s disease, people who have Lewy-Body dementia also experience visual hallucinations, muscle rigidity, and sleep disturbances in addition to impaired memory.
- Nutritional deficiencies and hormonal imbalances can lead to certain types of dementia that may or may not be reversible.
- Frontotemporal dementia – this type of dementia causes damage to the nerve cells in the front and side areas of the brain leading to changes in personality and behaviors as well as difficulties using language.
- Hypoxia – when the brain is deprived of oxygen (due to a heart attack, asthma attack, anaphylactic reaction) for a length of time, a person may exhibit symptoms of dementia. Depending on the length of time and the area of the brain deprived of oxygen, this type of dementia may be reversible.
- Brain tumors – occasionally damage from a brain tumor can cause dementia symptoms; these symptoms will be related to the area of the brain affected.
- Mixed-Type dementia – mixed-type dementia occurs when two or more different types of dementia are present in the brain.
Environmental: Dementia may be caused by environmental influences such as substance abuse or toxic reactions to poisons. Other environmental causes for dementia include the following:
- Traumatic brain injuries – one severe brain injury or a number of chronic smaller head injuries (such as those experienced by boxers) can lead to the development of dementia.
- Infections or diseases – whether these are inherited or acquired infections or diseases, certain types can lead to the degeneration of cells in the brain, ultimately leading to dementia.
- HIV-associated dementia – the HIV virus, which progresses to AIDS, destroys brain cells. In the later stages of AIDS, the destruction of brain cells increases and can lead to cognitive impairment, memory loss, movement disorders, and problems with concentration.
- Creutzfeldt-Jakob disease – this very rare brain disease can develop in people without any known risk factors for dementia. This disease can be inherited or caused by exposure to diseased brain tissue or infected tissue of the central nervous system.
- Poisoning – repeated exposure to heavy metals, pesticides, and other poisons can lead to symptoms of dementia.
- Adverse medication events – this often-reversible type of dementia is caused by an adverse reaction to a single medication or combination of medications.
Psychological: Addiction and abuse of illegal recreational substances, especially long-term alcohol abuse can cause certain types of dementia.
- Wernicke-Korsakoff syndrome – often caused by long-term alcohol abuse, this chronic memory disorder is caused by an extreme deficiency in Vitamin B-1. While this syndrome causes chronic memory impairment it leaves other cognitive abilities unscathed.
Signs and Symptoms of Dementia
As dementia is a group of disorders rather than a single disorder, signs and symptoms will vary depending upon the specific cause for the dementia. In order to be diagnosed with dementia, at least two of the following areas must be affected to such a degree that it leads to impairment in daily living. These areas include: an increased inability to communicate and use language, impaired judgment and reasoning abilities, abnormal changes in visual perception, decreased ability to pay attention and focus, and memory impairment.
Other symptoms may include the following:
Mood:
- Agitation
- Anxiety
- Confusion
- Depression
- Frustration
- Problems with memory and concentration
- Social isolation
- Withdrawing
Behavioral:
- Changes in personality
- Problems carrying out routine tasks
- Short-term memory problems
- Forgetting appointments and events without later recalling them
- Putting items in strange places and being unable to locate them
- Challenges with organization and planning
- Challenges in solving problems
- Difficulties carrying out tasks that have been performed many times before
Physical:
- Challenges interpreting images
- Challenges judging distances
- Behaving inappropriately
- Malnutrition
- Difficulty navigating the environment
- Wandering
- Difficulty communicating and making needs known
Psychological:
- Problems using logic and reasoning abilities
- Paranoia
- Hallucinations
- Delusions
Effects of Dementia
As the causes for dementia are so varied and so complex, it can be hard to identify which effects are caused by dementia and which are caused by the condition causing the dementia. The following are the most common effects of dementia:
- Memory decline
- Cognitive decline
- Challenges with communication
- Depression
- Anxiety
- Changes in sleep patterns
- Deterioration of emotional health
- Hallucinations and delusions
- Improper nutrition
- Decreased safety awareness
- Inability to care for self
- Inability to live independently