The dementia

introduction

Dementia is an umbrella term that describes a large number of failure symptoms of the brain and can be traced back to various causes. It is important that learned skills and thinking processes are lost. In addition, it can lead to disturbances of attention and consciousness. Social and emotional skills can also be affected, as can physical activity.
The patients who suffer from dementia are very often severely limited in everyday life. Reasons for dementia can be, for example, Alzheimer's dementia, Lewy body dementia, vascular dementia, frontotemporal dementia and Pick's disease. However, many other causes are not yet fully understood. Few forms of dementia can be stopped and even less completely cured.

Symptoms of dementia

Dementia can show a number of signs that suggest the nature of the condition. Read about this too: How do I recognize dementia and Signs of dementia

Alzheimer's dementia affects the cerebral cortex and can be divided into three stages. The first signs of Alzheimer's dementia are forgetfulness, memory loss and difficulty orienting oneself in time. In this initial stage, an independent life is usually still possible and the social environment of the person concerned usually does not yet recognize the disease.
As the disease progresses, practical skills such as cooking, dressing, and washing are lost. Speech comprehension and independent decision-making also suffer increasingly. The increasing loss of mental abilities becomes more and more noticeable and the sick person is restricted in his independence.
In the final stages of Alzheimer's, most patients are noticeable for being bedridden and lack of concern. The language becomes more and more indistinct and the patient hardly feels hunger or thirst. Urine and stool can also no longer be adequately held.
Read more about this under: Symptoms of Alzheimer's

Vascular dementia initially manifests itself as muscle weakness, movement disorders, increased tendency to fall and pain or loss of stimuli in different areas of the body. In addition, there are often concentration problems, loss of interests and ultimately memory loss, as well as orientation difficulties.

In patients suffering from frontotemporal dementia - for example Pick's disease - the first thing that is noticeable is a change in personality that is accompanied by increased aggressiveness, lack of distance and disinhibition. In addition, overeating is often observed. As the disease progresses, speech and memory disorders also occur. The latter, however, are much less pronounced than, for example, in Alzheimer's disease.

Further information on this topic is available at: Symptoms of dementia

The different types of dementia

The umbrella term dementia encompasses the loss of mental, emotional and social capacities. The reason for this is usually damage to the brain. However, this damage can have various causes. Read about this too: Causes of dementia

In general, dementia is divided into a primary and a secondary form. The primary form is defined as an independent dementia disease. Here the focus is on the brain itself. Primary dementia is further divided into neurodegenerative, vascular and mixed forms. Alzheimer's dementia, for example, is one of the neurodegenerative forms; various substances such as tau protein and amyloid plaques are deposited in and next to the brain cells. A death of these cells can then be observed. As a result, less of the messenger substance acetylcholine can be released and the brain mass decreases significantly. The shrinkage of the brain can be up to 20%.
Another form of neurodegenerative dementia is Lewy body dementia. Here too, deposits in the brain, the so-called Lewy bodies, can be seen. Similar to Alzheimer's dementia, these deposits lead to the destruction of nerve cells.
Another representative of neurodegenerative dementia is frontotemporal dementia. This mainly attacks the nerve cells in the front and sides of the brain, which are primarily responsible for personality and language.
For more information on this topic, read also: Dementia vs Alzheimer's

The neurodegenerative forms of dementia are by far the most common dementia types. Alzheimer's dementia comes first with a 60-75 percent frequency, measured against the absolute number of all dementia cases. In neurodegenerative diseases, increased concentrations of glutamate, a messenger substance from nerve cells, are measured. This causes overstimulation and thus the death of the nerves.

Vascular dementia also originates in the brain, but circulatory disorders lead to a lack of oxygen and the resulting reduced brain activity. The poor blood circulation can have various causes. For example, the atrial fibrillation of the heart can form a blood clot that enters the brain and closes a vessel there. Calcification of the arteries can also cause vascular dementia. At 10-15%, this disease is far less common than the neurodegenerative variant.
Mixed dementia has its cause in both types and is the rarest form of primary dementia.

Secondary dementia arises as a result of another, mostly neurological disease. These include brain tumors, cerebral water drainage disorders, Parkinson’s syndrome and Korsakov’s syndrome. The latter is caused by persistent alcoholism. Metabolic diseases, drug abuse, depression and vitamin deficiencies can also be the cause of secondary dementia. Up to 10% of all dementia cases are due to secondary causes.

Read more about this under: The forms of dementia

Therapy of dementia

There are many different therapeutic approaches aimed at stabilizing or even improving mental performance. The most common form of dementia, neurodegenerative dementia, includes drugs that inhibit enzymes that normally break down acetylcholine. Such drugs are called acetylcholinesterase inhibitors. As a result, more of this messenger substance is available. Acetylcholine is normally produced by nerve cells to transmit information, but since many nerve cells die in Alzheimer's disease, this messenger substance is deficient. This deficiency is compensated for by administering the medication. Typical representatives of this group of drugs are rivastigmine and galantamine.
Read more about this under: Drugs for dementia

Another group of drugs are memantines. These lower the glutamate level and thereby the number of dying nerve cells. It should be noted, however, that these drugs can halt the progression of dementia, such as Alzheimer's, for about a year. A cure is currently not possible.
Studies show that mental and physical exertion have a supportive effect as non-drug therapy.
Read about this too: Therapy of Alzheimer's

In vascular dementia, the focus is on lowering the risk of a renewed vascular occlusion. Blood pressure should be brought to a normal level and blood thinners should be used. In the case of secondary dementia, treatment consists of treating the original disease. For example, by giving vitamin preparations in the event of a vitamin deficiency or drug withdrawal.

Diagnosis of dementia

The diagnosis of dementia is first and foremost based on the history of the disease, the anamnesis. The attending physician asks about the specific symptoms of the disease. He collects the information in conversation with the patient and their relatives. During contact with the sick person, standardized neuropsychological test procedures, such as the mini-mental status test and the watch test, are available to the doctor. The criteria that are required for the diagnosis of dementia are queried here.
Read about this too: Dementia test
Depending on the type of dementia, an imaging method of the head such as computed tomography or magnetic resonance tomography can provide information.

Read more about this under: Diagnostics in Alzheimer's

Prognosis of dementia

Basically, it is currently not possible to cure dementia. However, drug and non-drug therapy, such as special brain performance training, can improve the patient's quality of life.
The secondary forms of dementia are an exception. The underlying diseases can often be cured and the dementia symptoms eliminated. Since most dementias are associated with old age and the sick person dies an average of ten years after diagnosis, life expectancy is hardly affected.

Read more about this under: Course of dementia

Can I prevent dementia?

Studies prove the protective effect of physical and mental activity, so the likelihood of mental performance impairment can be significantly reduced. A healthy diet also has a positive effect. To avoid vascular occlusions and thus a lack of oxygen in the brain, increased blood pressure should be reduced as early as possible, as this is the cause of arteriosclerosis (Vascular calcification) can be.

Read more about this under: How can you prevent dementia?