Dr. Arun Kumar Dhanuka
MBBS, MD, DM (Neurology)
1799/1, Maharaj Nagar, Ludhiana.
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Dementia is the loss (usually gradual) of mental abilities such as thinking, remembering, and reasoning. There are manydifferent types of dementia, each with their own causes. The most common dementia symptoms include loss of memory,confusion, and changes in personality, mood and behavior.Dementia usually affects older people and becomes more common with age. About 6 in 100 of those over the age of 65 willdevelop some degree of dementia, increasing to about 20 in 100 of those over the age of 85. Dementia can develop in younger people but is less common, affecting about 1 in 1,000 of those under 65. Although most of the people who develop dementia are over the age of 60, it’s important to remember that dementia is not anormal part of growing old, and most older people never develop dementia.

A) Symptoms: In most cases, the symptoms of dementia progress gradually, often over a period of several years. The early signs (usuallymemory problems) are normally subtle and may not be immediately obvious.The symptoms of dementia can vary greatly, but those with dementia often have one or more of the following:

1) Problems with memory – this may include forgetting the names of people they know well, or forgetting where they live.Normally, recent memories are affected first, with memories of events further in the past only affected once the dementiabecomes more developed. As dementia progresses, memory loss may affect memories of recent events so completelythat the person appears to be living in the past – they may even think of themselves as young and not recognize their trueage.

2) Problems with speech and language – they may forget simple words, may use the wrong words without noticing, or their conversation may become simplified, repetitive or irrelevant.

3) Confusion – they may become confused in new surroundings or by new people, or about who or where they are. Theymay lose track of time so that they are unsure what day it is, or even whether it is morning or afternoon.

4) Changes in mood or behaviour – they may become irritable or aggressive. As dementia progresses they may lose their normal inhibitions and begin to say or do inappropriate or antisocial things; in some cases this can include inappropriatesexual behaviour. They may lose interest in the outside world or their own care, giving up interests and hobbies, payinglittle attention to their personal hygiene, or forgetting to wash or change their clothes.

5) Difficulty performing simple tasks they may have difficulty doing everyday tasks such as cooking a meal. They may begincooking and then wander away, forgetting what they were doing, or they may prepare a meal and then forget to serve it.

6) Problems learning new information, ideas or skills.Some types of dementia can cause less common symptoms, including:

7) hallucinations,
8) obsessive or repetitive behaviour,
9) the belief that they have done or experienced things that never happened (confabulation),
10) disturbed sleep, or sleeping in the daytime and being awake at night,
11) depression,
12) physical deterioration, loss of appetite, loss of weight and increased vulnerability to infection, and
13) Incontinence.If dementia becomes severe, it can cause other symptoms, including:
14) difficulty with swallowing,
15) difficulty changing position or moving from place to place without assistance, and
16) Complete loss of short-term and long-term memory.Sometimes, those with dementia are unaware that they have any symptoms, especially symptoms that affect behaviour.Many conditions (such as depression) have symptoms similar to dementia, so it is important not to assume that someone hasdementia just because they have some of the symptoms above.

B) Causes: Dementia develops when cells in the parts of your brain involved with mental ability become damaged. Damage to these cellscan be caused by: Alzheimer’s disease, vascular dementia, brain tumour, head injury etc.The most common type of dementia is that caused by Alzheimer’s disease, which is responsible for about 60% of all cases. Thecause of Alzheimer’s disease is unknown, except for a very small percentage of cases that are inherited. About 20% of all cases of dementia are vascular dementias, the name given to dementia caused by poor circulation of blood inthe brain. The risk of developing vascular dementia is increased by the same things that increase the risk of stroke and heartdisease. These include high blood pressure, diabetes, smoking, poor diet and excessive alcohol intake.
Other less common types of dementia include:Lewy body dementia, Picks disease, HIV/AIDS, alcohol, drugs, toxins and vitamin deficiency.

C) Diagnosis: Depends on history and clinical examination, supplemented with investigations.

D) Treatment: Most types of dementia cannot be cured. The exceptions are:

1) those dementias related to vitamin or hormone deficiency, which can be treated with supplements,
2) those related to head injury, hydrocephalus or tumour, which may be treatable with surgery,
3) those related to medication, which can be treated by altering the medication, and
4) those related to infections, where treating the infection will normally cure the dementia. Alzheimers disease cannot be cured.

However, for some people in the early and middle stages of the disease, the medicinesdonepezil, rivastigmine, galantamine and memantine may help prevent some symptoms from becoming worse for a period of time.There is some evidence that the herbal remedy Ginkgo biloba can delay the progression of dementia for some of those with Alzheimer’s disease or vascular dementia, and even make a small improvement in symptoms such as forgetfulness andconfusion. It is thought that mental activity can help to slow the progress of some types of dementia, so you should encouragesomeone with dementia to stay mentally and physically active and ensure their environment is stimulating.

Puzzles, games(particularly memory games), reading and simple mental arithmetic are good choices, but its important not to overwhelm themwith too many demands, or unrealistic demands, as this may only frustrate them. A technique called reality orientation may help some people with dementia. It uses repetition to help the memory and involvesregularly reminding the person of information such as the time, date, where they are and important information for that day, suchas a visit to see a friend. The information could be given verbally by a carer, or be written on a board in their home where theywill see it regularly. The aim of reality orientation is to help people understand their situation by reminding them or telling themabout what’s going on.Many of those with dementia in the early and intermediate stages are able to cope well in their own home, due to the familiar surroundings. Others may need more frequent supervision, full time care in the home, or care in a residential or nursing home.

Compiled in year 2008.This article is for information only and should not be used for the diagnosis or treatmentof medical conditions. We have used all reasonable care in compiling the information but make no warranty as to itsaccuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
Compiled by:-
Dr. Arun K. Dhanuka
MBBS, MD, DM (Neurology)
1799/1, Maharaj Nagar, Near PAU Gate No. 3,Ludhiana (Punjab).Ph: 0161-4662345, 98550-30365, 98147-20265