Dementia

What is dementia? Such a common term, yet it is often misused and misunderstood. According to the World Health Organisation, “dementia is a a syndrome in which there is deterioration in cognitive function beyond what might be expected from the usual consequences of biological ageing”. When most people hear the word dementia, they tend to only relate it to memory loss or to an old and “crazy” person. These false “definitions” are part of the reason why people are afraid to seek help when dementia-like symptoms are recognised, as the diagnosis of dementia is highly degrading.

What is dementia?

Dementia is an umbrella term for the loss of thinking abilities, such as memory, language and problem-solving skills. These impairments can progress and can lead to a diminished quality of life. Dementia should not be considered a normal part of ageing, as 60% to 80% of diagnosed dementia cases are caused by Alzheimer’s disease.

How can we recognise the signs of early dementia?

There are 10 agreed upon warning signs, which could lead to a diagnosis of early dementia.

1. Memory loss affected day to day life
2. Difficulty in performing familiar tasks
3. Language Problems
4. Disorientation
5. Impaired judgement
6. Problems with abstract thinking
7. Object misplacement
8. Mood and behavioural changes
9. Personality changes
10. Loss of initiative

After reading this short list, I believe it is quite feasible to realise that a person suffering from dementia can be very confused and frustrated, especially when they are not able to remember how to prepare a very simple meal or which words to use in simple sentences. Dementia mainly affects people who are over 65 years old; 1 in 14 people in this age group suffer from this disease.

How can dementia be diagnosed?

Even though the warning signs of dementia are quite clear, they are also quite common for other neurological diseases. Hence, there is no single test which is considered to be the golden standard when trying to diagnose dementia. It is quite common to reach the diagnosis of dementia through the diagnosis of Alzheimer’s disease. The latter is diagnosed through a series of investigations, consisting of medical history, mental status tests, physical and neurological exams, diagnostic tests and brain imaging. In 2021, it was estimated that, in the United States of America, 6.2 million people, aged 65 or older, are living with Alzheimer’s dementia. Apart from an Alzheimer’s diagnoses, dementia can be diagnosed by the use of brain scans, which can identify tumours or strokes. The most widely used test is a Computed Tomography scan of the brain. Moreover, testing the patient’s thinking ability can help the physician assess cognitive status. 

The stages of dementia

In addition to early warning signs, there are different stages of dementia. These stages can help a physician create individualised treatment plans, based on the patient’s current condition, needs, and wishes. The most used way of staging dementia patients is the Global Deterioration Scale, or simply, the GDS. This scale divides the dementia progression into seven stages, depending on the patient’s cognitive decline. As you can see, the first three stages of the disease present with very little to no cognitive decline, which renders the diagnosis of early dementia almost impossible to make.

Hence, dementia can usually be diagnosed after a moderate cognitive decline, which is considered to be the 4^th stage of the disease.

Is dementia curable?

Most cases of dementia can not be cured. The only possible treatment option is considered palliative, by means of symptom management. There are quite a few types of medications which can be used in order to alleviate some of the symptoms. I do not want to get into too much detail about pharmacological mechanisms of action, but I do believe it is important to acknowledge some of the amazing life improvements which can result from pharmacological treatment.

1. Cholinesterase inhibitors increaselevels of a chemical messenger involved in memory and judgment. There were initially used to treat Alzheimer’s disease, but they are now also prescribed for dementia patients.
2. Memantine, like cholinesterase inhibitors, regulates the activity of glutamate, a chemical messenger, involved in functions, such as learning and memory.

In addition to pharmacological treatments, life-style therapies are also used in order to improve the patient’s quality of life.

• Occupational therapy can increase a patient’s safety, by preventing home accidents (e.g. falls)
• Modifying the environment, by reducing clutter and noise, can increase the level of focus
• Simplifying tasks can have a great impact on the patient’s mentality, as it can reduce confusion and frustration, by increasing the rate of success when performing simple tasks.   

Final thoughts

I would like to conclude by saying that it is my hope that this short overview about dementia can raise awareness about the true signs and symptoms of this disease. I consider it to be of tremendous importance to not label people because of their diagnosis. The Guardian has reported that 41 million people live with undiagnosed dementia worldwide. Educating ourselves about this disease can help us recognise early warning signs in the people around us and help them get the treatment they need and deserve.