Dementia

What is Dementia?

Dementia is a progressive brain dysfunction (in Latin 'dementia' means irrationality), which results in a restriction of daily activities and in most cases leads in the long term to the need for care. Many diseases can result in dementia, the most common one being Alzheimer's disease.

How common is dementia?

In our society of longer lifetime the probability of suffering from dementia increases with advancing age. Dementia predominantly occurs in the second half of our life, often after the age of 65 - some experts think that this is the 'price society has to pay' for our higher life expectancy and therefore the term 'dementia' activates similar fears and repression mechanisms as 'cancer' or 'AIDS'.

The frequency of dementia increases with rising age from less than 2 % for the 65-69-year-olds, to 5 % for the 75-79 year-olds and to more than 20 % for the 85-89 year-olds. Every third person over 90 years of age suffers from moderate or severe dementia (Bickel, Psycho 1996, 4-8). About half of those affected by dementia suffer from Alzheimer's disease.

About 5 % of people above 65 years of age, about 20 % of those over 80 years and about 30 % of those over 90 suffer from Alzheimer's disease.

The relatives share their fate with many people who are equally affected.

Dementia Causes

Dementia has many different causes, some of which are difficult to tell apart. Many medical conditions can cause dementia symptoms, especially in older people.

• The causes of dementia include various diseases and infections, strokes, head injuries, drugs, and nutritional deficiencies. 
  
• All dementias reflect dysfunction in the cerebral cortex, or brain tissue. Some disease processes damage the cortex directly; others disrupt subcortical areas that normally regulate the function of the cortex.
  
• When the underlying process does not permanently damage the cortical tissue, the dementia may sometimes be stopped or reversed.
  
• In classifying dementias, medical professionals may either separate cortical or subcortical dementias or divide reversible and irreversible dementias.

Dementia Symptoms

Symptoms of dementia vary considerably by the individual and the underlying cause of the dementia. Most people affected by dementia have some (but not all) of these symptoms. The symptoms may be very obvious, or they may be very subtle and go unrecognized for some time. The first sign of dementia is usually loss of short-term memory. The person repeats what he just said or forgets where she put an object just a few minutes ago. Other symptoms and signs are as follows:

Early dementia

• Word-finding difficulty - May be able to compensate by using synonyms or defining the word
• Forgetting names, appointments, or whether or not the person has done something; losing things
• Difficulty performing familiar tasks – Driving, cooking a meal, household chores, managing personal finances
• Personality changes (for example, sociable person becomes withdrawn or a quiet person is coarse and silly)
• Uncharacteristic behavior
• Mood swings, often with brief periods of anger or rage
• Poor judgment
• Behavior disorders – Paranoia and suspiciousness
• Decline in level of functioning but able to follow established routines at home
• Confusion, disorientation in unfamiliar surroundings – May wander, trying to return to familiar surroundings

• Worsening of symptoms seen in early dementia, with less ability to compensate 
• Unable to carry out activities of daily living (eg, bathing, dressing, grooming, feeding, using the toilet) without help 
• Disrupted sleep (often napping in the daytime, up at night) 
• Unable to learn new information  
• Increasing disorientation and confusion even in familiar surroundings  
• Greater risk of falls and accidents due to poor judgment and confusion  
• Behavior disorders – Paranoid delusions, aggressiveness, agitation, inappropriate sexual behavior 
• Hallucinations 
• Confabulation (believing the person has done or experienced things that never happened) 
• Inattention, poor concentration, loss of interest in the outside world  
• Abnormal moods (anxiety, depression)

• Worsening of symptoms seen in early and intermediate dementia 
• Complete dependence on others for activities of daily living  
• May be unable to walk or move from place to place unassisted  
• Impairment of other movements such as swallowing – Increases risk of malnutrition, choking, and aspiration (inhaling foods and beverages, saliva, or mucus into lungs)  
• Complete loss of short- and long-term memory – May be unable to recognize even close relatives and friends  
• Complications – Dehydration, malnutrition, problems with bladder control, infections, aspiration, seizures, pressure sores, injuries from accidents or falls

Depression in elderly people can cause dementialike symptoms. As many as 40% of people with dementia are also depressed. Common symptoms of depression include depressed mood, loss of interest in activities once enjoyed, withdrawal from others, sleep disturbances, weight gain or loss, suicidal thoughts, feelings of worthlessness, and loss of ability to think clearly or concentrate.

People with irreversible or untreated dementia present a slow, gradual decline in mental functions and movements over several years. Total dependence and death, often from infection, are the last stages.