Dementia
WHAT IS DEMENTIA?
Dementia is a medical disorder caused by malfunctions in the brain. It is characterized by multiple cognitive symptoms, including loss of memory, difficulty using written or spoken language, difficulty initiating movements, difficulty recognizing familiar objects, and difficulty planning and completing complex behaviors.1 For an official diagnosis of dementia to be made, these symptoms must cause severe difficulties in the person’s life and represent deterioration in his or her level of functioning. Dementia is much more severe than occasional, normal forgetful moments. Typically, dementia is caused by some kind of medical illness or the use of substances, such as medications, drugs, or alcohol.
Frequently, the first recognizable symptom of dementia is memory loss. In the early stages of the illness, people often display difficulties in retaining new information. For example, a person might have trouble remembering the names of people he or she recently met, might repeatedly forget where he or she just placed an object such as keys, or might consistently ask others for help in remembering new information. But as the illness progresses into more severe stages, the person also starts to forget older, previously learned material, such as facts about his or her own life and the lives of family and friends.
Similarly, as a person’s dementia progresses, other symptoms of the illness, including aphasia, apraxia, and agnosia, may become more noticeable. Aphasia is difficulty in using or understanding language. The person’s style of speech may become rambling or difficult to understand, and in the later stages of dementia, he or she may become completely mute.
Apraxia is an inability to start or complete movements or actions. This can lead to the person being unable to feed, dress, or take care of himself or herself. In some cases, the person may simply pretend to do the action, such as brushing his or her teeth, without remembering the goal of the action.
Agnosia is the inability to recognize familiar objects even when looking at them, listening to them, or feeling them. For example, a person with dementia may not recognize family members when looking at them or know what an object is when holding it in his or her hand.
People with dementia also frequently experience difficulty making complex decisions and planning complex behaviors. This is known as a deterioration of executive functioning. As a result, people with dementia may find themselves getting lost in unknown places, unable to plan for the future, and unable to complete complicated tasks.
Typically, dementia is experienced by older adults, especially those in their eighties and nineties. But the disorder can affect people much younger, especially when it is the result of brain injury or illness, such as HIV or Alzheimer’s disease.1
ARE THERE OTHER PROBLEMS RELATED TO DEMENTIA?
People with dementia often experience many other related problems.1 For example, they may experience difficulties navigating their position in space, which can make activities like driving very dangerous. Similarly, they can become disoriented in regard to time and forget what year it is.
People with dementia may also be unaware of their deteriorating functioning, and therefore overestimate their abilities to carry out tasks. Their social behaviors may also be affected, leading to inappropriate behavior and language. In addition, they frequently experience symptoms of anxiety and depression, and in severe cases may experience delusions and hallucinations.
Interestingly, true dementia is often difficult to distinguish from pseudodementia, which is associated with depression. This makes an accurate diagnosis very important, since a person who is experiencing memory problems as a result of pseudodementia might respond to a treatment for depression.
In true dementia a person’s symptoms usually progress in severity over time and the person is unaware of his or her problems or denies these problems. In addition, people with true dementia experience great difficulty recalling newly learned information and recognizing previously learned information.
In comparison, the symptoms of pseudodementia often begin abruptly. It’s often associated with depression, and the person experiencing the symptoms is very aware of his or her memory problems and is concerned about them. Plus, people who are struggling with pseudodementia have little problem recognizing information, but they do have difficulty remembering how to do tasks, like paying bills or driving a car.
WHO IS AFFECTED BY DEMENTIA?
A study published in the journal Alzheimer Disease and Associated Disorders in 2003 estimated that 25 million people worldwide struggled with dementia due to various causes and predicted that the numbers would increase to 63 million in 2030 and to 114 million in 2050.2 The study further estimated that 6 percent of the population age sixty years and older suffered from some kind of dementia and that 59 percent of them were female. The worldwide responsibility of caring for so many people with this illness currently translates into yearly health care costs of about 156 billion dollars.3
However, the costs of the illness cannot be measured in financial terms alone, nor does the illness affect only those struggling with dementia. Many people struggling with dementia, especially dementia caused by Alzheimer’s disease, are cared for by family and friends, and the burden of the illness takes its toll on them as well. In one study that examined the health of people who cared for a spouse with Alzheimer’s disease, 30 percent of the caregivers developed some type of depressive disorder themselves.4 In another study of family caregivers, 68 percent felt overburdened with responsibilities and 65 percent displayed symptoms of depression.5
For these reasons, it’s very important for caregivers to know when they should seek professional help for their loved ones, such as residential care; plus, it’s extremely important that caregivers learn to take care of themselves. Sometimes having information about what to expect over the course of dementia, knowing how to handle repetitive questions, and knowing how to cope with a loved one’s distressing emotions can greatly reduce the stress level of the caregiver.(Click here for information about caregiver self-help techniques.)
WHAT CAUSES DEMENTIA?
There are many causes of dementia and each type of dementia progresses in a slightly different way.
According to the Alzheimer’s Association, Alzheimer’s disease is the most prevalent cause of dementia, accounting for nearly 65 percent of all cases of dementia.6 This type of dementia more commonly affects people over the age of 65, but it can also affect people much younger. Its symptoms progress slowly, and as a result, it may be difficult to diagnose in the early stages of the illness. In the earliest stage of Alzheimer’s disease, people may have problems remembering newly learned information, exhibit spatial navigation problems like wandering, and become easily irritable or sad. They will likely have difficulty naming familiar people and objects. In the second stage of the illness, their mood becomes unstable or very flat. They also become increasingly agitated or restless, begin to lose older memories, and may completely lose the ability to use language or control physical movements. And, finally, in the last stage of Alzheimer’s disease, people’s cognitive functioning becomes severely worse, they no longer display emotions, and movement stops completely. The entire course of the illness often lasts just ten years.
The exact causes of the illness are still unknown, but autopsies commonly reveal unnatural amyloid plaques and neurofibrillary tangles in the brain.
There is no cure for Alzheimer’s disease, but common treatments often include medications to slow the disease’s progress, such as the cholinesterase inhibitors donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), as well as the glutamate regulator memantine (Namenda). In addition, antidepressants are often used to reduce depression, antipsychotic medication may be used to reduce hallucinations, and psychotherapy techniques can be used to reduce agitation and assist family members.7
Dementia can also be caused by events related to cerebrovascular disease, such as a hemorrhage or blockage of a blood vessel in the brain, commonly referred to as a stroke. Dementia can also be caused by other diseases, including human immunodeficiency virus (HIV), Parkinson’s disease, Pick’s disease, Creutzfeldt-Jakob disease, Huntington’s disease, and syphilis. Other common causes of dementia result from the regular use of certain drugs, medications, and alcohol, or exposure to toxins such as mercury or lead. Each of these forms of dementia will cause a unique pattern of symptoms, but all include some form of memory loss, cognitive deterioration, and slowing of movement (and possibly involuntary movements), as well as depression and possibly other emotional effects. In each case, treatment of the dementia will depend on the medical cause of the disease.
REFERENCES FOR DEMENTIA
1. American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revision. Washington, DC: American Psychiatric Association.
2. Wimo, A., B. Winblad, H. Aguero-Torres, and E. von Strauss. 2003. The magnitude of dementia occurrence in the world. Alzheimer Disease and Associated Disorders 17: 63-67.
3. Wimo, A., L. Jonsson, and B. Winblad. 2006. An estimate of the worldwide prevalence and direct costs of dementia in 2003. Dementia and Geriatric Cognitive Disorders 21: 175-181.
4. Dura, J. R., K. W. Stukenberg, and J. K. Kiecolt-Glaser. 1990. Chronic stress and depressive disorders in older adults. Journal of Abnormal Psychology 99: 284-290.
5. Papastavrou, E., A. Kalokerinou, S. S. Papacostas, H. Tsangari, and P. Sourtzi. 2007. Caring for a relative with dementia: Family caregiver burden. Journal of Advanced Nursing 58: 446-457.
6. Alzheimer’s Association. 2008. Related dementias. www.alz.org/alzheimers_disease_related_diseases.asp. Accessed March 2, 2008.
7. American Psychiatric Association’s Work Group on Alzheimer’s Disease and Other Dementias. 2007. Practice Guideline for the Treatment of Patients with Alzheimer’s Disease and Other Dementias. www.psychiatryonline.com/pracGuide/pracGuideTopic_3.aspx. Accessed March 2, 2008.