When we think of Dementia, we think of an old person that is forgetful and confused. The keyword here is ‘old’. It makes sense. As we age, everything in our bodies declines. Skin gets wrinkled, the joints become arthritic, the heart acquires abnormal rhythms; vision and hearing become impaired, teeth fall off and we start needing high maintenance medications (whether for heart or blood pressure or diabetes etc) because just like a car, we have already used up our warranties and we need to check it under the hood frequently and immediately address its problems before it breaks down in the middle of the road. Obviously, the brain also declines. Most of us get by with occasional forgetfulness with funny anecdotes of looking for your eyeglasses while wearing them or looking for keys that you are holding in your hands. I do have those ‘senior moments’ but they don’t automatically mean dementia. Dementia is far more damaging than simple forgetfulness. It gets worse when it progresses to Alzheimer’s disease. There is a joke about how to differentiate Dementia from Alzheimer’s. Dementia is driving to a mall to do your shopping and after shopping you cannot remember where you parked your car. Alzhemier’s is driving to a mall to do shopping and once you’re done, you flag a taxi or take the bus without knowing where your address is.
It may sound funny to many of us, and we laugh at this with a nervous laugh because we all know this could happen to any of us who are now stepping into our 60s.
What is dementia? It is simply memory loss. In Rehab parlance, it is cognitive loss.
And it can be manifested by these symptoms:
- Difficulty performing ‘normal’ tasks
- Language problems (aphasia)
- Decline in judgment (poor safety awareness)
- Poor abstract thinking (decline in complex mental processes)
- Misplacing things frequently (I am guilty of this)
- Moodiness, abrupt changes in behavior
- Change of personality (confident to insecure, brave to fearful etc)
- Loss of motivation or initiative or purpose in life
It has been suggested that neurological changes in the brain occur years prior to the manifestation of the symptoms described above.
What are the categories of Dementia?
Reversible Dementia are those temporary memory losses and confusion brought about by brain tumors, brain bleeding, hydrocephalus (water in the brain), metabolic disorders such as vitamin B12 deficiency, low thyroid hormones, psychiatric problems like depression, and major infection or sepsis. Once these conditions are resolved, Dementia can possibly resolve as well.
In clinical settings reversible dementia can also be caused by Acute Respiratory Distress Syndrome(ARDS) which basically means failure of the lungs (breathing) that requires ventilation in an ICU setting. Though reversible, 78 percent of people who suffered ARDS show cognitive deficits (mental decline) one year after being discharged from hospital, 50 percent may still show the mental decline 2 years after discharge, for those with associated severe sepsis or infection, the mental decline can persist up to 5 years. Prolonged hospitalization causes severe mental decline. However there is still a big chance to reverse it though it might take time.
Non-Reversible Dementia is the one that we classically deal with when it comes to managing patients with dementia.
Parkinson’s Disease is the most common cause of Dementia. 50-80 percent of people with Parkinson's Disease will experience Dementia around 10 years after being diagnosed. Some neurological hallmarks for this include presence of a protein “Lewy bodies” and beta-amyloid plaques and neurofibrillary tangles. (this is more on the domain of Neuro specialists).
Everybody is familiar with Parkinson’s Disease - the person’s movements are slow, body is rigid, their posture is bent, especially the head, their walking are short and shuffling, they drool, they ‘freeze’ when they change directions while walking, they don’t have normal facial expressions, and they don’t sleep well.
The second most common cause of Dementia is Multi-Infarct (Vascular) Dementia. This type of dementia is caused by reduced blood or blockage in the flow of blood in the brain, which could have resulted from stroke or mini-stroke and especially strokes that occur multiple times. This is very common among men between 55 - 75 years old. It does co-exists with Alzhimer’s. Sadly, there is no cure for this, the damage is non-reversible.
People with strokes have a high risk of developing dementia. Other medical conditions that increase one’s risk for Dementia include diabetes, atherosclerosis or hardening of arteries prevalent to smokers and alcoholics, poor diet and no exercise. Once Vascular dementia occurs to these types of people, they show difficulty doing things that used to be easy to do for them, they get lost all the time, they could not easily find the words they want to say, they lose interest in tasks they used to enjoy doing (like hobbies), their faces are blank and flat, they misplace things, they have poor dealing with people (as opposed to them being sociable before), they get easily agitated, they have poor short term memory, meaning they may not remember what they just did 5 minutes ago.
There is a special condition among the Vascular Dementia worth mentioning here. It is called front-temporal Dementia. It involves the front and side parts of the brain where blood flow is restricted. It could be a result of a stroke or bleeding in the brain due to injury like a fall and bumping the head. The reason this is special is because the involved part of the brain is the seat of Reason, Logic, Self-Control and Judgment.
Their family members are shocked by the sudden changes in the personality of ones with this type of Dementia. Oftentimes families come to me saying their father (or mother) is a total stranger to them. These patients appear possessed by another being. A very decent Pastor starts cursing, a retired Doctor starts swinging his arms to punch everyone that gets close to him, a beloved parent is aggressively getting out of the room to go ‘to my house; or ‘to my parents’(who are most likely dead for decades) or they call on old friends or lovers or children or relatives to come help them because they need to go to the bathroom. They are highly obsessed to escape where they are, causing extreme stress to their family or caregivers. Some of them become amorous, suddenly hitting on everyone and looking for a new sexual partner all the time. They have propensity to make indecent proposals, taking off their clothes in public spaces. Patients with Fronto-Temporal Dementia show marked changes in personality and mood, communication is highly altered for the worse, they are very impulsive, they get easily bored and apathetic(they don’t care about anybody except what they feel), very inappropriate in social behavior (they have sudden flaring up of temper, saying things that are not said in normal conversations, can become suspicious, they call you names etc) Surprisingly, their memories remain largely intact.
Finally, the third most common type of Dementia is called Lewy Body Dementia. It is very similar to Parkinson’s with or without the neuro plaques and tangles, a common diagnostic include abnormal proteins that develop inside nerve cells of the brain. These patients move like Parkinson’s, their eyes fixed on the floor and mumbling all the time. This type of Dementia is often underdiagnosed and lumped up with the other forms.
There is another form of Dementia, Korsakoff syndrome, which is very common among people with a history of alcohol abuse especially binge drinkers. 1 in 8 people with alcoholism will develop this type of Dementia.
… to continue