Dementia is basically an umbrella term that encompasses a group of disorders characterized by misperception, memory problems, disorientation, mental confusion and in some cases, behavioral problems. At this point, it is important to note that dementia is not a normal sign of aging. According to researchers, there are more than 50 underlying causes of dementia, including diseases such as stroke, head injuries and Alzheimer’s disease. While each dementia type has its own unique features, they all cause brain cells to die quicker than normal. As a result, dementia patients often suffer from judgment, personality and memory problems.
Dementia typically progresses slowly in three stages (early, middle and late stage). As it slowly damages the brain, it causes substantial impairment in cognition and thinking, interfering with a patient’s ability to live independently.
According to the World Health Organization, about 50 million patients suffer from dementia worldwide. Out of these, about 35 million suffer from Alzheimer’s dementia, which is the sixth leading cause of death among seniors in the US. In fact, the Alzheimer’s Association says that one out of every three seniors in America dies with dementia. Even worse, the WHO expects this number to double and triple by 2030 and 2050, respectively. What’s more, dementia is the main cause of dependency in seniors, putting a severe strain on the nation’s healthcare system. Currently, dementia costs the US healthcare system an estimated $600 billion annually. With that in mind, here is a detailed look at dementia.
Types of Dementia
As mentioned above, dementia is a collective name for a group of mental disorders. The most common types of dementia include:
Creutzfeldt-Jakob disease (CJD)
Caused by the accumulation of a toxic protein called prion in the brain, CJD is a fatal but rare type of dementia that affects only about 300 seniors (age 60 and older) annually in the US. Prions damage the brain, causing it to shrink. CJD progresses rapidly, moving from the initial stage to the final stage within a year or so of onset. The disease can be spread through direct contact with infected body fluids.
Some of the most common CJD symptoms include:
• Poor balance and coordination
• Personality changes
• Visual impairment, cognitive impairment and inability to make judgments
• Muscle jerks (myoclonus), which can eventually cause blindness
In the late stage, patients experience loss of mobility and can become comatose.
There is currently no treatment for CJD.
Huntington’s disease (HD) is a genetic disease that causes progressive brain damage, causing the loss of physical, intellectual and memory abilities.
Some of the common symptoms associated with Huntington’s disease include slurred speech personality changes, significant weight loss, mood swings, depression, forgetfulness and impaired judgment, anxiety, depression, myoclonus, and difficulty swallowing. It is worth noting that these symptoms typically appear between the ages of 30 and 50 and get progressively worse over a 10 to 15 year period. Moreover, the common causes of death from HD are an inability to swallow, slip-and-fall injuries and pneumonia.
HD Risk Factors
Because HD is an hereditary disease, a child born to parents with HD has a 50% chance of inheriting the disease.
To diagnose HD, doctors typically review a patient’s family medical history, perform a neurological and psychiatric exam, as well as ask the patient certain questions in order to judge the patient’s mental status, coping skills, reflexes, mood, and memory.
You can prevent HD through genetic testing and taking the necessary preventative measure if you or your partner carry the Huntington’s gene.
Frontal Temperal Dementia (FTD)
This disease affects the temporal and frontal lobes of the brain. These are the parts of the brain responsible for processing sensory input and memories, as well as cognitive skills, such as problem-solving skills.
Patients often exhibit antisocial behavior, impulsiveness, speech impairment and memory problems.
To lessen the undesired behaviors associated with FTD and ease FTD symptoms, doctors often use behavior modification therapy and antidepressants.
Caused by the accumulation of a snipped protein called amyloid-ß (amyloid beta) in the hippocampus, the area of the brain responsible for memory, Alzheimer’s dementia is a neurodegenerative condition that damages brain cells, leading to cognitive decline and memory loss. In particular, this condition interferes with a specific type of neuron synchrony called gamma rhythm. It starts mild and gets progressively worse. According to the Alzheimer’s Association, more than 5 million Americans currently have some type of Alzheimer’s disease, making it the most common type of dementia in the US. Worldwide, about 60 to 70% of patients who have dementia have Alzheimer’s disease, too, according to figures from the WHO.
The main causes of Alzheimer’s disease include stroke, head injuries, brain tumor, infections to the brain, lifestyle and environmental factors.
Alzheimer’s symptoms generally depend on the stage of the disease. More specifically, the early stage of the disease is typically characterized by confusion and short-term memory loss. The symptoms of the middle stage of Alzheimer’s dementia include constant questioning, slurred speech, communication and language difficulty, tremors and difficulty performing regular tasks. The final stage is characterized by long-term memory loss, emotional and physical instability and major personality changes.
Currently, there are no effective treatment options for Alzheimer’s disease because researchers do not yet know enough about the underlying biology of the disease. This is due to a number of reasons. Firstly, researchers are yet to understand how amyloid-ß plaques and tau tangles accumulate in the hippocampus or why the progression of the disease varies from one patient to another. Secondly, Alzheimer’s symptoms typically develop slowly over time, preventing the timely diagnosis of the disease before the brain undergoes irreversible neurodegenerative changes. Thirdly, Alzheimer’s may coexist with types of dementia such as vascular dementia. Finally, researchers are yet to manufacture Alzheimer’s drugs that can effectively cross the blood-brain barrier.
Caused by both large and small strokes in the brain, this is the second most common type of dementia after Alzheimer’s dementia. In essence, this condition occurs when the blood vessels that supply the brain with oxygen-rich blood are damaged, depriving the brain of enough oxygen. This means that brain injuries, tumors, and brain infections can also cause vascular dementia.
Diagnosis typically involves MRI screening as well as assessments of a patient’s cognitive functions.
The risk factors for vascular dementia include age (seniors age 60 and older are at a greater risk), gender (men are at a greater risk compared to women) heart disease, stroke and vasculitis.
Some of the common symptoms of vascular dementia include communication and language difficulty, confusion, disorientation, trouble understanding speech, emotional instability and partial vision loss.
Similar to other types of dementia, there is no cure for vascular dementia now. However, there are medications that improve a patient’s quality of life.
Caused by the accumulation of a protein called alpha-synuclein, Parkinson’s dementia manifests symptoms similar to Alzheimer’s dementia and can occur after years of having Parkinson’s disease. According to the National Parkinson’s Foundation, about 1 million Americans are currently living with Parkinson’s dementia. Out of those, 50 to 80% will Parkinson’s disease dementia. Moreover, the Alzheimer’s Association says that patients with Parkinson’s disease are six times more likely to develop dementia compared with patients without Parkinson’s dementia.
The risk factors for Parkinson’s dementia include gender, ethnicity, age, genetics, head injuries and environmental factors, such as exposure to toxins.
The common symptoms of Parkinson’s dementia include declining memory functions, tremors, slow shuffling gait, muscle rigidity, gait disturbance, bradykinesia, hallucinations, depression, anxiety, trouble interpreting visual information, sleep disturbances, and personality and behavioral changes.
The diagnosis of Parkinson’s dementia involves MRI screening and lab tests and a thorough physical examination.
There is no specific treatment for this condition currently. However, certain medications including cholineesterase (acetylcholinesterase) inhibitors, L-opa, antidepressants (SSRI) and Clonasepam can help stop the progression of the disease and the symptoms.
Lewy Body Dementia (LBD)
LBD is a Parkinson’s-like condition that often causes hallucinations, balance problems, and confusion. In other words, it causes function and cognitive impairments. It is worth noting that LBD is the second common cause of dementia after Alzheimer’s disease. This condition is characterized by the presence of Lewy bodies in the cerebral cortex.
Lewy bodies are essentially small clusters of proteins, mainly alpha-synuclein protein, which occurs naturally in the brain and other body tissues and organs including the heart and muscles. In nerve cells, alpha-synuclein protein plays a role in the release of neurotransmitters, allowing nerves to communicate with each other effectively. This means that it perfectly healthy to have small amounts of alpha-synuclein in your body. However, when this protein is deformed due to mutation or damage, it clumps together, forming Lewy bodies, which eventually cause Lewy body dementia.
Some of the symptoms associated with LBD include confusion, concentration problems, hallucinations, tremors. stiffness and difficulty in walking, declining memory functions, sleep disturbances, and personality and behavioral changes, communication and language difficulty and bradykinesia.
The diagnosis of LBD involves a thorough physical examination.
Similar to other types of dementia, there is no current cure for LBD. Moreover, LBD patients tend to have a severe sensitivity to most antipsychotic drugs, which are used to manage hallucinations.
The risk factors for LBD include age (seniors are at a greater risk for LBD than young people), gender (affects more men than women), and genetics.
How to Cope With a Loved One Suffering from Dementia
Because dementia gradually diminishes a person’s mental and cognitive abilities, a dementia patient typically has difficulty understanding others, as well as expressing thoughts and emotions. Here are some tips to help you communicate with a loved one sufferings from dementia.
• When communicating with your loved one, always ensure you create a “kind voice.” To do this, speak gently and smile while you talk. At the same time, be sure to talk slowly and clearly.
• To orient your loved one and get his/her attention, always call your loved one by his/her name. To avoid startling your loved one, always approach your loved one from the front. Additionally, always tell your loved one who you are, even if your child or spouse.
• Avoid asking your loved one multiple questions at a time. Instead, ask hi/her one question at a time. At the same time, use short phrases and simple words, refrain from using reason and logic and more importantly, avoid asking, “Do you remember when…?” type of questions. Additionally, do not get impatient if your loved fails to respond to your questions immediately. Instead, be patient and allow him/her extra time to process your question. If he/she fails to respond after a reasonable amount of time, you may repeat your question, but be ensure to use a gentle voice and friendly tone.
• When having a conversation with your loved one, don’t interrupt, criticize, correct or argue with him/her. At the same time, let your loved one know you are listening and trying to understand the message. To do this, always maintain good eye contact and show the person you care about what he/she is saying.
• In case your loved one says something mean to you, do not take it personally. Instead, focus on your loved one’s feelings, not the negative information. You should understand that dementia may cause your loved one’s personality to change, causing him/her to be emotionally unstable and exhibit antisocial behavior. Because of this, your loved one might say some hurtful things to you. When this happens, simply let it go.
• As a home care aide, always allow your loved one to think about and describe whatever he/she wants. If he/she uses the wrong word or cannot find a word, try guessing what he/she wants. If you’re unable to understand what your loved one wants, ask him/her to gesture or point.
Some of the things you should avoid when caring for your loved one with dementia include:
• Avoid overstimulating your loved one. This could be in the form of too much physical activity without rest breaks or other activates such as quizzing. Overstimulation is a problem because it could easily overwhelm your loved one’s ability to cope, causing your loved one to become combative and more resistant to you. Additionally, it makes your loved one more prone to accident, including slip-and-fall accidents.
• As a caregiver, you should avoid being overprotective of your loved one. In fact, unless it’s a big safety issue, allow your loved one to do what he/she wants. This is particularly important because your loved-one may have lost his ability to make good judgment. However, if you treat your loved one as a child, he/she may see you as the unreasonable and become argumentative, combative, or resistant to you.
• Do not force your loved one to do things that he/she does not want to do.
• Avoid giving your loved one multiple choices. This is important because your loved one may have lost his/her ability to make decisions, as well as intellectual and cognitive abilities.
Although currently available medications, including acetylcholinesterase inhibitors and glutamate (memantine), temporarily manage the symptoms of dementia, they do cure the disease. Because of this, new treatment options are focused on slowing or reversing the disease process itself, by targeting the underlying biology. Fortunately, researchers have made promising breakthroughs in this area in the recent past. Current research in this field includes:
Optogenetic stimulation is a non-invasive procedure that uses flickering light to destroy amyloid beta protein, preventing brain damage, particularly in the hippocampus region. Previous research on light-therapy as a treatment for dementia has not produced the desired results. However, in late 2017, Dr. Li-Huei Tsai of the Picower Institute for Learning and Memory at MIT and her team used optogenetics to correct the gamma rhythm in the hippocampus of genetically modified mice with Alzheimer’s disease. By stimulating brain neurons in the 40 Hz range, at the optimal gamma rhythm amplitude, the researchers were able to correct the gamma rhythm in Alzheimer’s mice by activating genes in brain cells called microglia. Microglia are part of the brain’s immune system and function in part to ingest or clear away microorganisms that might cause disease.
Optogenetic stimulation (flickering light to restore the gamma rhythm and reduce the levels of amyloid beta) at the 40 Hz range activated microglia to promote the clearance of amyloid beta.
The 40 Hz flickering light caused enhanced gamma rhythm neuronal activity and reduced amyloid beta levels by over 50% in the visual cortex. In addition, the 40 Hz flickering light treatment caused microglia in Alzheimer’s mice to become more active and dramatically increase in size by engulfing amyloid beta.
Researchers at the Washington University have developed a compound called tau antisense oligonucleotides that, according to the researchers, stops the producing of tau protein in the brains of dementia patients. The researchers claim that this compound could possibly prevent and reverse the side effects caused by the tau protein. When present in the brain in large quantities, tau protein causes the brain to undergo neurodegenerative changes.
Immunotherapy involves creating antibodies that bind to the protein clumps in the brain, including amyloid-ß and tau proteins, marking them for destruction by a range of mechanisms. For example, a synthetic antibody called aducanumab that targets amyloid-ß has shown promise in clinical trials. Currently, this antibody is in its third and final clinical trial phase.
Ultra Sound Therapy
Ultrasound therapy entails using ultrasound to open the blood-brain barrier temporarily, allowing doctors to introduce therapeutic antibodies into the brain. This is important because, according to researchers such as Jürgen Götz of the Jones Centre for Ageing Dementia Research at the University of Queensland, only about 0.1% of antibodies (both natural and synthetic) enter the brain.
Researchers at the Clem Jones Centre for Ageing Dementia Research at the University of Queensland have successfully used this technique in lab mice. Using this treatment technique, the researchers were able to clear toxic plaque buildup in the brain of test mice. According to the researchers involved in this study, combining an antibody fragment treatment with ultrasound is more effective in eliminating plaque buildup from the brain and improving dementia symptoms than either treatment option alone.
Dementia is not one disease but a collective name for a group of mental disorders that characterized by the destruction of brain cells. These disorders include Creutzfeldt-Jakob disease (CJD), Huntington’s Disease, Frontal Temporal Dementia (FTD), Alzheimer’s Dementia, Vascular Dementia, Parkinson’s Dementia and Lewy Body Dementia (LBD). Although dementia is commonly associated with aging, it is not a normal stage of aging. In fact, dementia can affect virtually anyone irrespective of a person’s age. Some of the common causes of dementia include brain injuries, brain infections, accumulation of certain proteins in the brain, certain diseases such as Alzheimer’s and brain tumors. Because there are different types of dementia, it is important to know which type of dementia a patient. This information helps to identify the symptoms and make a timely diagnosis. To manage the condition effectively, doctors recommend seeking medical advice as soon as the symptoms start to develop.
The risk factors for dementia include age, genetics, gender, and ethnicity. The common symptoms of dementia include communication and language difficulty, confusion, disorientation, trouble understanding speech, emotional instability. Dementia is a progressive condition that starts with short-term memory loss. Its rate of progress varies from one individual to another. Additionally, different stages of the disease manifest different symptoms. Currently, there is no cure for dementia, but there are medications for easing the symptoms. Because of this, dementia is one of the leading causes of death among seniors in the US. Additionally, dementia is a big burden on the nation’s healthcare system. Thankfully, researchers have made breakthroughs in finding a cure for dementia. Some of the possible treatment options that scientists are currently testing include ultrasound therapy, immunotherapy, antisense oligonucleotides and optogenetic stimulation, a non-invasive technique that uses flashing lights to reset the gamma rhythm to its optimum frequency.