Dementia is a general term used for a decline in cognitive functioning (thinking, remembering, and reasoning) severe enough to interfere with daily life. Dementia is not a disease; instead, it is a group of symptoms caused by conditions that have damaged an individual’s brain. Symptoms that signal the onset of dementia may be subtle and not noticeable for years. The characteristic symptoms of dementia include memory loss, communication difficulties, confusion, changes in mood, and apathy.
Memory loss is often subtle and tends to involve short-term memories. The individual may be able to remember years past, but not what they had for breakfast.
Communication difficulties make it hard for individuals with dementia to carry on normal conversations. They may struggle with vocabulary, have problems finding the right word, or call things by the wrong name.
Confusion may initially appear as problems with more complex tasks such as balancing the checkbook or playing games that have a lot of rules. As the cognitive decline progresses, the person may struggle to complete familiar tasks or become disoriented to a familiar place.
CHANGES IN MOOD
Changes in mood are common in dementia. Individuals can become suspicious, depressed, fearful, and anxious. The person may show increased irritability and explosive outbursts of anger when a routine or schedule is disrupted, and sudden mood swings can occur regularly.
Apathy is a frequent problem in the early stages of dementia. Individuals begin to lose interest in hobbies or activities once considered pleasurable. Emotionally, the person may appear flat and have no interest in spending time with friends or family.
Types of Dementia
To be diagnosed with dementia, a person must show a significant cognitive decline in one or more of the following areas:
- Learning and Memory
- Perceptual Motor
- Executive Function
- Social Cognition
In addition, the individual’s capacity for independence in everyday activities must be impaired. The following are some of the most common types of dementia and their causes.
ALZHEIMER’S DISEASE (AD)
Alzheimer’s Disease (AD) is the most common cause of dementia, accounting for 60-80% of all cases. In AD, proteins inside the brain’s cells (neurons) form abnormal bundles, called neurofibrillary tangles. Plaques, abnormal clumps of protein, also appear in high concentration in the spaces between the brain cells in AD patients. The accumulations of protein causes the neurons to stop functioning and die.
Vascular Disease is the second most common cause of dementia, accounting for about 10% of all cases. In this type of dementia, damaged vessels supplying blood to the brain deprive neurons of the nutrients and oxygen needed to function normally. Vascular dementia can result from a number of conditions including stroke, diabetes, and hypertension.
LEWY BODY DISEASE (LBD)
Lewy Body Disease (LBD) is one of the most common causes of dementia. Protein accumulates inside neurons forming balloon-like structures called Lewy bodies. In LBD, cells in a region deep in the brain become impaired or die, and the brain’s outer layer (cortex) degenerates.
FRONTOTEMPORAL DEMENTIA (FTD)
Frontotemporal Dementia (FTD) is not a single disease but rather a group of brain disorders that accounts for up to 10% of all dementia cases. The common characteristic of the diseases that cause this type of dementia is atrophy or shrinking in the frontal and temporal lobes of the brain.
Prevalence and Age of Onset
The prevalence of dementia (any type) in the United States among individuals 71 or older is approximately 13.9%. The prevalence rate rises steeply with age, from 5% of those 71-79 years to 37.4% of those 90 years and older.
Treatment & Support
While there is presently no cure for the diseases that cause the neurodegenerative dementias, a number of treatments and interventions have been shown to slow or minimize the development of symptoms.
Medications that boost the levels of ACh in the brain called cholinesterase inhibitors are the first line of treatment for Alzheimer’s and Lewy Body Disease. This class of medications includes:
- Aricept (donepezil)
- Exelon (rivastigmine)
- Razadyne (galantamine)
Namenda (memantine), a drug that raises the levels of the neurotransmitter glutamate in the brain, has also been shown to be effective in minimizing the symptoms of dementia.
These drugs temporarily improve symptoms by increasing the amount of chemicals called neurotransmitters in the brain. The effectiveness of these drugs varies from person to person and is limited in duration. Depression is common among individuals with dementia. Antidepressants are often prescribed to deal with mood swings and antipsychotics may be used to treat individuals who show disruptive or aggressive behaviors.
COGNITIVE STIMULATION THERAPY
A non-invasive, psychological intervention for those with a cognitive impairment, cognitive stimulation therapy (CST) focuses on the improvement and strengthening of spared cognitive functions and resources as well as on the maintenance of social and interaction skills, with the goal of improving mood and quality of life. CST involves taking part in activities and exercises designed to improve memory, problem-solving skills, and language ability. However, CST has not shown to affect mood, challenging behaviors, or the ability to perform activities of daily living.
Individuals with an incurable illness such as dementia may be offered palliative care, so they are able to live as well as possible until their death. The goal of palliative care is not to cure the disease but rather to improve the person’s quality of life, not just in body but also in mind and spirit.
A Spiritual Perspective
Old age is considered a blessing of God to which wisdom is attributed. The scriptures are clear, we are called to honor and respect the elderly. Those advanced in age are to be cared for by the church and fellow human beings. Their presence within the fellowship is both a reminder of our faith heritage as well as the opportunity for the wisdom of experience to be passed onto the next generation. In the face of dementia, the elderly are to be cared for and protected from mistreatment.