Dementia

Dementia describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily life. It isn't a specific disease, but several different diseases may cause dementia. Though dementia generally involves memory loss, memory loss has different causes. Having memory loss alone doesn't mean you have dementia. Alzheimer’s disease is the most common cause of progressive dementia in older adults, but there are a number of causes of dementia. Depending on the cause, some dementia symptoms may be reversible.

A person with dementia may show any of the symptoms listed below, mostly due to memory loss. Some symptoms they may notice themselves, others may only be noticed by caregivers or healthcare workers.

Possible symptoms of dementia:

• Recent memory loss – a sign of this might be asking the same question repeatedly.
• Difficulty completing familiar tasks – for example, making a drink or cooking a meal.
• Problems communicating – difficulty with language; forgetting simple words or using the wrong ones.
• Disorientation – getting lost on a previously familiar street, for example.
• Problems with abstract thinking – for instance, dealing with money.
• Misplacing things – forgetting the location of everyday items such as keys, or wallets, for example.
• Mood changes – sudden and unexplained changes in outlook or disposition.
• Personality changes – perhaps becoming irritable, suspicious or fearful.

Loss of initiative-showing less interest in starting something or going somewhere.

Dementia can be caused by brain cell death, and neurodegenerative disease – progressive brain cell death that happens over time – is associated with most dementias. However, it is not known if dementia causes brain cell death or the brain cell death causes the dementia. But, as well as progressive brain cell death, like that seen in Alzheimer’s disease, dementia can be caused by a head injury, a stroke, or a brain tumor, among other causes.

• Vascular dementia (also called multi-infarct dementia) – resulting from brain cell death caused by conditions such as cerebrovascular disease, for example, stroke. This prevents normal blood flow, depriving brain cells of oxygen.
• Injury – post-traumatic dementia is directly related to brain cell death caused by injury.

Some types of traumatic brain injury – particularly if repetitive, such as those received by sports players – have been linked to certain dementias appearing later in life. Evidence is weak, however, that a single brain injury raises the likelihood of having degenerative dementia such as Alzheimer’s disease.

Dementia can also be caused by:

• Prion diseases – for instance, CJD (Creutzfeldt-Jakob disease).
• HIV infection – how the virus damages brain cells is not certain, but it is known to occur.

Reversible factors – some dementias can be treated by reversing the effects of underlying causes, including medication interactions, depression, vitamin deficiencies, and thyroid abnormalities.

Diagnosing dementia and its type can be challenging. To diagnose the cause of the dementia, the doctor must recognize the pattern of the loss of skills and function and determine what a person is still able to do. Your doctor will review your medical history and symptoms and conduct a physical examination. He or she will likely ask someone close to you about your symptoms as well.

No single test can diagnose dementia, so doctors are likely to run a number of tests that can help pinpoint the problem.

Cognitive and neuropsychological tests

Doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills, such as memory, orientation, reasoning and judgment, language skills, and attention.

Neurological evaluation

Doctors evaluate your memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes and other areas.

Brain scans

·CT or MRI. These scans can check for evidence of stroke or bleeding or tumor or hydrocephalus.

·PET scans. These can show patterns of brain activity and whether the amyloid protein, a hallmark of Alzheimer's disease, has been deposited in the brain.

Laboratory tests

Simple blood tests can detect physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. Sometimes the spinal fluid is examined for infection, inflammation or markers of some degenerative diseases.

Psychiatric evaluation

A mental health professional can determine whether depression or another mental health condition is contributing to your symptoms.

Physical Therapy

Physiotherapy for people with dementia is best provided by a neurological physiotherapist. A thorough assessment will be performed on each room within the home environment. From this, a physiotherapist will provide advice and suitable recommendations on aids and adaptations to maximize the independence of the patient.

A specific fall prevention program can be created, to be completed between treatment sessions. The home assessment, along with the fall prevention program, will greatly increase safety at home and reduce the risk of falls.

Patients with dementia enjoy physiotherapy as it increases their independence and reduces their fear of falling. Neurological physiotherapy also provides acupuncture, hydrotherapy, seating/wheelchair assessments, and advice on postural management for individuals with dementia.

Several dementia symptoms and behavior problems might be treated initially using non-drug approaches, such as:

·    Occupational therapy. An occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior, and prepare you for dementia progression.

·    Modifying the environment. Reducing clutter and noise can make it easier for someone with dementia to focus and function. You might need to hide objects that can threaten safety, such as knives and car keys. Monitoring systems can alert you if the person with dementia wanders.

·    Simplifying tasks. Break tasks into easier steps and focus on success, not a failure. Structure and routine also help reduce confusion in people with dementia.