Dementia is a progressive brain dysfunction (in Latin 'dementia' means irrationality), which results in a restriction of daily activities and in most cases leads to long term care. It is a general term that describes a group of symptoms-such as loss of memory, judgment,language, complex motor skills, and other intellectual function-caused by the permanent damage or death of the brain's nerve cells, or neurons.One or more of several diseases, including Alzheimer's disease, can cause dementia.

Alzheimer's disease is the most common cause of dementia in persons over the age of 65. It represents about 60 percent of all dementias.The other most common causes of dementia are vascular dementia, caused by stroke or blockage of blood supply, and dementia with Lewy bodies. Other types include alcohol, dementia, caused by sustained use of alcohol; trauma dementia, caused by head injury; and a rare form of dementia, fronto-temporal dementia.

The reversible forms of dementia are mainly caused due to vitamin deficiencies, depression and acute clinical problem in elderly patients. Hence, an early diagnosis is critical to reverse these types of dementia. The clinical symptoms and the progression of dementia vary, depending on the type of disease causing it, and the location and number of damaged brain cells. Some types progress slowly over years, while others may result in sudden loss of intellectual function.

In our aging society the probability of suffering from dementia increases with advancing age. Dementia predominantly occurs in the second half of our life, often after the age of 65 - some experts think that this is the 'price society has to pay' for our higher life expectancy and therefore the term 'dementia' activates similar fears and repression mechanisms as 'cancer' or 'AIDS'. The relatives share their fate with many people who are equally affected.

Alzheimer's disease was first described in 1907 by the physician Alois Alzheimer. The most commonly known symptom of Alzheimer's disease is confusion. This behaviour in particular causes us to become 'estranged' from others and to be unpredictable in our interactions. Acute confusion can also occur i.e. suddenly and limited in time - for example triggered by a hospital stay, directly after heart surgery etc. It is difficult to understand this estrangement and it cannot be explained away - on the other hand everybody also experiences similar situations from time to time: we forget, misplace, can not remember names, cannot find our car in the car park and similar lapses. So both aspects are present: dementia is not familiar but also not entirely alien to us. 

The slowly progressing destruction of nerve cells in the brain leads to the previously mentioned symptoms of Alzheimer's disease. It is a natural phenomenon to loose a certain number of nerve cells during ageing but this loss occurs much more rapidly in people suffering from Alzheimer's disease. As a result the brain of the patient does not function normally any longer.

In rare cases, the disease is caused by genetic changes (mutations) in the family. In these cases symptoms usually occur before the age of 60 and progress rapidly. All currently known mutations result in an overproduction of a protein which destroys the nerve cells. In most cases the exact cause remains largely unexplained; interaction of several factors probably leads to the onset. Everybody is at risk of developing this disease. Several genetic factors are known to increase the risk, without themselves being the cause. These include a (normal) variant of the gene apolipoprotein E which encourages the deposition of the harmful protein.

The probability of developing Alzheimer's disease increases with advancing age. The probability is higher for women and for people having a lower standard of education.

Alzheimer's disease can take very different courses. It is a slowly unfolding, progressive disease which is accompanied over time by changes in the appearance of the patient. The disease is typically divided into three stages. In medical terms, Alzheimer's disease is divided into mild, moderate and severe or early-stage, mid-stage and late-stage Alzheimer. The mild stage is typically characterized by impairments of mental abilities as well as mood swings. In the moderate stage, behavioural disturbances usually increasingly develop, whereas physical problems are dominant in the advanced stage. The individual course of the disease is, however, very variable.

There are a number of favorable conditions which can ease the situation of the patient and his/her relatives - these conditions concern in particular the actual care and the organization of the environment. Improvements can be achieved through physical, emotional and also mental activation, for example with the help of occupational therapists. These helpful approaches will be subject of the next units. There is even help for a number of physical problems such as incontinence, difficulties of food intake and problems of lying down.

In the early stage, training of thinking and memory functions should only be carried out carefully, otherwise there is the danger that the patient is always reminded of his/her diminishing mental abilities.

As with numerous other diseases there is no cure for the illness but medication can improve disease symptoms. There are a number of drugs on the market today for improving brain function.

The most commonly used drugs are 1. Psycho tropics for behaviour management 2. Anti-depressants 3. Anti-anxiety medication

Please consult your doctor to see which of these might benefit you or the patient.

In addition to drugs the most favorable treatment approaches aim at managing the symptoms effectively with good understanding of the disease.

Hence training and rehabilitation in understanding how to help the patient through the various stages of the disease and also how to cope with the progression of the disease is very critical in limiting the adverse effects of this disease on the family dynamics.

What are the most important early indications of dementia?

  1. Forgetfulness with effects at work:  Most people sometimes forget names or appointments. If this happens more frequently and inexplicable states of confusion also occur, this might be an indication for a decline in memory function. 
  2. Difficulties with familiar activities: People who are very busy are sometimes absent-minded and for example forget the pot on the stove. People with dementia possibly not only forget the pot on the stove but also that they have cooked at all. 
  3. Language problems: Most people sometimes experience difficulties in finding the right words. Dementia sufferers often cannot remember simple words and instead they use inappropriate fillers which makes it difficult to understand the sentences. 
  4. Problems with spatial and temporal orientation: A lot of people sometimes forget e.g. the day of the week or they get lost in unfamiliar surroundings. Dementia sufferers might be in their own street and no longer know where they are, how they got there and how to get home again. 
  5. Impaired capacity of judgment: People not always choose clothes suitable for the weather. Dementia sufferers sometimes wear totally inappropriate clothes. For example, they wear a bathrobe while shopping or several blouses on top of each other on a hot summer day. 
  6. Problems with abstract thinking: For many people running a bank account is a challenge. Dementia patients can often neither recognize numbers nor carry out simple calculations. 
  7. Leaving things behind: From time to time almost everybody leaves their keys or a wallet behind. Dementia sufferers however might put things in completely inappropriate places, such as for example the iron in the fridge or a watch in the sugar bowl. Afterwards they do not remember where they put them. 
  8. Mood swings and behavioural changes: Everybody has mood swings. People with dementia may have very sudden mood swings, often without discernible cause. 
  9. Personality changes: With advancing age the personality of most people changes a little. People affected by dementia may experience a very pronounced personality change suddenly or over a longer period of time. Somebody who is generally friendly, for example, becomes unexpectedly angry, jealous or timid.
  10. Loss of initiative: Nobody continuously works with the same motivation. Dementia patients sometimes loose the zest in their work and the interest in their hobbies completely without enjoying new activities.

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