About dementia

What is dementia?

Dementia is a condition where mental skills are weakened due to pathological changes in the brain. It is the overall term for a large number of disease states, all of which lead to a permanent weakening of the brain's functions. Although we do not know why dementia occurs, it is always due to pathological changes in the brain. Alzheimer's disease is the most common cause of dementia, affecting at least half of all people with dementia. However, there are over 100 forms of dementia; let’s take a look at some of the different dementia disease states 

Alzheimer’s Disease  

Alzheimer's disease is the most common type of dementia. It affects memory, especially short-term memory, and makes it harder to remember names or do everyday tasks. As the disease progresses, it can also change a person's emotions, personality, and behaviour, causing them to become irritable, passive, or withdrawn. 

Alzheimer's disease is caused by two proteins, Beta-amyloid and Tau, that deposit in the brain as plaques and tangles. These deposits are unique to Alzheimer's disease and affect the areas of the brain that control memory, causing memory problems. There is currently no cure for Alzheimer's disease, but medication can help reduce the symptoms temporarily.  

In Alzheimer's disease, the brain is progressively affected, starting with the front of the brain which is the area responsible for memory and logic. Later, the disease begins to destroy the centre that regulates our emotions and results in strong mood swings. One of the last stages is the effects on long-term memory (occipital lobe), which ends up being so bad that even close family members and loved ones may no longer be recognised. At the end stage, the cerebellum is affected, which regulates the heart and the ability to breathe, and sadly this leads to death.  

Vascular dementia 

Vascular dementia is caused by damage to the brain's blood vessels, such as calcification, blood clots, bleeding, or lack of oxygen. This damage can result in memory loss, confusion, and difficulty with thinking and communication. A person may have one or more strokes before developing dementia, which can cause sudden paralysis or speech difficulties. While for some people the symptoms develop suddenly after a stroke, for other people symptoms may develop gradually over time without any prior strokes. 

Vascular dementia symptoms differ from person to person and depend on which areas of the brain are affected. Symptoms are often caused by damage to the deep structures of the brain. This makes a person’s ability to think to become slower, they become more apathetic and develop concentration problems, and difficulties in finding words and solving more complex tasks.  

People with vascular dementia may experience symptoms of depression and emotional instability, such as uncontrollable laughing or crying, even in situations that don't warrant such a response.   

Although there is no cure for vascular dementia, medications such as blood pressure, blood-thinning, or cholesterol-lowering drugs may be prescribed to help manage the symptoms and prevent the disease from progressing further. 

Frontotemporal dementia 

Frontal lobe dementia is also called frontotemporal dementia (often abbreviated FTD). It is the term for a group of brain diseases that affect the frontal lobes and the front part of the temporal lobes. It is the fourth leading cause of dementia and accounts for somewhere between 5% and 10% of all dementia cases.  

The diseases often cause major changes in the personality with behavioural disturbances, the ability to speak (aphasia) and psychiatric symptoms. The disease means that inhibitions and situational awareness gradually disappear, and that the person with dementia becomes impulsive and reckless. People with frontal lobe dementia can also show indifference towards social norms and other people. Unlike Alzheimer's disease, memory function in people with Frontotemporal dementia is often relatively good well into the course of the disease. This type of dementia can be seen in both younger and older people. 

Frontotemporal dementia has no cure or drugs that slow the disease, but early support and specialised social education and environmental adaptations can help manage disturbances in behaviour and psychiatric symptoms for patients and their families. 

Frontal lobe dementia, or frontotemporal dementia (FTD), is a group of brain diseases affecting the frontal and temporal lobes that cause personality changes, impulsive behaviour, and speech problems. 

Lewy Body dementia 

Lewy body dementia is a slowly progressing brain disease that particularly affects older people. The cause of Lewy Body dementia is not known. No hereditary forms of this disease have been found (yet). The biggest risk factor for the disease is age. 

In Lewy Body dementia, a special protein is deposited inside the nerve cells in the brain and forms the so-called Lewy bodies, which have given the disease its name. 

In Lewy Body dementia, the dementia symptoms appear before or at the same time as possible Parkinson's symptoms such as slow movements, muscle stiffness or tremors. The dementia sufferer's attention and sense of direction are often affected. The symptoms are like those of Alzheimer's Disease. The special thing about Lewy Body dementia is that the person’s attention span can be very fluctuating, with the severity of the symptoms fluctuating not just over days, but also within minutes. 

The person's ability to plan, overview and orientation is affected. Lewy Body dementia also means that the sufferer tends to see visions. 

Lewy Body dementia cannot be cured, but medication can temporarily reduce the symptoms of dementia. The drugs work by slowing down the breakdown of the signal substance acetylcholine, which the brain cells use to communicate. The medicine improves the brain's ability to recycle its own signalling substance, acetylcholine. However, the medicine does not work on all patients with Lewy Body dementia. Medical treatment cannot stand alone either. Some patients need treatment for Parkinson's symptoms. 

Advice, as well as practical support and relief in everyday life, are the most important elements of the treatment. Most patients with Lewy Body dementia have difficulty tolerating antipsychotic medication, which can make it difficult to treat their visual hallucinations. 

Lewy body dementia affects older people and is caused by protein deposits in the brain; symptoms include memory loss, Parkinson's-like movements, and visual hallucinations. 

Rare dementia diseases 

Many of the different diseases that can cause dementia are very rare… 

Alcohol-related dementia 

Alcohol abuse may cause dementia, but it's not well-defined whether it's due to alcohol itself or unhealthy lifestyle habits, and it's uncertain whether the harmful effects are permanent or can be reversed with long-term abstinence. 

Korsakoff’s psychosis 

Korsakoff's psychosis is a chronic dementia disease in which the patient has pronounced memory problems. It is caused by damage to the deep structures of the brain as a result of thiamine deficiency. This deficiency state is seen almost exclusively in alcoholics who have not eaten for a long time. The memory is characterized by ‘gaps’, and the patient often unconsciously fills in the memory gaps with explanations or stories that sound reliable. The condition usually does not worsen once the acute phase is over. 

Huntington’s disease 

Huntington's disease is a distinctly hereditary disease. In Huntington's disease, there is often a mixture of neurological and psychiatric symptoms, including dementia in the late stages. The symptoms can vary from person to person, but there are usually varying degrees of involuntary throwing movements (chorea), unsteady gait and possibly more twisting movements (dystonia).  

Dementia is not seen in everyone. It develops slowly and only later in the process. In addition, delusions and depression may occur.  

AIDS dementia 

AIDS dementia is rare today because of treatment for AIDS has significantly improved. 

Creutzfeldt-Jakobs disease 

Creutzfeldt-Jakob disease (CJD) is a rare and fatal degenerative brain disorder that affects the nervous system and causes rapid deterioration of cognitive and motor functions, leading to dementia and eventually death. It is caused by an abnormal protein called prion that accumulates in the brain, leading to damage and death of nerve cells. There are different forms of CJD, including sporadic, genetic, and acquired forms, such as variant CJD that is linked to the consumption of contaminated meat products known as ‘mad cow disease’. 

Multiple sclerosis and inflammation 

Multiple sclerosis is a disease in which the body creates an inflammatory reaction (inflammation) which destroys the insulation around the nerve fibres. Multiple sclerosis can progress to dementia. There are also other rare inflammatory diseases that can affect the brain and cause dementia. 

Poisonings 

Certain heavy metal poisonings, including lead and mercury, and long-term exposure to organic solvents can cause memory and concentration impairment as well as dementia. In the case of what is called solvent dementia (painter's syndrome), the condition stops worsening as soon as the person is no longer exposed to the organic solvents. 

Metabolic diseases 

These diseases are rare causes of dementia. These are different types of the body's metabolic processes that can affect the brain, so that it produces dementia symptoms. It is not only diseases of the overall metabolism, which are controlled from the thyroid gland, that can cause dementia. For example, it can also be disturbances in the amount of calcium ions in the blood (a rare condition). For example, lack of vitamins B1 and B12, either because you get too little vitamin in the diet or because the vitamins cannot be absorbed by the body, can lead to damage to the spinal cord, which causes sensory disturbances in the legs as well as memory and concentration impairment. 





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