Understanding Dementia: A Complete Guide

Dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people worldwide. Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their carers, families and society at large. Unfortunately, there is often a lack of awareness and understanding of dementia, resulting in stigmatisation and barriers to diagnosis and care. As the global population ages, the prevalence of dementia is expected to rise, making it increasingly important to understand its various forms, causes, and risk factors. That’s why in this article, we provide a comprehensive overview of dementia, exploring its types, stages, diagnostic methods, treatment options, and preventive measures, to better equip individuals with the knowledge needed to navigate this complex condition. Let’s begin with some basics.

What is Dementia?

Dementia is a syndrome comprising aphasia, agnosia, apraxia and loss of executive function. It is usually chronic or progressive nature leading to complete incapacitation. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement along with changes in mood, emotional control, behaviour, or motivation. It may be grouped into primary and secondary dementia, and reversible and irreversible or progressive dementia. It can happen in any age group and may be associated with variable neurological features e.g. seizure, syncope, stroke, head trauma, fever, headache, brain infection, and brain tumour.

How common is dementia?

Worldwide, around 55 million people have dementia, with over 60% living in low- and middle-income countries. As the proportion of older people in the population is increasing in nearly every country, this number is expected to rise to 78 million in 2030 and 139 million in 2050. That said, globally, dementia has a disproportionate impact on women. 65% of total deaths due to dementia are women, and disability-adjusted life years (DALYs) due to dementia are roughly 60% higher in women than in men. 

What are the types of dementia?

Dementia encompasses a variety of conditions, each with its own underlying causes and characteristics. These types are broadly categorised into primary and secondary dementias (based on the underlying cause), and reversible and irreversible (based on the availability of treatment). Here’s an overview of the categorisation:

Primary dementia

Primary dementias are those that do not result from other medical conditions and are characterised by direct degeneration of brain cells. They typically progress over time, leading to significant cognitive decline and impacting daily living activities. Common types of primary dementia include:

• Alzheimer’s disease: The most common form of dementia, characterised by the presence of amyloid plaques and tau tangles in the brain. It leads to progressive memory loss and cognitive decline.
• Vascular dementia: Results from conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients. It often occurs after a stroke or series of strokes.
• Lewy Body dementia: Associated with abnormal deposits of the protein alpha-synuclein in the brain. Symptoms include fluctuating cognitive ability, visual hallucinations, and Parkinsonism.
• Fronto-temporal dementia: Involves degeneration of the frontal and temporal lobes of the brain, affecting personality, behaviour, and language.
• Mixed dementia: A condition in which abnormalities characteristic of more than one type of dementia occur simultaneously in the brain, such as Alzheimer's disease and vascular dementia.

Secondary dementia

Secondary dementias result from other medical conditions or injuries and often have more specific causes. These conditions may lead to cognitive impairment as a secondary effect, which means that treating the underlying condition might help mitigate some of the dementia symptoms.

• Huntington’s Disease: A genetic disorder causing the progressive breakdown of nerve cells in the brain, affecting movement, cognition, and emotions.
• Parkinson’s Disease: A neurodegenerative disorder that primarily affects movement but can also lead to cognitive impairment and dementia in its later stages.
• Creutzfeldt Jakob Disease: A rare, degenerative, fatal brain disorder caused by prions, leading to rapid mental deterioration and physical decline.
• Wernicke-Korsakoff Syndrome: A chronic memory disorder caused by severe deficiency of thiamine (vitamin B1), often linked to alcohol misuse.
• Traumatic brain injury: Repeated head injuries can lead to chronic traumatic encephalopathy (CTE), a form of dementia characterised by mood changes, memory loss, and cognitive decline.

Irreversible dementia 

Among irreversible or degenerative dementia, Alzheimer's disease (AD) is the most common form and may contribute to 60-70% of cases and other major forms include vascular dementia (VaD), dementia with Lewy bodies (DLB) (abnormal aggregates of protein that develop inside nerve cells), and a group of diseases that contribute to frontotemporal dementia (FTD), which is characterised by the degeneration of the frontal lobe of the brain.

Reverse dementia

Among reversible dementia, it may also develop after a stroke or in the context of certain infections such as HIV, harmful use of alcohol, repetitive physical injuries to the brain (known as chronic traumatic encephalopathy) or nutritional deficiencies. These types of dementia usually revert to normal with appropriate evaluation and treatment. These conditions include:

• Normal pressure hydrocephalus (NPH): An abnormal buildup of cerebrospinal fluid in the brain's cavities, which can sometimes be treated with surgical intervention.
• Vitamin deficiency: Deficiencies in vitamins like B12 can lead to reversible cognitive impairment if identified and treated early.
• Infections: Conditions such as HIV, syphilis, or Lyme disease can cause dementia-like symptoms that may be reversed with appropriate treatment.
• Metabolic and endocrine conditions: Disorders such as thyroid problems, diabetes, or liver and kidney diseases can cause reversible cognitive impairments.
• Medication side effects: Some medications can cause dementia-like symptoms which may improve once the medication is adjusted or discontinued.

Note: Other conditions and factors contributing to dementia include chronic depression, excessive use of alcohol, and certain neurological conditions. These factors can either directly cause dementia or increase the risk of developing it.

What are the causes of dementia?

Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain, such as Alzheimer's disease, stroke, infections, inflammation, haemorrhage, tumour, metastases, dyselectrolytemia, end organ kidney or liver dysfunction, autoimmune encephalitis. Besides age-induced degeneration of brain cells, dementia can be caused by various factors such as:

• Depression: Chronic depression can contribute to cognitive decline and dementia.
• Excessive use of alcohol: Long-term alcohol abuse can lead to brain damage and increase the risk of dementia.
• Thyroid disorders: Both hypothyroidism and hyperthyroidism can affect cognitive function, increasing the risk of dementia.
• Normal pressure hydrocephalus: An abnormal buildup of cerebrospinal fluid in the brain can cause dementia-like symptoms.
• HIV-associated dementia: A rare condition that occurs when the HIV virus spreads to the brain, leading to cognitive impairment.

What Increases the Risk for Dementia?

• Age: The risk of dementia increases significantly with age, particularly after the age of 65.
• Family history: A family history of dementia can increase the risk, indicating potential genetic factors.
• Ethnicity: Certain ethnic groups are at higher risk due to genetic and lifestyle factors.
• Poor heart health: Conditions like high blood pressure, high cholesterol, and diabetes can increase the risk of dementia.

What are the stages of dementia?

Dementia affects each person in a different way, depending upon the underlying causes, other health conditions and the person’s cognitive functioning before becoming ill. The signs and symptoms linked to dementia can be understood in three stages.

Early or mild Stage

In the early stage of dementia, symptoms are often subtle and may be easily overlooked. Individuals may experience:

• Mild forgetfulness, particularly of recent events or information
• Difficulty finding the right words during conversations
• Trouble with planning and organising tasks
• Losing or misplacing items more frequently
• Slight changes in mood, such as increased irritability or apathy
• Confusion about time or place
• Difficulty with complex tasks, such as managing finances or planning trips

During this stage, people with dementia can generally still function independently but may need some support.

Middle or moderate-stage

The middle stage of dementia is marked by a significant decline in cognitive abilities and greater difficulty with daily activities. Symptoms include:

• Increased memory loss and confusion
• Difficulty recognizing family and friends
• Greater problems with communication, including trouble speaking and understanding language
• Inability to perform complex tasks, such as cooking or managing a household
• Changes in sleep patterns, such as insomnia or increased daytime sleepiness
• Increased risk of wandering and getting lost
• Behavioural changes, such as aggression, agitation, depression, or anxiety
• Need for assistance with daily activities, such as dressing, grooming, and toileting

Individuals in this stage require more intensive care and support from caregivers.

Late or severe stage

In the late stage of dementia, cognitive and physical abilities are severely impaired. Individuals often experience:

• Severe memory loss, with an inability to recognize close family members and friends
• Extreme confusion and disorientation, even in familiar environments
• Inability to communicate effectively; speech may be limited to simple phrases or words
• Loss of physical abilities, such as walking, sitting, and eventually swallowing
• Incontinence and need for full assistance with personal care, such as bathing, dressing, and eating
• Significant changes in personality and behaviour, including increased agitation, aggression, or apathy
• Increased vulnerability to infections, such as pneumonia

During this stage, individuals require round-the-clock care and may need to live in a specialised care facility. The focus is often on providing comfort and maintaining quality of life.

How is dementia diagnosed?

Diagnosing dementia involves a comprehensive assessment to determine the presence and cause of cognitive decline. The diagnostic process typically includes the following steps:

Cognitive and neurological tests

• Problem solving: Evaluates the individual’s ability to solve problems and think abstractly.
• Learning: Assesses the capacity to learn new information and recall it later.
• Judgement: Tests the ability to make sound decisions and understand consequences.
• Memory: Measures both short-term and long-term memory.
• Planning: Evaluates the ability to plan and execute tasks.
• Reasoning: Tests logical thinking and the ability to understand complex concepts.
• Language: Assesses the ability to understand and produce language, including naming objects, following commands, and conversational skills.

Brain scans

• MRI (Magnetic Resonance Imaging): Provides detailed images of brain structures to identify changes such as brain atrophy, strokes, or tumours.
• CT (Computed Tomography) Scan: Offers cross-sectional images of the brain to detect abnormalities like bleeding, infarcts, or mass lesions.
• FDG-PET Scan (Fluorodeoxyglucose Positron Emission Tomography): Measures brain activity and glucose metabolism to identify regions of reduced function typical in various types of dementia.

Psychiatric evaluation

A psychiatric evaluation helps rule out other mental health conditions such as depression, anxiety, or other psychiatric disorders that may mimic or coexist with dementia.

Genetic tests

Genetic testing may be conducted to identify specific genetic mutations associated with familial forms of dementia, such as those linked to early-onset Alzheimer’s disease or Huntington’s disease.

Cerebrospinal Fluid (CSF) tests

CSF analysis can detect biomarkers associated with Alzheimer’s disease and other neurodegenerative conditions. This involves a lumbar puncture to collect a sample of spinal fluid. This procedure is commonly referred to as “spinal tap”. 

Blood tests

Blood tests help identify underlying conditions that may cause or contribute to dementia-like symptoms, such as vitamin deficiencies, thyroid disorders, infections, or metabolic problems.

The combination of these assessments allows healthcare professionals to diagnose dementia accurately, determine its type, and develop an appropriate care plan.

How is dementia treated?

While there is currently no cure for dementia, various treatments can help manage symptoms and improve the quality of life for individuals with the condition. Treatment strategies typically involve a combination of medication, therapy, lifestyle changes, and supportive care.

Medication

• Cholinesterase inhibitors: These medications, such as donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), are used to treat symptoms of Alzheimer’s disease and other dementias. They work by increasing the levels of acetylcholine, a neurotransmitter involved in memory and judgement.
• Memantine: Memantine (Namenda) is used to treat moderate to severe Alzheimer’s disease. It works by regulating the activity of glutamate, another neurotransmitter involved in learning and memory. Memantine can be used alone or in combination with a cholinesterase inhibitor.
• Other medications: Depending on the individual's symptoms, additional medications may be prescribed to manage behavioural changes, sleep disturbances, depression, anxiety, or agitation.

Non-pharmacological therapies

• Occupational therapy: Helps individuals with dementia maintain their independence by teaching them how to adapt activities and environments to their changing abilities. Occupational therapists can suggest modifications to the home to enhance safety and reduce confusion.
• Cognitive Stimulation Therapy (CST): A structured program that engages individuals in group activities and exercises designed to improve cognitive function and social interaction.
• Reminiscence therapy: Involves discussing past experiences and events to stimulate memory and improve mood.
• Behavioural therapy: Focuses on identifying and addressing specific behavioural issues, such as aggression or agitation, through non-medical interventions.

Lifestyle changes

• Simplify tasks: Breaking down complex tasks into smaller, manageable steps can help individuals with dementia complete activities more easily and reduce frustration.
• Healthy diet: Maintaining a balanced diet that supports overall health and brain function, such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains, and healthy fats.
• Regular exercise: Physical activity can help maintain physical health, improve mood, and possibly slow cognitive decline. Exercise programs should be tailored to the individual's abilities and preferences.
• Social engagement: Staying socially active can help improve mood and reduce feelings of isolation. Engaging in social activities and maintaining relationships are important aspects of dementia care.

Supportive care

• Creating a safe environment: Making changes to the home environment to enhance safety and reduce the risk of accidents, such as removing tripping hazards, installing grab bars, and using locks or alarms.
• Caregiver support: Providing education and support for caregivers is crucial, as caring for someone with dementia can be challenging and stressful. Support groups, respite care, and counselling can help caregivers manage their responsibilities and maintain their well-being.
• Assistive devices: Utilising tools and technologies, such as memory aids, GPS tracking devices, and communication aids, can help individuals with dementia maintain their independence and safety.

The combination of these treatment strategies aims to manage symptoms, improve quality of life, and support both individuals with dementia and their caregivers throughout the progression of the disease.

How can dementia be prevented?

Although age is the strongest known risk factor for dementia, it is not an inevitable consequence of biological ageing. Further, dementia does not exclusively affect older people – young onset dementia (defined as the onset of symptoms before the age of 45 years) accounts for up to 9% of cases. While there is no sure way to prevent dementia, studies show that people can reduce their risk of cognitive decline and dementia by adopting certain healthy lifestyle habits. Here are some strategies that may help prevent or delay the onset of dementia:

• Continuing education: Engaging in lifelong learning and mentally stimulating activities can help build cognitive reserve, which may delay the onset of dementia symptoms.
• Exercising regularly: Physical activity improves blood flow to the brain and promotes the growth of new brain cells. Aim for at least 150 minutes of moderate-intensity exercise per week.
• Limit alcohol intake: Excessive alcohol consumption can increase the risk of dementia. Limiting alcohol intake to moderate levels can help protect brain health.
• Avoid smoking: Smoking damages blood vessels, which can increase the risk of dementia. Quitting smoking improves overall health and reduces this risk.

• Social engagement: Maintaining strong social connections and participating in social activities can improve mental health and reduce the risk of dementia. Join clubs, volunteer, or stay connected with friends and family.

• Managing depression and anxiety: Untreated depression and anxiety can increase the risk of cognitive decline. Seek treatment for mental health conditions to maintain overall well-being.

• Balanced diet: Eating a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats supports brain health. The Mediterranean diet, in particular, has been associated with a lower risk of dementia.
• Avoiding high blood pressure, diabetes, and obesity: Managing these conditions through a healthy diet, regular exercise, and medication (if necessary) can help protect brain health.

• Hearing health: Untreated hearing loss is associated with an increased risk of dementia. Regular hearing check-ups and using hearing aids if needed can help maintain cognitive function.

• Protect the head from injuries: Wearing helmets when cycling or engaging in contact sports, and taking measures to prevent falls, can help reduce the risk of traumatic brain injury, which is a risk factor for dementia.
• Avoid highly polluted areas: Long-term exposure to air pollution has been linked to an increased risk of dementia. When possible, avoid highly polluted areas and advocate for cleaner air in your community.

By incorporating these healthy habits into your lifestyle, you can help reduce the risk of developing dementia and support overall brain health. While these strategies may not completely prevent dementia, they can contribute to maintaining cognitive function and delaying the onset of symptoms.

Final words

Understanding dementia is crucial for early detection, effective management, and improving the quality of life for those affected. While adopting healthy lifestyle habits can help reduce the risk, seeking professional advice is essential for accurate diagnosis and personalised care. If you or a loved one is experiencing symptoms of dementia, it is vital to consult a specialist. Max Hospitals offers comprehensive diagnostic and treatment services, provided by experienced professionals dedicated to delivering compassionate and expert care. Early intervention can make a significant difference, so don't hesitate to reach out to Max Hospitals to discuss your concerns and receive the support you need and world-class care you deserve.