Dementia & senile dementia

Definition

Dementia is an umbrella term for a wide range of illnesses. All subforms of dementia, which total around 55, have the common feature that they lead to a loss of mental abilities and intelligence. Typically, this involves deterioration in memory, thinking, speech and practical skills, without any clouding of consciousness.

These changes mean that people with dementia can no longer complete everyday tasks. Dementia is in no way an inevitable result of the ageing process that affects everyone to a greater or lesser degree; it is an illness that typically appears in old age.

Causes

9 out of 10 dementia sufferers have Alzheimer’s disease or vascular dementia. For this reason, this information focuses mainly on vascular dementia (from blocked arteries). Alzheimer’s disease is described in a separate overview (see here).

Arteriosclerosis (hardening of the arteries) narrows the blood vessels in the brain. When many small vessels are blocked or if there has been one or more strokes (blocking a major artery), brain function is also affected.

Other causes:

  • Alcoholism
  • Parkinson’s disease
  • Family predisposition
  • Metabolic disorders, thyroid diseases, vitamin B12 deficiency
  • Aids/HIV

The risk of dementia is (2 to 4 times) higher in first-degree relatives of a dementia sufferer than in the general population.

One form of dementia can present in early adulthood. People aged 30 to 50 are affected. This sub-form of Alzheimer’s disease involves a genetic change and can be, but is not necessarily, passed on to children. It is therefore possible for this form, which presents at an earlier age, to affect several family members.

Symptoms

Sudden memory loss should be taken seriously as a warning sign and absolutely must be investigated.

·         Major forgetfulness

·         Thought disturbances, e.g. incoherent answers to questions

·         Disorientation

·         Slow or imprecise speech

·         Impaired judgement

·         Personality changes, depression (significant loss of motivation)

The more advanced the disease is, the less sufferers can cope with everyday living. Hallucinations are possible and the person affected no longer recognises their surroundings and loved ones. Day-to-day activities like shopping, cooking or getting dressed can no longer be completed independently. There may also be personality changes.

Diagnosis (tests)
  •  Medical history including symptoms; family members should be questioned
  •  Physical, neurological and, potentially, psychiatric tests
  •  Computed tomography (CT scan) to exclude stroke or brain tumour
  •  Brain-function tests (mini mental status)
Treatment

First, any underlying illness must be identified and treated. Dementia itself cannot be cured, but the brain damage can be slowed down with targeted treatment.

General measures

A balanced diet, plenty of fluids and structured days help sufferers cope on a day-to-day basis. It is important to promote remaining capabilities, but without being overly demanding.

Through special brain and body training and by using artificial or manual abilities, sufferers can retain individual skills and remain independent for longer.

Treatment strategies

1. Treating the underlying condition or risk factors

  • Treating vascular risk factors (particularly high blood pressure) using medication.
  • Potentially also, surgical procedures (stents, removing blockages in the carotid arteries).

2. Prevention of further strokes or arterial blockages

  • Platelet inhibitors
  • Potentially, blood thinning with anticoagulants, if coronary embolisms (dislodged blood clots) are suspected as a cause.

3. Non-drug treatment (e.g. social help, cognitive training, self-help and family groups)

  • Memory training, functional training
  • Psychotherapy, couples’ therapy
  • Occupational therapies (painting, cooking, music, inclusion in a healthy household, etc.)
  • Movement, sociability, games

4. Accompanying psychiatric and medical therapy

Medication

  • According to some studies, ginkgo biloba extract may have a positive effect on brain functioning among dementia sufferers.
  • Acetylsalicylic acid (aspirin) is recommended if there is an increased risk of bleeding.
  • Acetylcholinesterase inhibitors have proved to be effective not only for Alzheimer’s disease but also for vascular dementia.

The acetylcholinesterase inhibitors (galantamine, donepezil, rivastigmine) prevent acetylcholine that has already formed in the brain from being broken down again, thereby improving transmission of information. These drugs have a positive effect on cognitive functions (e.g. memory and thought disturbances, “loss of reality”), on everyday activities and on the general picture of health. However, the extent of the effect is modest.

Drugs in this substance class cannot cure the disease but only delay its course.