Dementia is a term that denotes a group of symptoms that include memory loss as the most pronounced one. Along with memory disturbances, there are other symptoms that lead to the continuing damage of the cognitive function and increasing dependence of the patient on the help of others. Speech disorders, inability to perform complex actions and the inability to recognize objects with preserved vision may also occur.

Numerous causes of an illness

Most dementias are the result of advancing brain damage which cannot be cured or significantly stopped with a treatment.

Dementia is not an individual disease, but there are many reasons (some unknown) that lead to damage of the existing mental capabilities. Most of dementias are the result of advancing brain damage that cannot be cured or significantly stopped with currently available treatment methods.

The most common of these Health Estimates is the dementia in Alzheimer's disease which incidence in aging population is increasing rapidly, although a significant proportion of dementias are occurring in cerebrovascular disease and other degenerative brain diseases (such as Frontotemporal dementia, dementia with Lewy bodies (DLB) and dementia in Parkinson's, Huntington's and Creutzfeld- Jakob disease).

However, some small proportion of the known causes of dementia can be cured, which means that a person with the disorder can again function as before the appearance of the damage. This is the main reason for the need of an early (immediately after noticing memory disturbances and other symptoms) conduction of targeted examinations to prove potentially reversible causes of deterioration of the cognitive function. These include metabolic disorders (endocrine disorders, vitamin deficiencies, liver and kidney failure), inflammatory brain diseases (autoimmune diseases, infections, paraneoplastic syndrome), hematoma and brain tumors, some forms of epilepsy, poisoning and increased pressure inside the skull.

Non-specific symptoms

The distinction between initial dementia and depression is important, since the depression in most cases can be treated successfully.

Dementias are diseases that are most common in older people, given that these are the people who are not working and are not intellectually active; the initial symptoms are difficult to notice. Usually the beginning of a disease is gradual, and patients rarely notice the increasing symptoms, or they simply deny them. Surrounding replaces them with harmless forgetfulness, and there is conventional wisdom and thinking that intellectual deterioration and growing dependence on others is the normal consequences of aging. Older people visit a doctor when behavioral problems occur - such as aggression, wandering tendency and night restlessness.

The symptoms preceding the developed disease are personality changes, suspicion, a gradual loss of interest, mood swings and irritability, and sleep disturbances, which are all easily confused with symptoms of depression. The distinction between initial dementia and depression is important, since the depression in most cases can be treated successfully. However, depression often occurs in demented patient and exacerbates the already impaired functioning. This means that in any case, one should recognize mood disorders and start the treatment as soon as possible.

Path to diagnosis

Examination of cerebrospinal fluid can detect the inflammation causes, as well as biological markers specific for Alzheimer's disease.

Today there are numerous and sophisticated diagnostic methods for detecting damage to the brain and causes of dementia, and mostly they are imaging techniques such as computed tomography or magnetic resonance imaging. But the greatest importance for the detection of the disease belongs to anamnesis (because of the described disturbances often obtained from family members) with a detailed psychiatric, internist and neurological examination. Blood tests (blood count, electrolytes, glucose, liver enzymes, renal function, thyroid and adrenal glands, serologic tests for syphilis, HIV and Borel, levels of folate and vitamin B12) are able to detect potentially reversible causes of dementia. Examination of cerebrospinal fluid can detect the inflammation causes, and more recently fluid may be useful in determining the biological markers for Alzheimer's disease.

Electroencephalography (EEG) is the old, non-invasive and easily accessible method that is useful for the diagnosis of encephalopathy (Creutzfeldt-Jakob disease, subacute sclerosing panencephalitis, hepatic encephalopathy). The stage of the disease and the degree of cognitive impairment are usually quantified by a simple and rapid test called Mini Mental State Examination (MMSE).

Treatment

Alcohol directly and indirectly damages the brain, leading to dementia, which is often more severe and irreversible.

If a reversible cause of dementia is detected, treatment should begin as soon as possible because the reversible causes can eventually become irreversible.

It is insufficiently emphasized that the excessive consumption of alcohol can cause dementia. The direct toxic effect of alcohol, but also indirect (vitamin deficiency, frequent head trauma, blood clotting disorders and bleeding), damages the brain, leading to dementia, which is, contrary to popular belief, often irreversible and severe in degree so it requires admission of a patient into an institution.

For the majority of dementias there is only a symptomatic treatment available. There are multiple drugs registered for the treatment of dementia caused by Alzheimer's disease. Some of them act by increasing the availability of acetylcholine, a neurotransmitter deficient in all cases, by inhibiting acetylcholinesterase enzyme which degrades it. These drugs slow down the progression of the disease and delay the loss of independence and admission of a patient into an institution. They also reduce the need for additional psychiatric drugs such as antipsychotics and mood stabilizers, which in the older population may have serious side effects. This not only reduces the cost of care for a patient but, most importantly, improves the quality of his/her life and the life of the family.

The question is - does it make sense to give the mentioned drugs in case of dementia not caused by Alzheimer's disease? It is logical that, given that it is a symptomatic therapy (similarly as treating Parkinsonism with L-dopa) which increases the availability of acetylcholine or reduces neuronal damage, these drugs may be useful not only in dementia, but also in Alzheimer's disease. Thus, there are more and more individual reports suggesting the usefulness of the administration.

Conclusion