From the Editor’s Keyboard

Dementia: A need to know

20 August 2018 at 04:53 | 2562 views

By Dr. Nanah Sheriff Fofanah-Sesay, Health Correspondent, USA

One of the advantages of having a formal education in the field of medicine and using that knowledge to provide healthcare in diverse ways is the ability to recognize visible or subtle medical anomalies through assessments.

Most healthcare providers can attest to encounters involving passive or active medical issues with people in their neighborhood, friends, families, bystanders, or through interaction in social media.

The purpose of this narrative is to shed some light on dementia and with its associated types, causes, signs and symptoms, and management.. Bringing awareness of this emerging disease will assist non-medical people to recognize its sequelae when inflicted with their loved ones but most importantly, it will prepare loved ones to deal with the unwanted symptoms of this progressive, debilitating, and irreversible disease.

Dementia is a group of symptoms that affect mental cognitive tasks such as memory and reasoning. It is an umbrella term that falls under Alzheimer’s disease. There are various types of dementia, in a nutshell, these types will be briefly described.

Alzheimer’s disease-is also called senile dementia and it is characterized as a progressive disease that destroys memory and other important mental functions.

Cruetzfeldt-Jacob disease-is also called CJD or subacute spongiform encephalopathy and characterized by a degenerative brain disorder that leads to dementia and death.
Dementia with lewy bodies-is also known as lewy body dementia and characterized by protein deposits in nerve cells in the brain regions involving thinking, memory, and movements.

Frontotemporal dementia-also referred to as frontotemporal lobar degeneration is characterized by a diverse group of uncommon disorders that primarily affect the frontal and temporal lobes of the brain which are areas generally associated with personality behavior and language.

Parkinson’s disease dementia-is a disorder of the central nervous system that affect movements, often involving tremors.

Huntington’s disease-is also called HD or Huntington’s chorea and characterized by an inherited condition in which nerve cells in the brain breaks down over time.

Mixed dementia-this type of dementia represent more than one type of dementia that occur simultaneously in the brain.

According to Hebert et al. (2013), an estimated 4.5 million people in the United States live with Alzheimer’s dementia and that number is expected to double each year. Vieira et al. (2013), described pre-senile or early onset dementia (EOD) as a public health problem that differs from senile or late onset dementia (LOD) in the sense that, its encloses a significant number of cases that are poorly studied and often go undiagnosed.

The causes of dementia are multifaceted but the most predominant causes include but not limited to: Normal Pressure Hydrocephalous, Neoplasm, Multiple concussion in boxers, Vasculitis, Wilson’s disease, Strokes, Brain hemorrhage, HIV disease, Tertiary Syphilis, Chronic Meningitis, Vitamin B12 deficiency, Hyperthyroidism, Hypothyroidism, Alcoholism, Depression, age, and genetic factors.

The most common signs and symptoms of dementia are initially forgetfulness or mild memory impairment which progresses to moderate and advanced cognitive impairment. As cognitive impairment progresses, its leads to a decline in motor function, leading to disorientation, behavioral changes such as becoming narcissistic, blunted, blissful, or just being inappropriate in public. The affected persons may easily become suspicious of others actions and motives. They may become accusatory and charge others around them inappropriately.

Disorganization or difficulties planning and organizing is another common early warning of dementia. The affected persons may become easily frustrated leading to agitation. These individuals often confabulates to make up for lost memories. As memory impairment further progresses, the affected persons may experience visual or auditory hallucinations or seeing and hearing things that does not exist. In addition, the affected persons may exhibits inappropriate sexual behaviors such as removing clothing in public or touching and saying tasteless things.

As cognitive decline worsens, the affected persons may experience inability to reason, learn, retain information, problem solve, speech, language, and overall decline in decision making abilities.

Another hallmark of dementia is apathy and withdrawal where the affected persons lose interest in things they previously enjoyed. Another indication of advanced dementia is reduced concentration where the affected persons are easily distracted and have difficulties focusing on even simple tasks. Moreover, performing complex tasks and abstract thinking become a major issue for this population. Their judgement becomes impair leading to difficulties in relating to others and the environment. They may experience insomnia or sleep difficulties.

Like other diseases, certain risk factors such as age and genetic susceptibility cannot be controlled however, other risk factors that increased susceptibility to this diseased can be controlled. On that premise, abstinence from illicit drugs and alcohol, reducing cardiovascular risk factors, smoking cessation, adequate mental health, absence of brain trauma, and balance hormonal levels in women can diminish the occurrence of this disease.

Other treatment regimen includes the management of any underlying diseases such as the intake of Vitamin B12 to treat pernicious anemia, hormonal supplements to treat thyroid diseases, SSRI’s to treat related depression, and antibiotics to treat brain infections such as encephalitis or meningitis.

Memory enhancers does not reverse or bring back lost memories but will prevent rapid decline in cognition. Cholinesterase inhibitors such as Aricept (Donepezil), Razadyne (Galantamine) Exelon (Rivastigmine) alleviate symptoms of lewy body dementia. Glutamate inhibitors such as Namenda (Memantine) prevents the harmful over production of glutamate that accompanies dementia.

Non-pharmacologic agents includes cognitive stimulation therapy (CST) which involves training memory, language ability, and problem solving skills in order to improve cognitive functions, and increase memory and reasoning skills without medications. In addition, behavioral therapies can be used as an adjunct non-pharmacologic therapy in order to provide appropriate outlet for unwanted behaviors.
Other non-pharmacologic therapy includes reality orientation therapy to reduce confusion, validation therapy to foster positive communication, and stress reduction for the affected persons. Other non-pharmacologic consideration are external memory aids, consistent daily routine, stress management, and environmental modification.

The fight against dementia in our respective stressful ridden environments does not solely rest in the hands of medical people. Since dementia is an emerging healthcare crisis that affect us in diverse ways, we must be able to recognize the onset of this disease and take appropriate interventions. In addition, individuals with decrease cognition can pose safety issues to those around them and an overall public safety concern therefore, it is the responsibilities of each and every one to be aware of this health issue.

It is my hope that this article will help others to be cognizant of certain behaviors associated with this diseases in order to supports those affected to seek early and appropriate interventions.

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This article is dedicated to all those affected by dementia and their care-givers.