Dementia is defined as an acquired decline in cognitive ability that impairs activities of daily living. Dementia resulted from disruption of normal brain’s circuits in characteristic regions or patterns that define the symptoms. The onset is usually insidious and typically slow but progressive affecting not just the memory but language and speech, judgement, motor function and mood may all be altered in varying proportions leading to significant impairment in day to day functioning.
There are various type of irreversible dementia most commonly is Alzheimer's disease, vascular dementia (post-stroke), dementia with Lewy body, fronto-temporal dementia and prion- associated disorders (Creutzfeld- Jakob disease). There are also various reversible causes of dementia such as secondary to infection (meningitis, encephalitis), toxic or metabolic causes (hypothyroidsm, vitamin B 12 deficiency, alcohol intoxication), brain cancer, depression and normal-pressure hydrocephalus.
Criteria for dementia require presence of memory impairment (amnesia) which short term memory loss is the most common early symptom for at least 6 months and more, with deficit in one of other cognitive domains, aphasia (word- finding difficulties), apraxia (problems with dressing, using utensils), agnosia (problems recognizing fmailiar faces) and executive dysfunctioning (problem-solving difficulties, managing finances) and as a result, cause sufficient impairment in day to day activities and becoming more dependent to others.
In addition to cognitive decline, patient with dementia may also develop behaviour and psychological symptoms such as agitation and agression, wandering, delusion, sleep reversal pattern (sleeping during daytime and waking up at night), paranoia and hallucinations causing distress to both patient and the caretakers.
Treatment includes reversing or stabilising underlying disease process including treatment of reversible causes of delirium that can cause acute change of mental state, replacement of B12 if deficient, thyroxine replacement if hypothyroidsm and treatment of underlying infection if present. It is also important to optimise control of blood pressure, diabetes and cholesterol level by lifestyle and medications. Cholinesterase inbibitor such as Donepezil and Rivastigmine are used for mild to moderate case to delay progression of dementia. Other medication can also be use depending on the symptoms such as anti-psychotic and anti-depressants.
Dementia can be considered a progressive disease of the brain and the mind. With advancement in medical treatment, more and more people lived longer life and are at risk of developing dementia. Unfortunately, there is not yet a cure for dementia. It is important to practice healthy lifestyle, stop smoking, maintaining healthy weight, exercise regularly, eating balanced diet, managing your health problems including diabetes, high blood pressure and high cholesterol to prevent from dementia. It is also important to keep your brain healthy and active by being socially engaged and meeting people, challenging yourself with a mind game or puzzle and learning a new skill or unleashing a talent that you never realised you had.
If you have memory problem or know someone with memory impairment or would like to know more about dementia, talk to our doctor for consultation.