Dementia
What is "dementia"?
Dementia is a syndromal state. What that means is that there is usually a combination of several things. So with dementias, the common thread is a memory problem. Associated with that memory problem is typically going to be a neurological finding, whether it involves language or the ability to do things with one's hands or the ability to plan and organize. And typically, this is something that is brought about by a particular reason. As I mentioned, 65% of dementias that are not reversible are due to Alzheimer's Disease. The reversible causes of dementia could include things like depression, a drug interaction, an infection of the urinary tract or the lower respiratory tract. It could be because of say a hormonal imbalance, an electrolyte imbalance. Those would be typical things that would tie into a delirious state that would look like a dementing process. Now other nonreversible dementias outside of Alzheimer's Disease include things like vascular dementia or mixed dementias, Lewy body dementia or Parkinson's Disease with dementia. There are a whole slew of other dementing processes but the common thread here is a problem with short term memory.
What are the symptoms of dementia?
The symptoms of dementia not only include memory problems but also the abilities to do things on a day to day basis, what we call instrumental activities of daily living, and basic activities of daily living. So again here, things that would fall into place would be: managing money, hobbies, utilizing appliances around the house, or again, just engaging in our environment the way most of us would. Also, behavior. So, we typically talk about the ABC's: activities of daily living, behavior, cognition. And so in essence, this isn't just a problem with memory, it's a problem with the ability to do things, but also, behavioral issues. Typically, when we talk about behavior we talk about things like say, psychotic symptoms, like hallucinations or delusions, affective symptoms like depression or anxiety, sleep, appetite. Again, combative behaviors like irratibility, or hostility or abberant motor behaviors. And in essence, it's really a consolation of several different things.
What causes dementia?
Dementia is brought about by a number of different things. There are reversible causes and then there are irreversible causes. The most common reversible cause is due to drug interaction. But it could be an infection. It could be an electrolyte imbalance or it could be a problem with a hormonal regulation or a vitamin deficiency, and those things can easily be fixed by a doctor. So prompt medical attention to the individual that's having the problem with their memory would probably be the best thing to resort to, to find out whether it's something that could be fixed or not.
What are the dangers of dementia?
The danger associated with dementia is that the individual with memory problems would probably fall into harms way because of just forgetful related issues. The individual that often neglects to really identify what's causing a problem could end up in a severe state. I'll give you an example. Somebody that's having a urinary tract infection for example and that's clouding their sensorium or their ability to think or remember, might get to the point where they actually get the bacteria in their blood or become septecemic or they become again, severely infected and as a consequence of that, that might actually threaten their lives. The individual that's having additional problems that could be fixed because of a drug drug interaction for example, could cause some serious problems to different organs. So any time there's a question, seeking out a medical professional would make the most sense.
How does a doctor test for dementia?
The typical tests that are utilized include lab testing to make sure that there isn't an infection or metabolic abnormality or electrolyte imbalance or deficiency of a vitamin. In addition to that, when the individual is early on in the disease state, maybe a battery of neuro-psychological testing can help out to a great degree. Neuroimaging, such as CT scans or an MRI scan are very helpful for taking a look at structures and ruling out other things that could cause a problem. Functional scans of the brain are also very useful because they can help differentiate dementias. So something like Positron Emission Tomography, PET scan, is very, very useful for that, as well. In cases where we might expect an infectious process of say, the central nervous system, lumbar puncture can also be done. But these are more esoteric tests. The usual way of diagnosing somebody with this illness is to rule out things that are reversible, that have a strong suspicion that this is in fact the illness and to do some baseline, at least baseline neuroimaging with that individual.
Who is most at risk for developing dementia?
Older individuals are most at risk from dementia, and again a very important point to keep in mind is that the individual is taking several different medications to address their problems with their liver, their heart, their kidneys, their thyroids, etc. It could have an interaction with those medications, which might bring about a problem. The individual that's having recurrent or frequent urinary tract infection or lower respiratory infection depending on what climate that individual lives in, might be at greater risk of dementia for those given problems. A vitamin deficiency, so the dietary intake of the individual. Alcohol consumption, the individual is drinking too much is that danger of falling or striking their heads and again just the direct influence of too much alcohol can actually be bad on the brain. So, there are many different groups of individuals that could suffer from specific problems of a dementia. The individual that has had a history of depression and because there's a suspicion that this is just part of their depression and there isn't a dementing process of spewing underneath might be missed also. So, again those would be individuals with a reversible dementing process. Individuals with say a specific non-reversible dementia that are at greater risks typically older and having had a family history of any one of those given conditions whether it's Alzheimer, Parkinson's Disease, etc.
What is the difference between dementia and delirium?
The difference between delirium and dementia is that delirium can be reversed. There's usually a cause that can be identified and fixed. With delirium, there's a very acute onset, or a very fast onset of a confusional state. There's a waxing on and off of the censorial state of the individual; they'll be alert and then confused, alert and confused, and typically it occurs very rapidly. There's oftentimes an associated situation with an increase in temperature, and oftentimes lab testing can help along the lines of detecting what exactly just recently went wrong with the individual that became delirious; it could be due to an acute intoxication or acute withdrawal from different medications, or it could be because of a combination of different things the individual might have ingested. So, with delirium there's usually a very fast onset that can be fixed and reversed with appropriate medical care. With dementia, there's oftentimes sort of a gradual thing that sets in insidiously, meaning that, again, it sort of creeps in unnoticed and gradually gets worse.
