With advancing age, most people experience forgetfulness. Simple things like forgetting
engagements, being unable to recall someone’s name, forgetting why you entered a room in the
first place etc. But what does it mean to suffer from dementia? By definition, dementia is a
syndrome due to disease of the brain which is usually chronic or progressive, in which there is
disturbance of higher brain functions including memory, thinking, orientation, comprehension,
calculation, learning capacity, language and judgement. Patient retains full consciousness. However,
there can be symptoms of deterioration of emotional control, social behaviour or motivation.
How does dementia present?
Onset of symptoms is mostly above the age of 65 years. Symptoms usually develop insidiously and
progress gradually over a period of a few years. Often the exact starting point is difficult to pinpoint.
– The most prominent symptom is that of forgetfulness. This typically affects the registration
and retrieval of new information first, for e.g., whether he/she has eaten medications or not,
where things have been kept, names of new people etc. Relatives will typically report that
the elderly person will remember the names of their school friends or name of their college
but will have trouble finding things on a daily basis. As the disease progresses, previously
learned or familiar material also begins to be lost. Patients have trouble remembering dates
or months. In advanced cases, people are unable to name or even recognise close family
members, forget how to do everyday things like bathing, wearing clothes or eating and need
supervision or assistance with self-care. They might forget paths/directions and this poses a
safety risk as they run a risk of getting lost when stepping out of the house. They might get
confused between rooms inside the house.
– There is an impairment of thinking and reasoning. They are unable to take decisions which
require weighing multiple factors, unable to perform complex calculations etc.
– Patients find it difficult to attend to multiple stimuli at a time; they have trouble following
conversations in a group or switch attention from one topic to another.
– There may be accompanying behaviour problems like irritability, aggression, stubborn
behaviour. Emotional problems such as feeling low, anxious, loss of confidence, lack of
motivation, dullness, sense of hopelessness can occur.
Causes of dementia
The most commonly occurring variant of dementia is Alzheimer’s disease which occurs due to brain
degeneration. Vascular dementia can present with sudden onset and is associated with stroke.
Dementia can be associated with other neurological illnesses such as Parkinson’s disease, HIV
infection, Huntington’s disease, Pick’s disease etc. Some reversible causes are tumours, drug
induced, vitamin B12 or folate deficiency or hypothyroidism.
Treatment
Management of dementia involves preserving the remaining memory and slowing down or
preventing further deterioration. This involves medications and certain lifestyle measures such as
increasing physical activity of the patient; improving mental activity by reading, solving puzzles etc;
good nutrition and socialisation. Patients need to be handles gently with love and understanding as
the symptoms can be as bewildering to them as to others.
