What is dementia?

Dementia is a syndrome comprising of disturbances in multiple cognitive functions with deficits manifested across higher cortical functions like memory, learning, judgement, language, comprehension, calculations and orientation.

Dementia is not a rapidly fluctuating condition and the consciousness of the person remains intact. The onset of the disorder is typically gradual and the early signs include impairment in memory characteristically manifested as difficulty in registration, storage and retrieval of new information. It primarily impacts individuals who are more than 65 years of age.

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    How is dementia different from normal age-related changes?

    Dementia is a disease of the brain with evident decline in memory and thinking. Unlike normal ageing as the disease progresses the decline in memory is accompanied by impaired attention, and processing of information. There is increase in difficulty in reasoning, sustaining attention in tasks, attending to more than one input at a time, comprehending instructions and there is overall reduction in the flow of ideas.

    Does dementia only impact cognitive functioning or does it also impact other domains of functioning?

    Cognition is just one of the domains impacted in a person having dementia, dementia leads to global deterioration. Other than disturbance in cognition there is a decline in motivation and regulation of emotions. Often the individual experiences fluctuations in mood, irritability or indifference.  The social behaviour of the individual may be increasingly impacted and a general decline in social skills becomes visible. Challenging behaviours might include sexual disinhibition, shouting, wandering, hoarding and aggression.

    Are there any behavioural or psychological symptoms of dementia?

    A person with dementia can have behavioural symptoms like aggressive outburst, agitation, wandering and night time disturbances. Similarly, psychological symptoms like uncontrolled emotions, anxiety and psychotic symptoms like delusions and hallucinations can be present.

    What are the types and causes of dementia?

    Dementia is divided into reversible and irreversible subtypes. The common subtypes of irreversible dementias are Alzheimer’s disease, Vascular dementias, Dementia with Lewy Body, Fronto-temporal dementia. Common potentially reversible causes of dementia are emotional depression, medication induced, metabolic derangements, hypothyroidism, Vitamin B12 deficiency, Thiamine deficiency, chronic diseases, tumours and infections like neurosyphilis and HIV/AIDS.

    What is the most evident symptom that warns us of about the possibility of a dementia?

    A decline in memory with obvious difficulty in learning new information both verbal and non-verbal is often most evident. However, even mild degree of memory disturbance is sufficient to interfere with everyday activities.

    As the disease progresses, how much does it impact the person?

    With the progression of dementia, it becomes difficult for the individual to carry out activities of daily living. They find it difficult to perform daily household tasks, cope with money and find ways indoors or in familiar streets. They may often dwell in the past and find it difficult to grasp the current situations and explanations.  Eventually they may have to seek assistance in carrying out basic activities like feeding, dressing and take care of self-hygiene, excretory and toilet activities.

    Where can the treatment for dementia be implemented?

    There are various treatment setting of management of dementia like home-based care, institutional guidance, short-term hospitalization and long-term assisted living.

    What are the treatments for dementia?

    The target for treatments in dementia is cognitive functions, behavioural disturbances and activities of daily living. Both pharmacological and non-pharmacological interventions are used for the treatment of the aforementioned symptoms.

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