What Is Dementia?
Dementia is a neurological term that covers a spectrum of symptoms. It encompasses a progressive decline in cognitive, emotional as well as social functioning that occurs at a rate more progressive than would be expected due to normal ageing. The death of cells in the cerebral cortex, responsible for memory, calculation and behaviour/personality is the underlying pathophysiology.
The new term for dementia as defined by the DSM-V Manual (Diagnostic and Statistical Manual of Mental Disorders) is "Major Neurocognitive Disorder." The reason for the change in terminology is to lessen the stigma related to the disease.
There are different types of dementias, based on their underlying pathology and clinical presentation. Dementias can either be reversible in 1-2% of cases, non-progressive, or progressive ( a majority of cases).
Alzheimer's and Vascular Dementia (progressive dementias) are the commonest types of dementia. Alzheimers Dementia (AD) occurs in between fifty to seventy percent of cases, and Vascular Dementia (VD) in about twenty percent of cases.
To date, there are no specific cures for dementia. Disease progression can be retarded by certain lifestyle factors such as diet, mental activities, social participation, and exercise.
What Are The Symptoms Of Dementia?
Dementia is diagnosed in the presence of a significant decline in the level of cognitive functioning from previous functioning status. One or more areas of cognition may be affected. These include:
- Executive functioning
- Learning and memory
- Intricate attention
- Social interactions and interpersonal relationships
- Perceptual-motor skills
The symptoms must be severe enough to affect activities of daily living, and should not be caused by delirium (acute state of confusion due to underlying correctable causes in contrast to dementia’s chronic onset).
What Are The Causes Of Dementia?
Potentially reversible causes of dementia include medications or alcohol. Dementia due to medical conditions such as hypothyroidism, hydrocephalus, Vitamin B 12 deficiency, neurosyphilis and major depressive disorder may be potentially reversible when the underlying condition is properly treated. Immunological causes of dementia such as Sjögren’s syndrome, SLE, and multiple sclerosis may also be reversible.
Non-progressive dementia is due to conditions such as:
- Head injury (traumatic brain injury)
- Brain tumours
- Meningitis/ Encephalitis
- Drug Abuse
Alzheimer's is caused by degeneration of the cerebral cortex and deposits of protein in the neural tissue. To date, no specific cause or preventable factors could be found for Alzheimer's. Old age and family history are the two biggest factors. Twenty percent of people with Alzheimer are over the age of eighty years. Family history is another important factor, although no particular gene could yet be identified.
Vascular dementia is caused by a series of small strokes in the brain. Narrowing of blood vessels or blood clots causes decreased blood flow to areas of the brain. The lack of blood flow is called ischaemia. Atherosclerosis is the biggest cause of cerebral ischaemia. Hypertension, diabetes, hypercholesterolemia all predispose to atherosclerosis formation. Treating these conditions may prevent the progression of vascular dementia, but cannot reverse the loss of function already present. Multiple areas of infarction may be seen on MRI scans.
Frontotemporal dementia, Lewy body dementia, and Creutzfeld-Jacob disease are other causes of progressive dementia.
What Are The Things One Should Do To Manage Dementia?
- Exercise has been shown to improve cognitive functioning- a minimum of one and a half hours per week of moderate exercise such as walking is recommended. Exercise reduces the progression of dementia.
- Engaging in regular social activities has shown to decrease cognitive decline.
- Lose weight. Insulin resistance and metabolic syndrome have proved to increase chances of dementia.
- Participation in music and art reduces cognitive decline.
- Mental exercises like learning a new topic, learning an instrument, solving problems and puzzles improve cognition.
What Are The Things One Should Avoid To Manage Dementia?
- Do not smoke. Smoking may increase your dementia risk by 45 percent.
- Do not leave stress unattended. Learn mindfulness and meditation practices.
- Do not skimp out on sleep. Sleep deprivation has been linked to cognitive decline.
What Are The Best Foods For Dementia?
Diet plays a significant role in cognitive functioning. A diet high in fresh fruits and vegetables, antioxidants, and unsaturated fatty acids is of importance.
- Folate containing foods improve cognition and reduce homocysteine levels. Homocysteine causes inflammation of blood vessels supplying the brain. Folate is high in green leafy vegetables such as kale, spinach, broccoli, mustard greens, beans and legumes.
- Vitamin B12 containing foods: Shellfish, salmon, sardines, fortified cereals, feta cheese, grass fed beef
- Omega 3 containing diets have shown to reduce the chances of dementia by almost 30 percent. Fishy foods such as salmon, mackerel, and tuna. Almonds, cashews and macadamia nuts and oils such as flax seed, coconut and olive oil are also good sources of omega 3.
- Antioxidant containing foods:
Vitamin E (specifically in Alzheimers disease): Asparagus, wheat germ, sunflower, green leafy vegetables
Vitamin C: Citrus fruits, berries
Vitamin A: Sweet potato, egg yolks, papaya, grapefruit
- Medium chain triglycerides (MCTs) such those found in coconut oil have shown significant improvement in memory function in dementias.
What Are The Worst Foods For Dementia?
- Saturated fatty acids
- Grilled and fried foods. These foods are high in advanced glycation end (AGE) products, shown to increase dementia risk
- Processed foods, refined grains, and sugars. These foods have shown to have an adverse effect on insulin levels, specifically causing fluctuating blood glucose levels, that can damage blood vessels in the brain
- Red meat increases iron loading. Too much iron can deposit in the cerebral cortex leading to cognitive decline is. Red meat should not be completely avoided, just used in moderation. Grass fed beef is the best source.
- Excessive alcohol intake.
What Are The Medicines For Dementia?
What Are The Tips To Manage Dementia?
Co-enzyme Q10 supplements may reduce oxidative stress and protein deposits in the brain.
Turmeric supplements may be beneficial in lowering cerebral inflammation.