Dementia

 

Dementia is diagnosed as a deterioration in cognition and ability that are severe enough to interfere with everyday function (activities of daily living). This does not mean that we would wait until a Professor became fully “below normal” in everyday function – a drop in measured IQ from supernormal to “normal” is still indicative of a degenerative or dementing illness. Similarly, dementia can occur in people with DSM 5/ICD 10 “intellectual disability” such as as Down Syndrome – where Alzheimer’s Disease can occur in adulthood.

Memory loss generally occurs in dementia. However, memory loss alone doesn’t mean you have dementia. Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment or language, and the inability to perform some daily activities such as paying bills or becoming lost driving.

Textbooks describe Alzheimer’s Disease as the most common form of progressive dementia of old-age.

Vascular dementia is the second most common form and results from blocked or reduced blood flow. The blood flow problems can be caused by stroke, heart infections, and vascular disease.

Lewy Body Disease appears to be a distinct form of dementia, and creates nearly one-quarter of all dementia “cases”. It can include both visual hallucinations, parkinsonism, and a sleep behavior disorder where the patient will physically enact their dreams.

Frontotemporal Dementia (also called Pick’s disease) affects the frontal and temporal lobes – which are needed for “executive function”, communication, and movement. It accounts for almost 15% of all dementia cases – but it develops much earlier than the other dementia’s – sometime in the 5th decade of life. It can be divided into 3 types based on the portions of the brain that are most impaired: behavioral variant FTD first affects mood and personality and then becomes more obviously degenerative, Primary Progressive Aphasia affects language and then behavior, and the movement disorders including Progressive Supranuclear Palsy & Corticobasal Degeneration.

There are other dementing illnesses – which are considered to be reversible or mostly reversible. They include infections, abnormal immune responses, nutritional issues, poisoning & toxicity, and the so-called “dementia of severe depression”.

In 2014, we have some choices when it comes to treatment of progressive dementia. They include nutritional (for deficiencies and to enhance the nervous system) & bacteriologic approaches (targeting H. Pylori), and cutting edge interventions such as perispinal etanercept injections (for inflammation), deep brain stimulation (to reactivate dormant brain regions) and stem cell therapies (to fight inflammation and facilitate regeneration of destroyed cells).