Cognitive impairment

What is Dementia?

The term “dementia” is derived from the Latin “de-mens” (de = deprived of; mens = mind, reason) and literally means “deprived of reason”.

Dementia is not a single disease but a generic term for cognitive impairment which is severe enough to interfere with autonomy in activities of daily living. When neurodegenerative diseases progress, nerve cells and the connections between these cells in the brain can change or may be destroyed. This leads to difficulties in memory, orientation, attention, verbal expression, language comprehension and other cognitive abilities. In addition to intellectual changes, dementia can also lead to changes in mood, motivation and social behaviour. According to the World Alzheimer Report (2018), there are currently more than 55 million people living with dementia and this number is expected to almost triple by 2050. Unfortunately, this high number is associated with important societal and economic burden.

Some general characteristics may include:

• Memory problems: people with dementia often show difficulties in encoding, storing and recalling new information, as well as difficulties in recognising known objects.
• Attention and concentration: it may be difficult for people with dementia to focus their attention on a specific task (such as reading). Furthermore, they may experience variations in their level of alertness.
• Language difficulties: dementia affects the flow of speech. People with dementia often experience increased difficulty when finding the right words, use of incorrect words and problems understanding spoken language.
• Loss of temporal and spatial orientation: people with dementia may experience confusion of days, months, seasons or even years, have problems with telling the time and often get lost in known environments.
• People with dementia experience loss of planning as well as organisational and problem-solving skills.
• Dementia may affect people’s personality, motivation, mood (depression, anxiety or agitation) and social behaviour.

Causes and forms of dementia

Alzheimer’s disease is the most common form of dementia and accounts for 60% to 80% of dementia cases. It affects about 5% of people over 65 and 20% to 25% of people over the age of 80. Even though, dementia is often present in older people, it is not an inevitable consequence of “normal” ageing. Despite continuous progress in science and the existence of many promising theories, the exact causes of Alzheimer’s disease remain unclear at present. Currently, age and genetic factors are considered the most important risk factors for the development of Alzheimer’s disease.

There are also other forms of dementia, such as:

• Vascular dementia
• Mixed dementia
• Dementia with Lewy bodies
• Dementia associated with Parkinson’s disease
• Fronto-temporal dementia

It should be noted, that there are also forms of dementia considered “reversible” which may be caused by drugs, metabolic dysfunction, infections (e.g. AIDS or Syphilis) or severe forms of depression.

Diagnosis

The diagnosis of a neurodegenerative diseases leading to dementia must be made by a physician, especially a neurologist, based on a clinical examination, a cognitive assessment and the results of various other tests (e.g. MRI scan, lumbar puncture,..). An extensive neuropsychological evaluation, as it is conducted in the frame of the pdp, can be helpful in making a diagnosis.

Treatment

There is currently no “cure” available for Alzheimer’s disease, nor are there any disease-modifying drugs that can stop or reverse the brain damage that has occurred. However, there are drugs that can reduce the extent of some symptoms and slow the progression of the disease, such as cognitive enhancers; tranquillisers, antidepressants, anxiolytic drugs or anticonvulsants. Some drugs, such as lipid-lowering drugs (used to lower blood cholesterol levels towards normal values) are thought to have an indirect positive effect on the development of dementia. Only the treating physician can recommend the use of certain drugs.

Furthermore, there exist non-pharmaceutical treatment options, whose aim is to increase cognitive functioning and to allow the person affected with dementia to continue to perform activities of daily living to a certain extent. Furthermore, the aim is to help them and their caregivers to manage behavioural changes and to maintain a certain level of quality of life.