What is Dementia?

Dementia is an umbrella term commonly used to refer to any acquired (not present since birth) condition in which there is a progressive, often irreversible, decline in cognitive and functional abilities. The problem with this general term is that it offers no insight into the underlying cause of the dementia. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) recognizes the following forms of dementia, now referred to as neurocognitive disorders:

  • Alzheimer’s disease
  • Frontotemporal lobar degeneration
  • Lewy body disease
  • Vascular disease
  • Traumatic brain injury
  • Substance/medication use
  • HIV infection
  • Prion disease
  • Parkinson’s disease
  • Huntington’s disease
  • Another medical condition
  • Multiple etiologies
  • Unspecified

Dementia affects one or more of the following cognitive abilities: memory and learning, attention, language skills, social cognition (recognition of emotions in oneself and others; appropriate social behavior), and perceptual-motor skills (recognition of the surrounding space and objects, and appropriate execution of motor skills). Finally, a broad category called executive dysfunction – difficulties with planning, organization, multi-tasking, decision-making, insight, judgement, ability to correct errors through feedback, ability to inhibit inappropriate behaviors, etc. – is greatly affected as well. It is important to recognize that dementia is not merely a cognitive disorder; diagnosis requires that there is impairment in the ability for independent living

Today, Alzheimer’s disease alone affects over 6 million Americans. By 2050, over 13 million Americans will be afflicted by Alzheimer’s disease. Since age is the biggest risk for Alzheimer’s, and women live longer than men, they are more likely to develop Alzheimer’s. The condition is also more prevalent in Black and Hispanic Americans compared with White Americans. Nearly one in three seniors dies of Alzheimer’s disease in the United States while the mortality associated with other common diseases is gradually declining. The personal and socioeconomic toll is indicated by the fact that the cost of dementia care currently totals 355 billion dollars annually, with 11 million Americans who provide unpaid care for their loved ones. 

Given these astounding statistics, early diagnosis of dementia is key to providing the best possible care for those afflicted with the condition and their families. Early diagnosis and intervention provide time and opportunity for family education, advance care planning, addressing safety issues, and making potential housing and financial arrangements while the condition is still in its early stages. One of the most challenging problems arises when the diagnosis is missed for many years, and there are no preparations to deal with the myriad consequences of the disease. 

So, what are the early symptoms of Alzheimer’s disease, the most common form of dementia, that one should pay attention to? Here are some pointers from the Alzheimer’s Association (www.alz.org):

  • Memory loss that affects daily life (not just occasional forgetting)
  • Challenges in planning or solving problems, particularly in novel situations
  • Difficulties completing familiar tasks that used to be automatic before
  • Confusion about time and place (and eventually person)
  • Trouble understanding visual images and spatial relationships (in more advanced stages, may not recognize faces or familiar objects)
  • Decline in language skills, both the ability to express oneself and understand others
  • Misplacing things or losing the ability to retrace steps
  • Worsening judgement (personal safety, poor judgement about driving skills, etc.)
  • Social withdrawal 
  • Changes in personality, behavior, mood, and even psychosis in later stages of the condition

In future posts, I will review the typical clinical presentation, causes(s), course, diagnosis, treatment, and prognosis of the more common dementias. I will also provide an overview of what one might expect in the early, middle, and advanced stages of dementia. Commonly used office-based cognitive and functional assessments will be discussed as well. 

I welcome your comments, questions, and input. Stay tuned!

Ashok Bharucha, MD

ajb@transformationspsychiatry.net 

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