What is dementia?
"Dementia" - is a collection of symptoms that indicate impairment of higher brain functions (memory problems, language, initiative, recognition, perception, judgment), behavioral changes, and functional decline. There are many diseases that cause dementia. The most well-known and common of these is Alzheimer's disease , but there are other diseases that lead to dementia, as will be explained below.
The symptoms of dementia usually worsen over time. The nature of the symptoms and their rate of change vary between different diseases and from person to person, but as the disease progresses, the patient will have more and more difficulty performing daily activities, and over time will become completely dependent on others. Severe dementia may cause the patient to become mentally exhausted.
The estimated number of patients in Israel is about 150.
Causes of dementia
Alzheimer's disease is the most common cause of dementia. 60% of people with dementia are diagnosed with Alzheimer's disease. It is a degenerative brain disease that gradually worsens. The disease causes cell degeneration in brain tissue. In addition to the loss of nerve cells in the brain, deposits of the substance amyloid beta are observed in the patient's brain and in the nerve cells, the protein tau is deposited when it is phosphorylated. It is assumed that these changes disrupt the function of the cells.
The disease was first described a century ago by a German physician named Alois Alzheimer, who diagnosed the disease in a 51-year-old woman and described the changes that occurred in her brain. To this day, his findings are the basis for a definitive diagnosis of the disease.
People with Down syndrome are at risk for Alzheimer's disease in middle age.
Vascular dementia is caused by damage to the cerebral blood vessels. The brain depends on a network of blood vessels that supply it with oxygen-rich blood. When the oxygen supply to the brain is interrupted, brain cells are damaged. Vascular dementia may occur after a stroke due to blockage of large blood vessels, as a result of damage to small cerebral blood vessels (lacunar infarctions), and also as a result of blood diseases and bleeding. Diabetes, high blood pressure, high blood lipid levels, excessive clotting, and irregular heart rhythms are risk factors for vascular dementia.
Dementia with Lewy bodies - This form of dementia gets its name from tiny proteinaceous spherical structures that develop inside nerve cells, and was described by neurologist Fritz Lewy in Berlin. The disease is initially characterized by cognitive and behavioral impairments and later by signs of Parkinson's disease. Patients may suffer from hallucinations. During the day, their cognitive and behavioral functioning is usually erratic.
Fronto- temporal dementia : This disease is characterized by brain atrophy in the frontal lobes of the brain, the frontal lobes, and the temporal lobes. This disease is primarily characterized by behavioral changes. Patients sometimes suffer from language impairments. In advanced stages of the disease, the symptoms are sometimes similar to those of Alzheimer's disease.
Mild Cognitive Impairment (MCI) – is a condition in which a person aged 50 or over suffers from memory impairments, or other cognitive functions, of a mild degree of severity and beyond that expected for their age. However, functional capacity is not impaired and it is not dementia. MCI is a risk factor for dementia, especially Alzheimer's disease, but only about 50% of those suffering from MCI will develop Alzheimer's disease or dementia for another reason.
Creutzfeldt-Jakob disease Creutzfeldt-Jakob Disease (CJD) – A rare disease caused by a protein that attacks brain tissue and causes it to collapse. This disease has been linked to mad cow disease, a similar disease that affects cattle.
Creutzfeldt-Jakob Hospital Association website
AIDS dementia – People with AIDS may develop dementia in the advanced stages of the disease.
Wernicke-Korsakoff syndrome – a syndrome observed in alcoholics, and may also be caused by a disruption in the supply of oxygen to the brain during surgery or in pregnant women suffering from repeated vomiting, or after gastric bypass surgery. The patient suffers from memory impairments and usually does not suffer from impairments in orientation or language functions.
" Pseudodementia" - describes clinical signs similar to dementia in patients suffering from depression. Appropriate treatment for depression can lead to improvement or even disappearance of dementia symptoms.
Reversible dementia: There are dementia symptoms that resolve with treatment of the underlying medical condition. Reversible syndrome has been described in the context of vitamin deficiencies (such as B12), urinary tract infection, high fever, brain tumor, or decreased thyroid function. More about the phenomenon
Diagnosis of the disease
Diagnosis of dementia and Alzheimer's is performed by a psychogeriatrician, and may include several steps. The first diagnosis is usually made using the Mini Mental Test - a questionnaire consisting of a variety of questions that test memory functions, comprehension, orientation and concentration. The purpose of this test is also to rule out other dementia diseases and phenomena with identical symptoms. Sometimes, comprehensive neurological tests are also required.
Why is it important to get a diagnosis as early as possible?
Dementia treatment
Dementia is an incurable disease, but there are medications that alleviate its symptoms and even delay its development. The current overwhelming recommendation of professionals specializing in the treatment of dementia is to combine drug treatment with additional complementary treatments that include participation in patient support groups, as well as cognitive activity and sensory stimulation: creativity, writing, board and memory games, physical exercise, and more.
Cognitive stimulation has been found to be at least as effective as medications for improving cognitive function. It is recommended that anyone suffering from cognitive decline begin engaging in a variety of activities as early as possible.
For information on "5 important messages you need to know about dementia" click here
Clinical guidelines for the treatment of dementia (as of 2021)