Dementia

Definition

Dementia is a progressive decline in cognitive function, affecting memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. It is a syndrome, not a single disease, and it encompasses several underlying diseases, such as Alzheimer's disease and vascular dementia.

Aetiology

Dementia can be caused by various conditions, including:

• Alzheimer's disease
• Vascular dementia
• Lewy body dementia
• Frontotemporal dementia
• Mixed dementia (a combination of the above types)

Pathophysiology

Different types of dementia have different pathophysiological mechanisms:

• Alzheimer's disease: Accumulation of amyloid plaques and neurofibrillary tangles in the brain.
• Vascular dementia: Reduced blood flow to parts of the brain due to damaged blood vessels.
• Lewy body dementia: Presence of Lewy bodies (abnormal protein deposits) in the brain.
• Frontotemporal dementia: Atrophy of the frontal and temporal lobes of the brain.

Risk Factors

• Age (most common in people over 65)
• Family history of dementia
• Cardiovascular disease
• Diabetes
• Smoking
• Alcohol use
• Head injury

Signs and Symptoms

• Memory loss
• Difficulty in communicating or finding words
• Problems with visual and spatial abilities
• Impaired reasoning or judgement
• Changes in mood and behaviour
• Difficulty with coordination and motor functions

Investigations

• Clinical assessment and history taking
• Cognitive tests (e.g., MMSE, MoCA)
• Blood tests to rule out other causes of cognitive impairment
• Neuroimaging (CT or MRI) to identify brain changes
• Neuropsychological testing

Management

Primary Care Management

• Early diagnosis and assessment
• Providing information and support to patients and caregivers
• Managing coexisting medical conditions
• Encouraging healthy lifestyle choices (e.g., diet, exercise)
• Referral to memory clinic

Specialist Management

• Referral to a specialist (e.g., neurologist, geriatrician, psychiatrist) for further assessment
• Advanced cognitive and functional assessments
• Potential use of disease-modifying therapies (for specific types of dementia)
• Specialised support services for patients and caregivers
• Management of behavioural and psychological symptoms

Example Management for Dementia

A patient presenting with early signs of dementia should undergo a comprehensive assessment, including cognitive testing and neuroimaging. If Alzheimer's disease is diagnosed, treatment may include cholinesterase inhibitors (e.g., donepezil) and NMDA receptor antagonists (e.g., memantine) to help manage symptoms. Supportive care involves educating the patient and family about the disease, planning for future care needs, and connecting them with local support groups and services. Regular follow-ups are essential to monitor the progression and adjust the management plan as needed.

References

1. NICE. (2024). Dementia: Assessment, Management, and Support for People Living with Dementia and Their Carers. Retrieved from NICE
2. NHS. (2023). Dementia. Retrieved from NHS
3. Alzheimer's Society. (2023). Dementia Information. Retrieved from Alzheimer's Society
4. McKhann, G. M., Drachman, D. A., Folstein, M. F., Katzman, R., Price, D. L., & Stadlan, E. M. (1984). Clinical Diagnosis of Alzheimer's Disease: Report of the NINCDS-ADRDA Work Group under the Auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology.
5. Burns, A., & Iliffe, S. (2009). Dementia. BMJ.