The Causes and Treatments of Dementia

Currently, toxic protein clumps around brain cells are considered to be a key factor in developing dementia. For Alzheimer’s disease, these proteins are known as amyloid and tau. When these symptoms begin to interfere with daily life, a dementia diagnosis will be made. Alzheimer’s disease causes around 60-70% of all cases, but there are other causes of dementia, such as vascular dementia. Alzheimer’s treatment for almost 20 years, suggesting that the possibility of a cure may increase in the future.

It is not uncommon to know someone with dementia, whether a family member, friend or neighbor. Estimates say around 55 million live with the condition, though that number will increase as the global population rises.

As dementia appears in so many people, there is a strong interest in causes and treatments. There has been a long history of clinical research, slowly reshaping the understanding of the matter. However, there are still many widespread misconceptions about dementia.

‍What is Dementia?

‍Dementia is the general term for a decline in cognitive abilities to such an extent that it begins to interfere with daily life. The characteristics of dementia include memory loss, language confusion, and difficulty with reasoning or problem-solving, but there may also be various behavioral or personality changes.

Dementia can be thought of as a symptom of other conditions. Common types of dementia are Alzheimer’s disease, frontotemporal dementia, Parkinson’s disease, and vascular dementia. In addition, people experiencing various types of dementia at the same time are diagnosed with mixed dementia.

All types of dementia are progressive, meaning the damage to the brain continues to worsen. Most dementia types are also irreversible, so treatment is focused on management rather than cure.

‍About Dementia

‍The World Health Organization estimates that Alzheimer’s disease is the main contributor to 60-70% dementia cases. This leads to many people using the two terms interchangeably, but not all dementia is caused by Alzheimer’s disease. The difference between Alzheimer’s and dementia is that Alzheimer’s is a disease, whereas dementia is a syndrome (collection of symptoms) resulting from the disease.

The chance of developing dementia begins to rise from the age of 65 sharply. The Alzheimer’s Association states that one in nine (11.3%) people aged 65 and older suffer from Alzheimer’s dementia.

However, dementia can and does affect people of younger ages, in their 50s, 40s, and even 30s. When dementia is seen in someone under the age of 65, it’s referred to as ‘early onset dementia’ or ‘young onset dementia.’

A gradual weakening of cognitive function, known as senility, is expected when people become elderly; the brain shrinks in healthy aging but doesn’t lose neurons (brain cells) in large numbers. Dementia is not a natural consequence of aging, as it involves a more significant loss of cognitive function.

‍Memory Loss and other Symptoms of Dementia

‍One of the earliest signs of dementia is a significant change to short-term memory (LINK to Article 3), such as struggling to recall recent events despite being able to remember experiences that happened long ago—misplacing items or losing track of your ideas while speaking can also be early indicators of dementia.

Frequent cognitive symptoms include:

·   Memory loss

·   Difficulty forming language

·   Poor problem-solving or reasoning

·   Weakened visual-spatial performance

·   Diminished movement and motor skills

·   Inability to handle complicated tasks

·   General confusion

It’s important to note that dementia does not simply affect functional skills but also causes psychological concerns:

·   Personality changes

·   Depression

·   Anxiety

·   Paranoia

·   Agitation

Inappropriate behaviors and sudden personality changes can be incredibly upsetting for the friends and family of those who have dementia.

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What are the Causes of Dementia?

‍The causes of dementia vary between types. Current scientific understanding proposes that many forms of dementia share a connection with protein clumps around neurons. A stroke or hemorrhage can also develop into particular kinds of dementia, while diminished blood supply or damaged blood vessels can also contribute.

1. Toxic Protein Clumps

Various forms of dementia are caused by unusual protein build-up in the brain. In the case of Alzheimer’s disease, it is thought to occur from the abnormal build-up of two proteins, called amyloid and tau.

Amyloid proteins can be present in many different forms. For example, undesirable amyloids can congregate around brain cells, forming ‘plaques’, which are thought to affect how they communicate and function.

Tau is a vital protein for cell stabilization. However, certain genetically mutated versions of this protein can create ‘tangles’ in the brain, as they cannot adjoin with healthy tau. This is thought to interfere with normal cellular function.

In dementia with Lewy bodies (DLB) and Parkinson’s disease, the toxic clumps of protein are alpha-synuclein, though the process remains similar. Frontotemporal dementia and Pick’s diseases are also believed to be caused by tau dysfunction, amongst other proteins.

Important Note: The exact relationship between toxic protein clumps and the death of brain cells is not yet fully understood. The topic requires further research.

2. Reduced Blood Flow

For vascular dementia, the cause is not malformed proteins but rather reduced blood flow to the brain. This injures and ultimately kills neurons, which in turn causes the symptoms of dementia.

Insufficient blood flow can happen as a result of a stroke (infarction), whereby an artery was blocked, and blood supply was cut off. Mini or silent strokes can also lead to vascular dementia, with each iteration increasing the likelihood of developing the condition.

High blood pressure is a common cause of brain hemorrhages or narrowing blood vessels, both major risk factors for vascular dementia.

‍How does Dementia affect the Brain?

‍Dementia-causing diseases can impede communication between neurotransmitters, effectively unplugging the connections in the brain, leading to the eventual destruction of the brain cells themselves.

Alzheimer’s disease begins in the hippocampus and entorhinal cortex, both situated in the temporal lobe, the area of the brain most associated with memory. This is why an early sign of dementia is poor memory. With other types of dementia, or through general progression, the damage begins in or spreads to other areas of the brain. This explains the complex range of symptoms.

Damage to the frontal lobe, the area associated with self-control, organization, and working memory, will impact reasoning, judgment, and behavior. Any damage to the parietal lobe will show weakened language skills, such as difficulty forming long sentences or making sense of conversations heard.

The exact places where dementia first develops can depend on the cause. The symptoms correlated with the locality of the brain impaired. For example, frontotemporal dementia is concerned with the frontal and temporal lobes, impacting executive functions and memory. In contrast, Parkinson’s disease damages the basal ganglia, an area deeply buried in the brain responsible for motor skills.

‍Diagnosis of Dementia

‍There isn’t a standardized test for determining whether someone has dementia. Instead, the various diseases that cause dementia symptoms are diagnosed by healthcare professionals. Such an assessment can involve consultation on any sudden changes in thought, memory, or behavior, psychical examination, cognitive ability testing, and checking medical history against the various types of dementia.

Doctors can diagnose dementia accurately, though knowing the precise form of dementia usually requires further analysis. Mixed dementia, for example, can carry a range of symptoms that do not simply fall into one type. In addition, how different types of dementia interact with various regions of the brain is not entirely set, meaning it’s difficult to confirm dementia type without referring to a specialist, such as a neurologist or a psychologist.

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Dementia treatment and care

‍In most cases, dementia is irreversible, meaning it cannot be cured, and cognitive decline will simply continue. There are, however, specific treatments and therapies that can prolong mental abilities.

1. Drug Treatment

The new drug aducanumab, sold under Aduhelm™, was recently approved by the US Food and Drug Administration (FDA) to treat Alzheimer’s disease. It’s an antibody therapy that targets and removes amyloid protein clumps responsible for damaging brain cells. It has been shown to be effective for those who have early Alzheimer’s. It has been the first new Alzheimer’s treatment for nearly 20 years.  

Other drugs can be used to alleviate dementia symptoms, including Acetylcholinesterase (AChE) inhibitors, which increase levels of acetylcholine in the brain, a substance that helps nerve cells communicate.

In many scenarios, the same medications used to treat Alzheimer’s are prescribed to help with symptoms of other dementia types, under the general philosophy of improving quality of life in any way possible.

2. Therapy Treatment

Non-drug therapies can also alleviate some symptoms of dementia. One popular approach is Cognitive Stimulation Therapy (CST), which involves group activities and exercises designed to engage memory and executive functions like problem-solving, planning, and decision-making.

A professional alternative would be cognitive rehabilitation, whereby one works with an occupational therapist to set personal goals and work towards them. These can be related to any aspect of life, such as physical feats, new skills, or the refinement of everyday tasks. Cognitive rehabilitation acts by engaging the working parts of the brain to assist the less functional areas.

A great deal of clinical study is needed to develop further dementia treatments, though recent breakthroughs offer good promise for effective future developments.

‍Dementia Risks and Prevention

‍Despite the fact that around 5% of Alzheimer’s cases are familial or hereditary, it’s widely accepted that most dementia is not genetic. However, carrying specific genes does increase the chances of having the condition.

The presiding argument is that there are multiple dementia risk factors, including genetics, age, and existing conditions, as well as lifestyle choices that influence blood pressure and/or cholesterol, such as diet, exercise, and smoking/alcohol use.

Here are the ways in which you can lower risk to prevent dementia:

‍1. Exercise Regularly: Physical activity strengthens the heart, enabling it to pump more blood with less effort. Having a healthy heart reduces the chance of cardiovascular diseases, such as strokes or heart attacks, which lowers the risk of developing vascular dementia or Alzheimer’s disease.

‍2. Avoid Smoking/Alcohol: Smoking tobacco poisons blood vessels in all parts of the body, raising the risk of developing dementia, amongst an array of other diseases. Excessive alcohol consumption can raise cholesterol and blood pressure, both key risk factors of dementia diseases.

‍3. Watch the Cholesterol: A balanced, low-fat diet is usually enough to manage cholesterol, but consider cholesterol-lowering medications if you need them. Lowering the risk of strokes and heart attacks also reduces the likelihood of vascular dementia.

‍4. Maintain Healthy Blood Pressure: high blood pressure contributes to a range of diseases, including Alzheimer’s and vascular dementia. Keep your blood pressure within the normal range by following a healthy diet and exercise routine.

‍5. Prevent/Manage Diabetes: Various health issues increase the risk of dementia, including type-2 diabetes. Ensure a healthy diet, low in saturated fats, salts, and sugars, to minimize risk. Those that already have diabetes should carefully control their condition to avoid further damage to brain blood vessels.

‍6. Cognitive Stimulation: Research presented at the 2019 Alzheimer’s Association International Conference (AAIC) proposed that “having a higher cognitive reserve, built through formal education and cognitive stimulation, may benefit the aging brain by reducing the risk of dementia.” As well as Cognitive Stimulation Therapy (CST), specialized apps, like memoryOS, can train memory and thinking skills, acting as preventative measures against cognitive decline or the onset of dementia.

‍It is important to remember!

‍Dementia is not a disease but a syndrome (collection of symptoms). It is impossible to fully understand dementia until the range of degenerative diseases that cause it have been studied further. Until then, treatment remains focused on quality of life and patient comfortability rather than a cure.

Dementia is not a natural part of aging, though the irreversible nature of the condition often leads people to assume so. If you or someone you know is exhibiting early signs of dementia, seek medical advice. Depending on the underlying cause, treatments will vary. Getting an early diagnosis gives patients the best chance to extend their quality of life.

‍FAQ

What Is Dementia? Dementia is a term for a range of symptoms, including memory loss, language confusion, difficulty with reasoning, as well as various behavioral or personality changes. When these symptoms begin to interfere with daily life, a dementia diagnosis will be made. Alzheimer’s disease causes around 60-70% of all cases, but there are other causes of dementia, such as vascular dementia.

‍What causes Dementia? Currently, toxic protein clumps around brain cells are considered to be a key factor in developing dementia. For Alzheimer’s disease, these proteins are known as amyloid and tau. Abnormal build-up of proteins is believed to interfere with healthy cellular function. Damage incurred to brain cells will show as the symptoms of dementia. Alongside bad proteins, the poor blood supply to the brain is another contributing factor to dementia. Strokes, hemorrhages and high blood pressure all raise the risk of developing dementia.

‍Is there a cure for dementia? All types of dementia are progressive, meaning cognitive ability will gradually worsen. Most dementias are also irreversible, meaning there is no known cure. The new drug aducanumab (Aduhelm™) is being used to remove the harmful protein clumps in the brain, which damage neurons. It is the first new Alzheimer’s treatment for almost 20 years, suggesting that the possibility of a cure may increase in the future.