DEMENTIA: SYMPTOMS, TYPES, CAUSES AND TREATMENTS - NEUROPSYCHOLOGY - 2025

The dementia is defined as a chronic syndrome and / or progressive characterized by a serious deterioration of the more significant cognitive functions of the product is considered normal aging.

At the cognitive level, most of the functions are affected (Buiza et al., 2005): memory, learning, language, orientation, processing speed, etc. In addition, this condition usually occurs together with a deterioration in both the control of emotions and behavior (World Health Organization, 2015).

All these alterations in the initial stages can appear in a mild way, almost without producing significant discomfort; However, they are progressive, moving to a moderate and finally serious state and therefore, affecting the daily life of the person who suffers from it.

Dementia is one of the main causes of dependency and disability in the elderly throughout the world (World Health Organization, 2015). Both the cognitive and behavioral symptoms of dementia can cause suffering in the patient and their caregiver, aggravating functional impairment (Orzalán-Rodríguez, 2012).

Dementia is the product of medical conditions that cause injury and damage to the brain, such as Alzheimer's disease or strokes, among others. Generally, Alzheimer's is the most common cause of dementia (Alzheimer's Society, 2013).

On the other hand, the clinical course and symptoms of cognitive impairment will depend on both the affected areas, the primary pathology, and personal, protective or risk variables (Alzheimer's Society, 2013).

What is dementia?

Dementia is not an isolated disorder. This pathology is characterized by the presentation of a series of symptoms that will affect memory, thinking and / or social skills, serious enough to significantly interfere with the person's daily life (Mayo Clinic, 2014).

Dementia presents with alterations in at least two brain functions: memory loss, impaired judgment or language; Difficulty performing routine activities such as paying bills or getting lost in familiar places (Mayo Clinic, 2014).

Although it may seem that memory impairment is the most distinctive feature of dementias, memory loss in isolation does not unequivocally indicate that there is a dementia process.

There are many other pathologies that involve a certain degree of memory loss; Furthermore, different investigations have associated different memory alterations with aging (Mayo Clinic, 2014).

People with dementia have impaired intellectual functioning that interferes with both their personal and work activities and normal social relationships (National Institute of Neurological Disorders and Stroke, 2015).

With the progress of the pathology, they lose the ability to solve problems, plan actions and maintain emotional control. Changes in personality and behavior problems are common in the most serious stages - delusions, hallucinations, agitation, aggressiveness, etc. - (National Institute of Neurological Disorders and Stroke, 2015).

Statistics

It is estimated that worldwide, dementia affects approximately more than 47 million people, of which 58% reside in low- and middle-income countries. It has been detected that each new year around 7.7 million new cases are registered (World Health Organization, 2015).

Generally, it affects older people; however, dementia is not a normal cause of aging. It has been estimated that between 5-8% of people aged 60 years or older suffer from dementia at any given time (World Health Organization, 2015).

Symptoms

Each person is unique and different, so they will experience the symptoms and signs of dementia in a specific way (Alzheimer's Society, 2013).

On the other hand, both the stage of progress and the type of disease that is causing the dementia process, will contribute to the inter-individual variety of symptoms.

As we have noted, dementia is a progressive pathology, so the symptoms are usually divided into three stages (World Health Organization, 2015):

Early stage

The symptoms are mild or insignificant. They tend to go unnoticed by the person and those close to them, mainly because they do not involve a great alteration of their daily functioning. Some of the most common symptoms of this stage are (World Health Organization, 2015):

• Appearance of forgetfulness and memory failures.
• Loss of temporal orientation, that is, loss of notion of time
• Spatial disorientation in new and / or familiar places.

Intermediate stage

Depending on the temporal progress of the dementia, the symptoms begin to show more evident, causing a greater interference in the intellectual and social functioning of the person. The most characteristic symptoms of this stage are (World Health Organization, 2015):

• Memory failures for recent events.
• Difficulty or inability to remember people's names.
• Spatial disorientation at home.
• Alterations in language that significantly hinder communication.
• Difficulties in grooming and personal care.
• Behavioral changes (repeating the same questions, repetitive and stereotyped behaviors, etc.).

Late stage

The last stages of dementia are fundamentally characterized by the serious dependence that the person presents. The cognitive symptoms and physical disabilities are more than evident. Some of the most common symptoms of this stage are (World Health Organization, 2015):

• Severe spatial and temporal disorientation.
• Difficulty or inability to recognize relatives or close people.
• Need for help with personal care and grooming.
• Gait disturbances, difficulty walking.
• More significant behavioral changes.

In summary, in the case of cognitive functions, symptoms may appear in the following areas (Alzheimer's Society, 2013):

• Memory: difficulty remembering recent events, names, places, etc.
• Concentration, planning, attention: difficulty in making decisions, solving problems, executing sequences to carry out a task, etc.
• Language: difficulty holding a conversation, giving an answer, finding the correct words, etc.
• Visuospatial skills: difficult to perceive and judge distances and / or perceive objects in three dimensions.
• Orientation: temporarily misplaced in the time and day, not knowing where you are, etc.

In addition, on a behavioral and emotional level, some and / or several of the following signs and symptoms will appear (Mayo Clinic, 2014):

• Changes in mood: feelings of frustration, irritability, withdrawal, anxiety, etc.
• Changes in personality
• Innapropiate behaviours.
• Hallucinations, agitation, etc.
• Changes in eating patterns and appetite.
• Sleep disorders.

On the other hand, in the final stages, various physical symptoms may appear: muscle weakness or weight loss (Alzheimer's Society, 2013).

Phases or stages in cognitive decline and dementia

There are different clinical classifications that try to establish different phases or stages in the progress of dementia and cognitive deterioration.

The determination and definition of the stage in which the person is located helps professionals to determine the most recommended therapeutic intervention and the future prognosis of the patient.

One of the most widely used scales for the location of the patient's symptoms in one of the phases of dementia is the Global Deterioration Scale for the Evaluation of Primary Degenerative Dementia -GDS- (Dementia Care central, 2016):

Phase 1-

The person has normal intellectual functioning. There is no impairment of memory or any other cognitive function. At this stage, the general population is included (Dementia Care central, 2016).

Phase 2-

Usually associated with everyday forgetfulness related to normal aging. There are no obvious symptoms. Diagnosis of dementia is not made (Dementia Care central, 2016).

Phase 3 -

Memory failures, difficulty in concentration, or decreased efficiency in the execution of different tasks begin to appear. Normally these deficits are compensated with other strategies. Symptoms may remain stable or progress to more severe phases. Diagnosis of dementia is not made (Dementia Care central, 2016).

Phase 4 -

Difficulty concentrating, problems remembering recent events or performing routine tasks appears. Various episodes of temporal and / or spatial disorientation begin to appear. In many people there is awareness of these deficits. An early-stage dementia diagnosis is made (Dementia Care central, 2016).

Phase 5

People in this stage have severe memory deficits and require assistance to complete activities such as dressing, bathing, or preparing food. The temporal and spatial disorientation is more evident. A diagnosis of intermediate stage dementia is made.

Phase 6 - Severe cognitive impairment

In this phase the affected people are in a serious state of dependency. They do not remember names of relatives and events. In many cases, some people can only remember events from the early stages of their life. They present significant behavioral and personality problems. It is made from a diagnosis of dementia in the intermediate stage (Dementia Care central, 2016).

Phase 7- Severe cognitive impairment

In this phase they usually lose the ability to communicate and functional dependence is complete. A diagnosis of advanced dementia is made (Dementia Care central, 2016).

Causes

Multiple causes and factors related to dementia have been identified. Epidemiological studies have identified Alzheimer's disease as the most prevalent form of dementia, representing between 60 and 70% of cases (World Health Organization, 2015).

Other frequent pathologies are: vascular dementia, Lewy body dementia or cerebrovascular accidents (World Health Organization, 2015).

Types of dementia

Alzheimer disease

This disease is the most common cause of dementia in people over 65 years of age. Despite this, there are cases of early presentation as a result of genetic factors.

A specific cause of Alzheimer's disease has not been determined; however, the appearance of dementia symptoms are related to the elevated presence of beta-amyloid and tau protein.

Normally Alzheimer's has a clinical course of approximately 10 years, so cognitive abilities are progressively reduced (Mayo Clinic, 2014).

Vascular dementia

Vascular dementia is the second leading cause of dementia and occurs as a consequence of the presence of brain damage due to some cerebrovascular factor (stroke, reduced blood flow, etc.). Symptoms often appear suddenly (Mayo Clinic, 2014).

Lewi body dementia

It occurs in approximately 10% of dementia cases. It occurs as a consequence of the formation of masses of Lewi bodies in different brain areas.

The clinical course is similar to that of Alzheimer's disease, however it presents some distinctive characteristics: fluctuations between confusion and lucidity, tremor or rigidity, among others (Mayo Clinic, 2014).

Frontotemporal dementia

It is the most common type of dementia in younger ages. It occurs as a consequence of the degeneration of nerve cells in frontal and temporal areas. Symptoms can include personality, behavior, and language disturbances (Mayo Clinic, 2014).

Treatment

The World Health Organization (2015) points out that there is currently no specific treatment for dementia or to reverse its progressive evolution.

Despite this, there are various therapeutic interventions that can provide benefits both at the symptomatological level and in terms of quality of life for the patient and their caregivers (World Health Organization, 2015).

Neuropsychological intervention with the application of cognitive training programs are one of the most beneficial options for the maintenance of residual cognitive functions, the control of clinical progress and the development of compensatory strategies for the first deficits and symptoms.

All health and psychological interventions carried out with people with dementia must be oriented to (World Health Organization, 2015):

• Early detection of symptoms and early diagnosis.
• Improved physical and mental health.
• Improvement of the quality of personal and family life.
• Control of the clinical course.
• Offer support and information to both the patient and caregivers, both in the short and long term.

Conclusions

Dementias are progressive and highly disabling disorders. Despite the fact that in the early stages they can go unnoticed, as their development progresses, signs may appear that significantly alter the quality of life of people who suffer from it.

Different researches predict that in 2030 the number of people with dementia will be around 73.6 million and in 2050 approximately around 135.5 million people (World Health Organization, 2015).

These figures suggest that we are facing one of the main diseases of the 21st century, so it is essential that experimental and clinical research advance in the knowledge of its biological bases, causes and treatments.

References

1. Alzheimer's Association. (2016). What is Dementia? Obtained from Alzheimer's Association: alz.org
2. Buiza, C., Etxwbarría, C., & Yanguas Lezaun, J. (2005). Severe Cognito Impairment. Madri: Senior Portal.
3. DCC. (20016). Dementia. Obtained from Dementia Care Central: dementiacarecentral.com
4. Mayo Clinic. (2016). Dementia. Obtained from Mayo Clinic: mayoclinic.org
5. NHI. (2015). What is Dementia? Obtained from the National Institute of Neurological Disorders and Stroke: ninds.nih.gov
6. Olazarán-Rodríguez, J., Agüera-Ortiz, L., & Muñiz-Schwochert, R. (2012). Psychological and behavioral symptoms of dementia: prevention, diagnosis and treatment. Rev Neurol, 55 (10), 598-608.
7. WHO. (2015). Dementia Obtained from World Health Organization: who.int
8. Society, A. (2013). What is dementia ?.