Dementia is a syndrome or collection of symptoms that produce declines in memory and other mental abilities creating confusion and communication difficulty. Dementia is caused by various conditions diseases or conditions, most of which have no cure, such as Alzheimer’s disease, vascular dementia, or Parkinson’s disease. It is important to remember that the diagnosis or observation of this mental decline does not necessarily mean it is an untreatable or irreversible condition. However, the individual who is affected or family members observing these changes should seek neurological and neuropsychological confirmation of the type of dementia that is occurring.
The following is derived from the
Handbook of Health and Behavior: Psychological Treatment Strategies for the Nursing Home Patient
Joseph M. Casciani, PhD
This is part of a series where Dr. Casciani makes you aware of and informs you about series medical conditions your patient or loved one may be facing.
A more detailed, clinical, and complete description can be found in the handbook.
Medical Condition – DEMENTIA
Dementia is a syndrome or a collection or cluster of symptoms. It produces a decline in memory and other cognitive, or mental abilities. Dementia is caused by various diseases and conditions. Many of these diseases have no cure, while some causes of dementia are treatable. In most cases, however, dementia is not curable and cannot be reversed, once the disease process sets in. The diagnosis itself does not necessarily specify that the condition is treatable or not, only that there is present a loss of intellectual ability, especially memory loss. In most cases, however, once the dementia patient has undergone a thorough assessment, and treatable causes have been ruled out, the diagnosis implies that it is not a treatable condition. In addition to the mental changes that are present, a diagnosis of dementia also requires that this decline is severe enough to interfere with daily life.
Causes of Dementia
The most common type of dementia is Alzheimer’s disease, accounting for the majority of dementia cases. This is a degenerative disease that progresses over time, and is due to a deterioration, or atrophy, of nerve cells in the brain. The transfer of information from one set of brain cells to another begins to break down in Alzheimer’s disease, and eventually the brain cells die off. Scientists do not know the reasons why this dying off of brain cells occurs, but this loss of brain function affects the person’s overall functioning, including mental, social, and behavioral activity.
The second most common type of dementia is vascular dementia. This is produced by decreased blood flow to certain parts of the brain as a result of small strokes that block the flow of blood in the arteries. The changes that occur from vascular dementia are similar to those of Alzheimer’s disease, but the changes tend to be more erratic. That is, we may see a sudden change from one day to the next, and then no changes for several days or even weeks. The pattern of losses resembles a sawtooth picture, where it is flat, and then a sudden drop, then flat again, and so on.
Another common type of dementia is the Lewy bodies version. This is similar to the usual Alzheimer’s picture, with changes in memory, behavior, and judgment, but also is marked with changes in alertness, and the severity of the symptoms may fluctuate on a daily basis.
Patients with Parkinson’s disease often develop dementia as their disease progresses.
Infections, such as HIV, can produce dementia in later stages. Creutzfeldt-Jakob disease is a severe form of dementia believed to be caused by consuming products from cattle that are infected with “mad cow” disease.
Normal pressure hydrocephalus (NPH) is caused by an abnormal buildup of fluid in the brain, and also causes dementia. NPH can sometimes be corrected with a surgical procedure to drain the excess fluid.
Less common forms of dementia are “dementia pugilistica” caused by cumulative and repeated blows to the head, sometimes found in retired boxers and other athletes.
Mismanagement of certain medications, and nutritional or dietary imbalance (such as protein deficiency) can produce dementia but these are believed to be very reversible conditions.
Alcohol or illicit drugs are a possible reversible cause of dementia.
Toxins, such as carbon monoxide poisoning or lead poisoning, are another potential cause.
Similarly, depression, in some individuals, may resemble dementia because of the way depression can affect thinking, decision-making, concentration, and behavior. When this picture occurs, that is, when depression mimics or resembles dementia, the term pseudo-dementia is used. Pseudo implies that it is false, hence the term pseudo-dementia.
What are the Medical Consequences?
Depending on the nature and reversibility of the dementing condition, irreversible dementias will progress until there is profound mental deterioration and impairment of all cognitive functions.
What are Contributing Factors?
The irreversible, primary degenerative dementias are the result of a disease process or neurological condition that are uninfluenced by psychosocial factors. There may be reversible dementias, however, that are associated with behavioral or lifestyle factors such as excessive alcohol, medication, or illicit drug use that create impairments in orientation, and other cognitive functioning.
What Negative Attitudes can Develop?
The most usual cognitive style of the dementia patient, at least in the early or mild stage, is denial, and a tendency to minimize or mask the extent of difficulty he or she is experiencing.
For Professionals – Themes And Strategies in Behavioral Treatment can be found in the Handbook.
