Dementia - Things You Should Know About It

"Hello, my name is Dr. Santosh Bangar. I am a consultant psychiatrist with special interest in geriatric or senior citizens mental health. I have trained in UK and achieved this qualification, so let's talk about dementia today. Dementia as you maybe know it is mainly an illness of older people, people who are over 50, over 60.
Basically it's a syndrome, now people think that dementia happens only in older people but that's not the case, dementia can happen in people in the thirties or in their forties, so just merely having a bad day at work and then forgetting things does not amount to dementia which a lot of time people feel.

Oh I can't remember this so have I got dementia or have I got Alzheimer's that's a very common myth and dementia can happen in other people suffering from other mental illnesses. They can have memory problems which is sometimes called as pseudodementia so let's look at what are the different illnesses which can give rise to dementia. Alzheimer's disease or sometimes called as Alzheimer's dementia is the commonest cause, so common question that we are usually asked is, doctor what is the difference between dementia and Alzheimer. The simple answer is, Alzheimer's disease is the commonest cause of dementia so that is one of them and there are other types of dementia as well what is called as vascular dementia.
So vascular dementia can happen in people who have had a stroke or have had a mini-stroke or what we call as transient ischemic attacks or TIA. For short, in those people over a period of time they can develop. It can start suddenly after the stroke or insidiously after the stroke has resolved and then there is something called mixed dementia, so a combination of Alzheimer's and vascular dementia.
So vascular, as in problem with the vasculature or the blood supply then there are other types of dementia, what is called as Lewy body dementia, Parkinson's disease dementia and so on and so forth so altogether we are talking about more than 50 different types of dementias.

The common symptoms could be memory loss, so forgetting what happened few minutes ago, not remembering the conversation or repeating themselves telling the same story so that can happen, so a lot of times the relative will come and tell us that doctor ye bhul jata hai, ya kuch 2-5 minute pehle hua, ya khana khata hai bhool jata hai, so that is one of the symptoms and it is the commonest symptom of dementia.
Now the long-term memory or what we call as you know past memory or remote memory that is intact for a number of years so they will remember things from their childhood and them are very crystal clear in their mind, which school they went to, what job they did or when when they went out on the first holiday or family holiday, so all those things remain quite clear in their mind until later in the illness when those things unfortunately are also forgotten so they will not remember when they got married or how many children they have or what age they had the first child and so on and so forth.
So it's very disturbing and troubling for the family, this is about the memory the short-term memory loss now there are other symptoms like having difficulty holding a conversation or understanding a conversation. while speaking you may forget certain words or you may not remember what a particular object is called so you may describe it in great details.

For example, some object you write with, so the person wants to say a pen but they cannot say that word pen so they may describe the function or the purpose of the object as opposed to the name pen so this can happen in conversation so they may feel embarrassed during a conversation or have a lengthy conversation to just say a simple sentence because they have these deficiencies or what we call as Dysphasia about the words that they want to say or use, then some people are not able to recognize familiar people by face, so that is another symptom. Then not able to carry out routine day-to-day tasks so what we call are activities of daily living.

So because dementia is a syndrome of the whole brain, so it's not only memory but other functions of the brain are also affected so for example judgment, decision-making, language ability, carrying out a task and during the latter stages of illness, all the major body functions like the bladder function, the bowels so they may become incontinent, then the mobility is affected so walking is difficult and feeding themselves, that's very hard for the family to manage so this is about the common symptoms of dementia.

Now along with these symptoms or what we call as cognitive features, lot of behavioral problems also happen, so, for example, people can get depression, they can have anxiety, they can develop psychosis, they can have sleep problems, feeding problems so on and so forth so all this is under the umbrella of what we call as behavioral and psychological symptoms of dementia or BPSD.
So this is quite common during the course of the illness as much as up to 90% of people will have BPSD during the course of their illness at some point and that is very challenging for the family to manage. So not only this but they become very aggressive, very agitated, develop paranoid thoughts, they believe that the family is going to poison them or instead of giving them the tablets they are giving them poison or people are stealing or breaking into the house. So all these are very difficult symptoms to manage.

Then coming to another closely related condition called delirium or acute confusional state which closely resembles the symptoms of dementia but it's a distinct disorder and it starts very suddenly within matters of few minutes or few days and it can resolve once the underlying cause is identified and treated so let's look at some of the common causes of delirium.
So delirium is more common in people who have some kind of dementia, so commonly a person with delirium as I said in the matter of few minutes to a few days they may become very aggressive, so there is a change in their behavior and there are fluctuations so if a person has been having a normal period of say few minutes to a few hours and if you see that person after some time they may be completely different.
So the same symptoms wax and wane or they fluctuate in time more so these symptoms are worse after the sunset or what we call as sun-downing. So after say four or five o'clock their behavior worsens they may also have psychotic features like as I said the paranoid ideas, hallucinations.

Very classically or commonly visual hallucinations are seeing things which are not there or misinterpreting the stimuli. Say for example if they see a curtain hanging they may feel that there are snakes on the wall, so these are very disturbing to them. Then the sleep is affected, there is reversal of the what we call as the sleep/wake cycle so they may sleep during the day and be awake at night and the common causes are urine infection, undiagnosed pain or too much of painkillers, chest infection or any change in the medication and people with dementia are more prone to this, so this is broadly about delirium and dementia and what can be done so let's look at that what can be done to prevent or reduce the chance of developing dementia.

Dementia can run in family or it can be hereditary What are the other factors? So lifestyle, the environment that plays a major role. People with certain mental illnesses are also prone to develop dementia later in life, so if you are suffering from any mental illness get yourself checked and treated by your psychiatrist at the earliest opportunity.
So there is a talk about healthy lifestyle or reducing the excess amount of weight, having a healthy diet, good night's sleep because nowadays there's lots of emphasis on the sleep or what we call as rapid eye movement sleep. What happens is that the brain is sort of recharging its battery and all the memories are stored so this is as good as you know charging a phone, you are backing up the phone so it's similar so you need to have undisturbed refreshing sleep for at least six to eight hours.

Everybody’s sleep pattern is different so people who have some conditions called sleep apnea or obstructive sleep apnea, there is a link or an association between lots of other physical illnesses and also with dementia as well so taking your blood pressure medication regularly and on time, getting yourself checked is important because blood pressure itself is an independent risk factor for Alzheimer's and vascular as well because if your blood pressure is not controlled you may develop stroke and so on and so forth.

Having a sugar-free diet or treating your diabetes in time and having a stringent control of the blood sugar is also important because that's also a risk factor for Alzheimer's, so basically staying healthy, remaining stress-free, taking exercise regularly, not smoking and drinking alcohol very sparingly. Now patients ask us that doctor we read somewhere that if you drink alcohol within limits that may reduce the risk of stroke or dementia, there is some link but we cannot sort of prescribe or advise a person to start drinking so you should drink within limits as recommended and another thing is alcohol will nullify the effects of some of the medication that you may be already taking, so consult your doctor and get advice from them.

Let's end the talk here and I can be contacted, I practice at global Hospital and my own clinic is at Kemps Corner at Om Chambers and I am freely available, very easily approachable. Thanks very much, I will be happy to answer your questions.

Thank you!