Dementia

Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected.The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.

Dementia is caused by a variety of diseases and injuries that primarily or secondarily affect the brain, such as Alzheimer's disease or stroke. Dementia is one of the major causes of disability and dependency among older people worldwide. It is overwhelming not only for the people who have it, but also for their caregivers and families. There is often a lack of awareness and understanding of dementia, resulting in stigmatization and barriers to diagnosis and care. The impact of dementia on caregivers, family and societies can be physical, psychological, social and economic.
Signs and symptoms

Dementia affects each person in a different way, depending upon the impact of the disease and the person’s personality before becoming ill. The signs and symptoms linked to dementia can be understood in three stages.

Early stage: the early stage of dementia is often overlooked, because the onset is gradual. Common symptoms include: 

• forgetfulness
• losing track of the time 
• becoming lost in familiar places.

Middle stage: as dementia progresses to the middle stage, the signs and symptoms become clearer and more restricting. These include: 

• becoming forgetful of recent events and people's names
• becoming lost at home
• having increasing difficulty with communication
• needing help with personal care
• experiencing behaviour changes, including wandering and repeated questioning.

Late stage: the late stage of dementia is one of near total dependence and inactivity. Memory disturbances are serious and the physical signs and symptoms become more obvious. Symptoms include:

• becoming unaware of the time and place
• having difficulty recognizing relatives and friends
• having an increasing need for assisted self-care
• having difficulty walking
• experiencing behaviour changes that may escalate and include aggression.

Treatment and care

There is no treatment currently available to cure dementia or to alter its progressive course. Numerous new treatments are being investigated in various stages of clinical trials.

Much can be, however, offered to support and improve the lives of people with dementia and their caregivers and families. The principal goals for dementia care are:

• early diagnosis
• optimizing physical health, cognition, activity and well-being
• identifying and treating accompanying physical illness
• detecting and treating behavioural and psychological symptoms
• providing information and long-term support to caregivers. 

Risk factors and prevention

Research identifying modifiable risk factors of dementia is scarce. Prevention focuses on targets suggested by available evidence, which include countering risk factors for vascular disease, such as diabetes, midlife hypertension, midlife obesity, smoking and physical inactivity.

Source: who.int