The dementia Is defined as a chronic and / or progressive syndrome characterized by a severe impairment of cognitive functions, more significant than is considered a product of 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 presents along with a deterioration in both the control of emotions and behavior (World Health Organization, 2015).
All these alterations in the initial stages can be presented mildly, almost without causing significant discomfort; However, they are progressive, passing to a moderate state and finally severe and therefore, affected to the daily life of the person who suffers.
Dementia is one of the leading causes of dependence and disability in the elderly worldwide (World Health Organization, 2015). Both the cognitive and behavioral symptoms of dementia can cause suffering in the patient and his caregiver, aggravating the functional deterioration (Orzalán-Rodríguez, 2012).
Dementia is a product of medical conditions that cause injury and damage to the brain, such as Alzheimer disease Or the Stroke , 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, 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 are going to affect the memory, thought and / or social skills , Serious enough to interfere significantly with the daily life of the person (Mayo Clinic, 2014).
Dementia presents with alterations in at least two brain functions: loss of memory, impairment of 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 alterations in memory are 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 involving some degree of memory loss; In addition, different investigations have associated different alterations of the memory to the aging (Mayo Clinic, 2014).
People with dementia have impaired intellectual functioning that interfere with their personal and work activities as well as normal social relationships (National Institute of Neurological Disorders and Stroke, 2015).
With the progression of pathology, they lose the ability to solve problems, plan actions and maintain emotional control. Changes in personality and behavioral problems in the most severe stages - hallucinations, hallucinations, agitation, aggressiveness, etc. - are frequently present. (National Institute of Neurological Disorders and Stroke, 2015).
How many people have dementia?
Dementia worldwide is estimated to affect approximately 47 million people, of whom 58% are in low- and middle-income countries. It has been detected that each new year is registered about 7.7 million new cases (World Health Organization, 2015).
It usually affects older people; However, dementia is not a normal cause of aging. It has been estimated that 5-8% of people 60 years of age or older suffer from dementia at any given time (World Health Organization, 2015).
What are the symptoms of dementia?
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 illness that is causing the insane process will contribute to the inter-individual variety of symptoms.
As we have pointed out, dementia is a progressive pathology, so symptoms are usually divided into three stages (World Health Organization, 2015):
Early stage
Symptoms are mild or minor. They usually go unnoticed for the person and the relatives, mainly because they do not imply a great alteration of their daily functioning. Some of the most common symptoms of this stage are (World Health Organization, 2015):
- Appearance of forgettings and memory failures.
- Loss of temporal orientation, that is, loss of the notion of time
- Spatial disorientation in new and / or familiar places.
Intermediate stage
Depending on the temporal progress of dementia, the symptoms begin to show more clearly, causing a greater interference in the person's intellectual and social functioning. The most characteristic symptoms of this stage are (World Health Organization, 2015):
- Memory failures for recent events.
- Difficulty or inability to remember names of people.
- Spatial disorientation in the home.
- Alterations in language that make communication difficult.
- Difficulties for cleaning and personal care.
- Behavioral changes (repeating questions, repetitive and stereotyped behaviors, etc.).
Late stage
The last stages of dementia are characterized mainly by the severe dependence that the person presents. 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 cleanliness.
- Changes in gait, difficulty walking.
- Most significant behavioral alterations.
Briefly, in the case of cognitive functions the 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 for the accomplishment of a task, etc.
- Language Difficulty maintaining a conversation, giving an answer, finding the right words, etc.
- Visuospatial skills : Difficult to perceive and judge distances and / or perceive objects in three dimensions.
- Orientation : Temporarily getting out of the time and day, not knowing where it is, etc.
In addition, at the behavioral and emotional level, some or all of the following signs and symptoms will appear (Mayo Clinic, 2014):
- Changes in the State of mind : Feelings of frustration, irritability, withdrawal, anxiety, etc.
- Changes in personality .
- Inappropriate behaviors.
- Hallucinations, agitation, etc.
- Changes in eating patterns and appetite.
- Sleep disorders .
On the other hand, in the final stages, several physical symptoms may appear: muscle weakness or weight loss (Alzheimer's Society, 2013).
Phases or stages in cognitive impairment and dementia
There are different clinical classifications that try to establish different stages or stages in the progress of dementia and cognitive impairment.
The determination and definition of the stage in which the person finds the person helps the professionals to determine the most recommendable therapeutic intervention and the future prognosis of the patient.
One of the most widely used scales for locating patient symptomatology in one of the phases of dementia is the Global Deterioration Scale for the Assessment of Dementia Primary Dementia - GDS- (Dementia Central Care, 2016):
Phase 1- Absence of cognitive impairment
The person has normal intellectual functioning. There is no impairment of memory or any other cognitive function. At this stage the general population (Dementia Care central, 2016) is included.
Phase 2- Very slight cognitive impairment
Usually associated with everyday forgetfulness related are normal aging. There are no obvious symptoms. No diagnosis of dementia is performed (Dementia Central Care, 2016).
Phase 3 - Mild cognitive impairment
Memories fail, difficulty concentrating, or diminished efficiency in the execution of different tasks. Usually these deficits are offset by other strategies. Symptoms may remain stable or progress to more severe phases. No diagnosis of dementia is performed (Dementia Central Care, 2016).
Phase 4 - Moderate cognitive impairment
Difficulty concentrating appears, problems to remember recent events or to perform routine tasks. Several episodes of temporal and / or spatial disorientation begin to occur. In many people there is awareness of these deficits. A diagnosis of Dementia at an early stage (Central Dementia Care, 2016).
Phase 5 - Moderately severe cognitive impairment
People at this stage have severe memory deficits and require assistance in completing activities such as dressing, bathing, or preparing food. Temporal and spatial disorientation is more evident. A diagnosis of Dementia in the intermediate stage.
Phase 6?? Severe cognitive impairment
At this stage 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 problems and personality. It is performed from a diagnosis of Dementia in the intermediate stage (Central Dementia Care, 2016).
Stage 7 - Severe cognitive impairment
In this phase they usually lose communication capacity and the functional dependence is complete. A diagnosis of Advanced dementia (Central Dementia Care, 2016).
What are the causes of dementia?
Multiple causes and factors related to dementia have been identified. Epidemiological studies have identified Alzheimer's disease with the most prevalent form of dementia, accounting for between 60 and 70% of cases (World Health Organization, 2015).
Other frequent pathologies are: vascular dementia, Dementia of Lewy bodies Or cerebrovascular accidents (World Health Organization, 2015).
What are the most common 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 onset of dementia symptoms are related to the elevated presence of beta-amyloid and tau protein. Usually Alzheimer's presents a clinical course of approximately 10 years, so that cognitive abilities are progressively reduced (Mayo Clinic, 2014).
Vascular Dementia
The Vascular dementia Is the second cause of dementia and occurs as a consequence of the presence of brain damage due to some cerebrovascular factor ( ictus , Reduced blood flow, etc.). The symptoms usually appear suddenly (Mayo Clinic, 2014).
Dementia of Lewy bodies
It occurs in approximately 10% of dementia cases. It occurs as a consequence of the formation of masses of Lewi bodies in different areas of the brain. The clinical course is similar to that of Alzheimer's disease, but it has some distinctive characteristics: fluctuations between confusion and lucidity, tremor or rigidity, among others (Mayo Clinic, 2014).
Frontotemporal Dementia
It is the most frequent type of dementia in the early ages. It occurs as a consequence of the degeneration of nerve cells in frontal and temporal areas. Symptoms may include alterations in personality, behavior, and language (Mayo Clinic, 2014).
How is dementia treated?
The World Health Organization (2015) notes that there is currently no specific treatment for dementia or its progressive evolution.
Despite this, there are several therapeutic interventions that can provide benefits both symptomatological and 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, control of clinical progress and the development of compensatory strategies for early deficits and symptoms.
All health and psychological interventions carried out with people with dementia should be oriented towards (World Health Organization, 2015):
- Early detection of symptoms and early diagnosis.
- Improvement of physical and mental health.
- Improvement of quality of life Personal and family.
- Control of the clinical course.
- Provide support and information to both the patient and caregivers, both in the short and long term.
CONCLUSIONS
Dementias are progressive and highly disabling disorders. Although in the early stages can go unnoticed, as its development progresses, it will be possible to present signs that alter in a very significant way the quality of life of the people who suffer it.
Different research projects predict that by 2030 the number of people with dementia will be around 73.6 million and in the year 2050 approximately 135.5 million people (World Health Organization, 2015).
These figures suggest that we are facing one of the major diseases of the 21st century, so it is essential that experimental and clinical research advance in the knowledge of its biological basis, causes and treatments.
References
- Alzheimer's Association. (2016). What is Dementia? Retrieved from the Alzheimer's Association: http://www.alz.org/what-is-dementia.asp.
- Buiza, C., Etxwbarría, C., & Yanguas Lezaun, J. (2005). Severe Cognition Impairment. Madrid: Portal Majors.
- DCC. (2001). Dementia . Obtained from Dementia Care Central: http://www.dementiacarecentral.com/.
- Mayo Clinic. (2016). Dementia . Retrieved from the May Clinic: http://www.mayoclinic.org/diseases-conditions/.
- NHI. (2015). What is Dementia? Retrieved from the National Institute of Neurological Disorders and Stroke: http://www.ninds.nih.gov/disorders/.
- Olazarán-Rodríguez, J., Agüera-Ortiz, L., & Muñiz-Schwochert, R. (2012). Psychological and behavioral symptoms of dementia: prediction, diagnosis and treatment. Rev Neurol, 55 (10), 598-608.
- WHO. (2015). Dementia . Obtained from World Health Organization: http://www.who.int/mediacentre/.
- Society, A. (2013). What is dementia?.