By Dr. Jonathan Marsh
Dementia is a complex and multifaceted condition that affects millions of individuals worldwide, leading to significant challenges in memory, cognition, and daily functioning. Even though it is prevalent, it is often poorly understood. Read on to learn about causes, diagnosis, and treatment for dementia as well as working with loved ones struggling with dementia, and strategies for coping with dementia.
Dementia is a collective term for cognitive decline that affects daily life and is not reversible. Before diagnosing dementia, it is important your doctor rule out curable conditions that can mimic dementia such as infections, normal pressure hydrocephalus (NPH), and encephalitis. Common symptoms of dementia include memory loss, confusion, difficulty with language, and changes in mood and behavior. Changes in mood and behavior are often overlooked early symptoms and should prompt further investigation. The lifetime risk of an individual developing dementia is up to 40%, with dementia-related healthcare costs in the U.S. exceeding $305 billion annually and projected to surpass $1 trillion by 2050. Personal costs of dementia are significant such as emotional distress, loss of dignity, deterioration of social relationships, and isolation.
The most common types of dementia are Alzheimer’s, Vascular, Lewy Body, and Frontotemporal. Alzheimer’s disease accounts for 45% of dementia cases, followed by vascular dementia at 15%, Lewy Body Disease at 5.4%, and frontotemporal dementia at 1%. Alzheimer’s disease primarily affects memory, thinking, and behavior, with symptoms worsening over time. Risk factors include age, genetics, and lifestyle. It is caused by the buildup of Tau and Amyloid protein in the brain, with environmental factors and genetics playing a role. The APOE ε4 gene significantly increases the risk of Alzheimer’s, while the APOE ε2 gene offers protective effects.
Vascular dementia is caused by reduced blood flow to the brain, with symptoms including memory loss, confusion, and difficulty with decision-making. Lewy Body Disease is characterized by abnormal protein deposits in the brain and may present with visual hallucinations and fluctuating cognition.
Frontotemporal dementia involves more predominant personality changes and behavioral issues than the other types. Alzheimer’s and Vascular dementia typically start in the mid to late 60s and older, while Lewy Body disease and Frontotemporal dementia often start younger, in the 50s and 60s.
Historically, cognitive assessments, such as the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were the primary tools for diagnosing and categorizing dementia. Fortunately, new tools have been developed in recent years to help. Brain imaging, particularly PET scans, are essential for diagnosing dementia accurately and differentiating between types of dementia. Innovative blood tests, such as P-Tau 181 and Amyloid 42/40 markers, can detect dementia earlier and track disease progression and treatment response.
Dementia does not just happen, there are things you can do to help prevent it. Engaging in physical activity, maintaining a healthy weight, participating in mental activity, fostering connections, and managing chronic health conditions significantly decrease your odds of developing dementia. Current medicines alleviate symptoms, with cholinesterase inhibitors and Memantine helping moderate to severe Alzheimer’s symptoms. Emerging monoclonal antibody treatments, such as Lecanemab (Leqembi) and Donanemab (Kisunla), show promise in slowing cognitive decline and improving patient outcomes. Experimental treatments, including Reminetug, Buntanetap, and Semaglutide, are on the horizon.
Working with your loved ones to improve their quality of life is an important part of treatment. Establishing daily routines, using memory aids, staying socially engaged, and participating in enjoyable activities can significantly reduce the disease’s impact. Communication strategies are important for creating a stress free, loving environment. Using a calm, reassuring tone, avoiding contradicting the patient, keeping instructions simple, and discussing events and people the patient can recall can create a peaceful mental state conducive to good health and mood.
Proactive planning when dementia is a concern is crucial, and addressing difficult decisions early can significantly decrease stress for the patient and their loved oned. Genetic testing, medical and social support, and financial plans should all be addressed as soon as possible. Genetic testing can help individuals make informed decisions based on their personal risk profile. Periodic dementia screenings help involve families early, and ensures legal, medical and financial plans are in place.
Considering preferences for support early ensures a patient receives the care they wish in their preferred environment. Home with help versus assisted living needs to be considered, as well as what resources are available. Support for caregivers should not be overlooked, as they need breaks and often rely on family support. Financial planning involves addressing key questions such as where the patient will live, who will pay the bills, and whether a progressive care community or in-home care is needed.
Understanding dementia is vital for effective management and compassionate care. Recognizing early symptoms, exploring various treatment options, and implementing coping strategies can help patients and their families navigate the challenges of dementia together.
DR. JONATHAN MARSH
Specialty Information: Internal Medicine with a focus on health span and longevity Board Certification: ABIM – American Board of Internal Medicine
Dr. Jonathan Marsh provides personalized care so you can live your healthiest life for years. He will address your immediate medical needs and work with you to achieve your health and lifestyle goals. Throughout his career, Dr. Marsh has held a variety of leadership positions at both NCH and Physician’s Regional Healthcare Systems, where he is the current Chief of Medicine. With a unique understanding of the local medical landscape, Dr. Marsh can guide his patients seamlessly through their care plans.
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