HEAL Article - Nov/Dec 2023: Dementia

TheCareJournal
Dec 31, 2023
7 min read

Dementia Overview:

“The key to the future in an aging society is not found in increasing just our life span; we need to increase our health span at the same time.” (Chuck Norris). As life expectancy continues to increase worldwide thanks to modern technology, there are setbacks associated with this progress – conditions associated with old age are skyrocketing. One prominent condition that is more frequently found in the older population (those 65 and older) is dementia. Currently, the World Health Organization placed an estimate of around 55 million people globally that have dementia. This number is expected to increase by 84 million by the year 2050. Despite the commonness of dementia, not many people are familiar with what it is. The basic understanding of dementia is that it’s a condition that affects memory, but in reality, it’s much deeper than memory. Dementia is a neurodegenerative disease that affects numerous cognitive functions such as memory, problem-solving, decision making, attention, communication, and other abilities that are part of daily life.

Dementia is an umbrella term for neurodegenerative diseases, but it is often used interchangeably with Alzheimer’s disease. Utilizing both terms interchangeably isn’t entirely correct, as while the most prevailing form of dementia is Alzheimer’s disease, making up 60-70% of cases, there are also many other forms of dementia. The most commonly seen examples being vascular dementia, dementia with Lewy bodies, and Frontotemporal dementia, which compose the other 30-40%. However, some people can have different types of dementia simultaneously, also known as mixed dementia. A common example is patients with vascular dementia. These patients frequently also have Alzheimer’s at the same time.

Types Of Dementia:

Alzheimer’s disease - Alzheimer’s can be used to refer to either an illness that causes dementia, or the type of dementia that is caused by that illness. The physical disease that is Alzheimer’s causes damage to the brain and can result in difficulty with memory, thinking and reasoning, and language. It may also affect someone’s vision and hearing in addition to changing their mood. It’s caused by the build-up of amyloid and tau (nerve proteins) in the brain which create plaque, making it difficult for the brain to function in its intended manner.

Vascular dementia - Vascular dementia occurs when the routes of blood supply to the brain get damaged, in other words, when there is impaired blood flow to the brain. It causes problems with planning, organizing, making decisions, solving problems, concentrating, and following a series of instructions. It may also result in slower thought and periods of confusion. The most common cause of vascular dementia is through a stroke blocking an artery, but in some less common forms vascular dementia occurs gradually.

Dementia with Lewy bodies (DLB) - DLB is a form of dementia developed when Lewy bodies, a specific protein, clump up in nerve cells of the brain. The symptoms of DLB are similar to those of Alzheimer’s and Parkinson’s, making it somewhat difficult to make the correct diagnosis. The symptoms of DLB differ depending on what parts of the brain have the largest build up of Lewy bodies, causing issues with thinking, movement, mood, and regular bodily functions. The build up of these proteins also reduces chemical messengers and breaks connections between nerve cells.

Frontotemporal dementia (FTD) – FTD is a form of dementia that is less common due to its nature of specificity. It focuses on damage done to two lobes in the brain – the frontal lobe and the temporal lobe. FTD is caused by disease impairing nerve cells in either of these lobes. When the nerve cells are damaged, it causes connections in the brain to break down, eventually leading to brain tissue becoming smaller and weaker. Frontotemporal dementia manifests differently for everyone so it’s difficult to assign it one set of symptoms – they’ll depend on the areas of the frontal and temporal lobes that are affected.

Preventative Measures:

Dementia isn’t an easy disease to prevent. Often, it is considered genetic and is mostly prevented by maintaining healthy habits. The best way to prevent dementia is to be proactive. Ensure that you are physically active, eating healthy, avoiding addictive substances such as drugs, smoking, and alcohol, and maintaining mental and social health. Physical activity helps reduce the likelihood of dementia, because it maintains adequate blood flow to the brain to stimulate brain cell growth and survival. Avoiding drugs, smoking, and alcohol is imperative as well because such substances increase the risks for vascular problems – including strokes and small bleeds in the brain and inflammation to the cells. Furthermore, staying mentally and socially healthy is important because it keeps the mind sharp and challenged, allowing for constant development and a reduction in mental health diseases like depression. Moreover, another preventative measure is to avoid injuries to the head. Any injuries to the parts of the brain involved in cognitive function (learning and memory), such as the hippocampus may lead to dementia.

Lifestyle habits to form to prevent dementia:

Physical Activity - Physical activity helps to reduce the risk of dementia. It’s good for heart circulation, weight, and mental wellbeing. It’s recommended to aim for exercising 30 minutes daily, focusing on aerobic exercises (running, biking, swimming, etc.) as well as strength-building activities (utilizing weight machines, resistance bands, rock climbing, etc.). However, physical activity doesn’t have to be strenuous, it has been shown that daily tasks such as walking, cleaning, cooking, and gardening can also reduce the risk of developing dementia.
Eating Healthy - Eating a healthy, balanced diet helps to reduce the risk of dementia. Eating various foods in the correct proportions makes a difference in your health. A good example of a healthy, balanced diet that may assist in dementia prevention is the Mediterranean diet, which includes various food groups, such as healthy fats, whole grains, fruits, vegetables, beans, nuts, and seeds.

Avoid drinking alcohol and smoking - Smoking harms the blood circulation of the body which can cause severe health issues involving your heart, brain, and lungs. Smoking puts you at a higher risk of developing dementia. Drinking alcohol can also increase your risk of developing dementia. Drink in moderation and within recommended time limits.
Stay mentally and socially active - Participating in mental or social activities may help to prevent dementia. Any activities that may help you to process information and develop thinking skills. For example, finding activities you enjoy that help challenge your brain like puzzles, crosswords, playing board games, reading and writing, learning a new language, etc.

Treatments:

Unfortunately, no forms of dementia are curable; however, there are many treatments available for those affected by it. From the use of home remedies, therapies, and medication – many options can alleviate the symptoms of dementia. Due to the nature of dementia having no cure, many may opt for alternative medicine options because they don’t include the risks that come with medicinal side-effects. Alternative medicines are simply treatments that are non-pharmacological. These treatments focus on reducing stress and managing symptoms – some examples of alternative medicine include therapies, lifestyle changes, and natural health products.

Therapies such as aromatherapy, music therapy, and pet therapy allow those with dementia to reduce stress and eliminate stressors, lessening symptoms. Moreover, natural health products like herbs and dietary supplements such as ginkgo biloba, melatonin, and omega-3 fatty acid – can also be used to improve some symptoms of dementia. While some therapies and natural health products may help, implementing lifestyle changes – forming lifestyle habits similar to those used as a preventative measure for dementia – is the most effective alternative treatment because they allow people to live longer and slow the progression of dementia. However, it’s important to note that many alternative medicines are only applicable on an individual basis and more research is needed to see if these treatments can be proved beneficial for everyone. The only treatments for dementia that are clinically proven to lessen symptoms are certain types of pharmaceuticals.

Medications used to lessen symptoms of dementia:

Cholinesterase inhibitors - Cholinesterase inhibitors work by boosting acetylcholine – a neurotransmitter responsible for memory, learning, attention, arousal, and involuntary and voluntary muscle movements, as well as other chemical messengers that play a role with memory and judgment. This medication is mainly used as a treatment for Alzheimer’s but can also be given to those who have vascular dementia and DLB. Some examples of this medication include donepezil (common brand – Aricept), rivastigmine (common brand – Exelon) and galantamine (common brand – Razadyne ER).
Anti-amyloid treatments - Amyloid targeting approaches work by removing beta-amyloid – a protein that creates plaque in the brain. Types of amyloid targeting approaches work differently depending on the stage of plaque formation. If used in early stages of dementia, it can change the course of the disease, allowing people diagnosed with dementia to carry on with their daily life for a longer period of time. This drug slows down the progression of dementia by targeting the underlying cause of the spread of the disease. It’s mostly used for those who have Alzheimer’s. Examples of these treatments include aducanumab (common brand - Aduhelm), which is an IV infusion therapy given every month, and lecanemab (common brand - Leqembi), which is another option for an IV infusion therapy, but instead is given every two weeks.
Glutamate regulators - Glutamate regulators work by regulating glutamate – a chemical messenger involved in cognitive function that relates to memory and learning. This form of medicine can be prescribed along with cholinesterase inhibitors due to both pharmaceuticals focusing on chemical messengers that target memory. It’s used to treat those with Alzheimer’s in middle and later stages and DLB. It can help with worsening mental abilities and issues carrying out daily activities. An example of this medication would be memantine (common brand – Namenda).
Treatments for non-cognitive symptoms - Along with the cognitive symptoms of dementia, there are non-cognitive symptoms such as sleep disturbances, psychosis (hallucinations and delusions), mood disturbances, personality changes (disinhibition, apathy), and altered sexual behavior, that need to be treated as well. Two treatments for these symptoms are orexin receptor antagonists and atypical antipsychotics. Orexin receptor antagonists, such as suvorexant (common brand – Belsomra) is a drug prescribed as a treatment for insomnia which inhibits the activity of orexin – a neurotransmitter involved in the sleep-wake cycle. Atypical antipsychotics, such as brexpiprazole (common brand – Rexulti) are a group of antipsychotic drugs that target serotonin and dopamine pathways in order to treat agitation associated with Alzheimer’s.