First of all, there is not only one disease that makes dementia. There are different kinds of dementia diseases like Alzheimer, vascular dementia or Lewy Body Disease. The syndromes of dementia can also be caused by other diseases for example like by stroke, Parkinson, Hydrocephalus, brain tumor and others. It is the task of the neurologist to find out whether a person is suffering of a dementia disease and if yes, which kind. The most common dementia disease is the Alzheimer´s disease. In this article an overview of this disease is given.
Alzheimer´s disease is a chronic disease of the brain which starts slowly with little symptoms. One symptom alone is not enough to tell a diagnosis. To forget some things some time does not make an Alzheimer´s disease. With ongoing age it is totally normal that your remembrance becomes worse. When you are 60 years it is more difficult to memorize information than with 50, and with 70 more than with 60. That means you forget always a bit more becoming older in a natural way. It is very individual how much and how fast this process is ongoing. This depends a lot of your gens, your general health situation, your environment you live in and your education. In scientific papers is was found that people with high education, university degrees or a sophisticated job, so called “brain workers”, get Alzheimer´s disease more seldom and later than people who work more physically. Our brain has a lot of resources to compensate deficiencies. And a well-trained brain does it better than a “lazy” brain.
The beginning symptoms quite often do not really differentiate between the forgetfulness of age and an early stage of a dementia disease. There are special cognitive tests a neurologist can apply to find out whether the memory alteration is still in age range or not. If there are symptoms of an alteration more than “what is allowed”, further investigations have to be done.
The beginning of an Alzheimer´s disease causes not only a decline of memory but also other symptoms. The people seem to be depressed. Or they are really depressed because they realize their increasing problems. They feel tired, exhausted and try to avoid intellectual demanding tasks. Already in early stages of the disease the people change their behaviour. They lose interest in things which were important for them before like their job or hobbies. They avoid social contacts, want to be alone or only with very close persons like family members. The surrounding feels that something is wrong. First it is yet too little to talk or to worry about. There are always any excuses found to explain the changes. Then when the difficulties become more evident people feel unsecure how to talk about. There is a big inhibition threshold on both sides, for the affected person the same as for the family members or friends.
In these early stages of the dementia the diagnosis is sometimes difficult. Other diseases like depression, burn out syndrome caused by too much stress, physically exhaustion and other corporal diseases have to be excluded. But how to find out whether a person is suffering from dementia?
First of all go to your neurologist and talk to him about your problems. Already by talking to a patient the doctor gets a first impression. He doesn´t only hear the complaints themselves. Important are also the duration and the progression of the problems. The way how a person speaks, the signs of memory disturbances in conversation, indication of aphasia, disturbance of time or local orientation, all this might already show first straits of a beginning dementia. The doctor also watches the spontaneous behaviour to form his opinion weather it is adapted to the situation or not. It is also important to listen to family members or other close persons. Maybe they have more information the patient eventually already forgot. Or they have another view of the changes the patient did undergo.
Next step are different cognitive tests. For example this is the worldwide used MMSE (Mini Mental State Examination), a psychometric test to prove orientation, retentiveness, alertness, speech, memory and other function. The neurological examination gives information about the different systems of the brain, peripheral nerves and muscles. Reflexes, speech, gait and locomotor system sensibility, vision, balance and the cranial nerves are checked. It is important to look whether there are any signs which could give an advice for another disease than dementia causing the problems. Blood tests, more seldom examination of the CSF (cerebrospinal fluid) were done. The CSF is the liquid the brain and the spine are covered with all over. In this CSF special peptides can be found which indicate an Alzheimer Disease (Tau-peptide, A beta-peptide).
EEG (electroencephalography) is an examination which does not hurt, comparable to the ECG (electrocardiogram) of the heart. It gives a good overview of the global cerebral function. Other electrophysiological test like AEP (acoustic evoked potentials) or SEP (sensible evoked potentials) can give more information about a lesion in the nervous system to exclude another disease. Also ultrasonic investigations of the cerebral blood flow are part of the diagnostic procedures. The neurologist will send the patient to the imaging of the brain by MRI or CT. In early stages of dementia there are no specific signs for the disease. In more progressed stages you can find signs of atrophy in special parts of the brain (in the temporal area hippocampussklerosis). But the most important reason for the imaging in early stages is again to exclude other diseases which have to be treated in a different way and which might be healed.
Therapy of Alzheimer disease is possible. With the medication it is achievable to decelerate the progress of the disease, to stabilize the memory, concentration and basic life skills. In Alzheimer Disease nerve cells and nerve cell connections decay which cannot get restored. In consequence of the decay of the nerve cells the messenger substance Acetylcholine decreases. A special kind of medication, the so called “cholinesterase inhibitors”, compensates partly the deficit. By this the information processing improves again. There are other substances like memantine which influence the cerebral metabolism in a different way which might also have stabilizing effects on the cognitive functions. Coexisting symptoms like depression, sleeping disorders, anxiety or restlessness have to be treated with other drugs beside the special dementia medication.
Very important is the right contact and handling with the affected person. Lots of patience and sympathy, a quiet surrounding and good information for understanding the disease and the behaviour of the patient are absolutely essential. It is difficult and very exhausting to care for somebody in a more advanced stage when the person needs help in every daily activity, in personal hygiene, in nutrition and needs observation the whole day. The family should use all the help and frontline services they could get.
Dr. Irene Klyk, Senior Consultant in Neurology, German Neuroscience Center DubaiLeave a reply →