Forms of dementia

introduction

Under the Dementia disease one understands a so-called dementia syndrome, i.e. an interplay of several, different, simultaneously occurring symptoms caused by one advancing demise of brain tissue caused (this is particularly affected Cortical tissue and that immediately tissues under the bark).

Accordingly, the Dementia thus speaking of a neurological clinical picture. The symptoms must persist for at least 6 months in order to be able to make the diagnosis.

In summary one speaks of one Decrease in higher cortical functions, so more cognitive (e.g. perception, attention, memory, Learn etc.) and intellectual abilitywhich for the most part unstoppable in one Personality breakdown and one Loss of everyday skills ends (are few forms of dementia but also reversible, that is curable).

Three major groups of shapes Dementia will differ depending on the underlying causes in vascular dementias (Multi-infarct syndrome, after microvascular changes), neurodegenerative dementias (Alzheimer's disease, Frontotemporal dementia, Lewy body dementia) and so-called Mixed forms can be broken down.

root cause

Vascular dementia is usually the cause of this single or multiple, minor or major cerebral infarction or bleeding in the brainwhich destroyed and perished brain tissue. These infarcts or bleeding can, for example, be a longer lasting, poorly controlled high blood pressure, Thrombosis or embolism in cerebral vessels, Cerebral vessel ruptures underlie.

The types of dementia caused by neurodegenerative diseases occur, i.e. through hereditary, progressive decline of Neurons, are all caused by deposits of faulty protein breakdown products, whereby the various forms of dementia (Alzheimer, Frontotemporal dementia, Lewy body dementia) differ in the respective protein breakdown product and in the brain region in which these are deposited.

In addition, however, various Metabolic disorders and hormonal disorders (Vitamin B12-Defect, Hypothyroidism, Brain involvement in hepatic insufficiency or Renal failure), States of intoxication (alcohol, Carbon monoxide, solvent) or Infections (AIDS, Prion disease, Creutzfeldt-Jakob disease) cause dementia symptoms.

Symptoms

At the beginning of the disease there is usually a gradual loss of memory and short-term memory, making it increasingly difficult for those affected to absorb, store and reproduce new information.

Only in the further course, when the dementia is in an advanced stage, do disturbances in the long-term memory also occur, so that events that occurred in the past can be forgotten and skills and abilities acquired in the course of life can be lost.

Read more about this under Memory loss.

Furthermore, the forms of dementia can lead to disorders in orientation (first temporally, then spatially and then towards oneself), in thinking (slowed down, impeded in flow), in cognition, in language, voluntary movements and changes in personality (increased lability and Irritability, social withdrawal, paranoid traits).

In general, however, the present symptoms must have persisted for more than 6 months in order to be able to diagnose a dementia syndrome.

Read more on the topic: Signs of dementia

diagnosis

In order to diagnose dementia, standardized test procedures are primarily the method of choice. Tests such as the Mini Mental State Test (MMST), the Montreal Cognitive Assessment Test (MOCA-Test) or the DemTec-Test can be used to assess attention, memory, orientation as well as mathematical, linguistic and constructive skills. The probability of an existing dementia disease can then be estimated using a points system.
Read more about this under: Dementia tests

In addition, a detailed anamnesis (both an own and a third-party anamnesis by e.g. relatives), a physical and a neuro-psychological examination are part of the classic diagnosis, as well as a blood check, brain water examinations, an imaging (CCT, MRT) of the head or Brain and electroencephalography (EEG).

If vascular dementia is suspected, examinations of the carotid arteries and the heart (EKG, heart echo) can provide information about the existing situation. However, since there is no clear marker for dementia, the majority of these diagnostic methods are used to rule out other diseases that can have symptoms similar to the forms of dementia (e.g. depression, delirium, amnesia, old age, hypothyroidism, vitamin deficiency, etc.).

Therapeutic measures

Since the majority of forms of dementia are irreversible diseases of the Brain acts, are therefore also no therapy options available for approx. 90% of dementia patients, which allow complete healing.

Only one can Delaying progress and as long as possible Maintaining independence by a suitable combination of psychotherapeutic, social therapeutic and drug treatment can be achieved.

Both Dementia drugs these are so-called Antidementia drugs (e.g. Donepezil®, Galantamin® or Rivastigmin®), which are mainly used in Alzheimer's dementia and as central Cholinergics Act.

As supportive and symptom-relieving, medicinal measures can also be used Antidepressants (e.g. Citalopram®) for depressive symptoms or atypical neuroleptics (e.g. Risperidon®) can be used for psychotic symptoms and sleep disorders.

Special in vascular dementia the therapy is based primarily in the improved blood flow in the brain tissue and thus also in the Lowering the cardiovascular risk.

Course of the forms of dementia

The course of a Dementia can be found in three stages classify: mild, moderate and severe dementia.

The easy, initial dementia phase is through increasing forgetfulness (especially that Short term memory is affected) and Orientation difficultieswhich is initially limited on the temporal level. At this stage, those affected are usually not restricted in their independence, but one can stand out frequent misplacement of objects or for example a frequent erring in the weekday.

The moderate dementia comes to the worsening memory problems, Disturbances in communication, of the Recognition ability, of the mobility and the Ability to learn added, so that complex courses of action are often difficult and independence is gradually restricted. A can also be added Disorientation on a spatial and personal level and one Disturbance in the language.

Then the dementia goes in the difficult stage about, is usually a complete loss of recognition and memory before as well as a complete speech disintegration and mostly too Incontinence. Those affected become bedridden and increasingly need help and care.

In general, however, not every form of dementia is the same and not every patient has to have the same symptoms. In addition, the forms of dementia can differ significantly from one another over time, so that some faster (e.g. vascular dementia) and others more insidious (e.g. Alzheimer's dementia) advance.

Frequency of forms of dementia

Worldwide are currently around 47 million people suffers from a form of dementia, with growing numbers expected in the coming years (an increase in prevalence to 131.5 million people in 2050 is assumed), which is based on the fact that - due to demographic change - more people each year are new to one dementia fall ill than there are deaths among those already suffering from dementia.

The risk of developing one of the forms of dementia increases significantly with age, so that an estimated 1.2% of all people between the ages of 65-69, 2.8-6% between the ages of 70-79 and 13.3-23 , 9% between the ages of 80-89 and 34.6% of those over 90 are affected.

Women get sick with it more often from a form of dementia, as men (70% of the sick are female).

The most common form of dementia is Alzheimer's dementiawhich represents approx. 50-60% of all dementias. In second place is the vascular, as vascular dementiawhich make up about 20%. On the other hand, mixed forms are less common (15%).