Neurocognitive Disorders

Dementia
Dementia, also known as senility, is a broad category of brain diseases that can cause long term and gradual decreases in the ability to think and remember. Common symptoms include emotional problems, problems with language and speech, a decrease in motivation, and it may affect a person’s daily functioning. A dementia diagnosis requires a change from a person’s usual mental functioning and a greater decline that is not due to normal aging.

Globally, dementia affects 36 million people. About 10% of people develop the disorder at some point in their lives and it is more common with age. About 3% of people between the ages of 65–74 have dementia, 19% between 75 and 84 and nearly half of those over 85 years of age. In 2013 dementia resulted in about 1.7 million deaths up from 0.8 million in 1990. The most common type of dementia (progressive dementia) is Alzheimer’s disease, which makes up 50% to 70% of cases. Other types of progressive dementia include vascular dementia (25%), Lewy body dementia (15%), and Frontotemporal dementia.

Alzheimer’s disease
Most common type of dementia; accounts for an estimated 60 to 80 percent of cases.

Symptoms: Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking. Revised criteria and guidelines for diagnosing Alzheimer’s were published in 2011 recommending that Alzheimer’s be considered a slowly progressive brain disease that begins well before symptoms emerge.

Vascular dementia
Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common as a sole cause of dementia than Alzheimer’s, accounting for about 10 percent of dementia cases.

Symptoms: Impaired judgment or ability to make decisions, plan or organize is more likely to be the initial symptom, as opposed to the memory loss often associated with the initial symptoms of Alzheimer’s. Occurs from blood vessel blockage or damage leading to infarcts (strokes) or bleeding in the brain. The location, number and size of the brain injury can determine how the individual’s thinking and physical functioning are affected.

Dementia with Lewy Bodies (DLB)
Symptoms:  People with dementia with Lewy bodies often have memory loss and thinking problems common in Alzheimer’s, but are more likely than people with Alzheimer’s to have initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and slowness, gait imbalance or other parkinsonian movement features.

Mixed dementia
In mixed dementia abnormalities linked to more than one cause of dementia occur simultaneously in the brain. Recent studies suggest that mixed dementia is more common than previously thought.

Parkinson’s disease
As Parkinson’s disease progresses, it often results in a progressive dementia similar to Dementia with Lewy Bodies or Alzheimer’s.

Symptoms: Problems with movement are common symptoms of the disease. If dementia develops, symptoms are often similar to dementia with Lewy bodies.

Frontotemporal Dementia
Includes dementias such as behavioral variant FTD (bvFTD), primary progressive aphasia, Pick’s disease, corticobasal degeneration and progressive supranuclear palsy.

Symptoms:  Typical symptoms include changes in personality and behavior and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.  *Information provided by: http://www.alz.org

Stages of Dementia
The stages of dementia are used when a progressive dementia has been diagnosed. Dementia is diagnosed after a series of assessments, including a physical evaluation and determination of the history of any problems. Memory tests, imaging studies, and blood work may exclude other problems that might mimic dementia. The diagnosis of dementia can take a long time. The stages include:

Stage 1: No impairment. The patient has no problems.

Stage 2: Questionable impairment. The patient begins to have some difficulty but can still function independently.

Stage 3: Mild impairment. The patient has obvious, but still mild difficulty with daily activities.

Stage 4: Moderate impairment. The patient needs help with caring for him or herself as well as with carrying out daily activities.

Stage 5: Severe Impairment; patients are unable to function independently.


Dementia symptoms
Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere with daily activities. They often know about their forgetfulness. Not everyone with MCI develops dementia.

Symptoms of MCI include:

  • Difficulty doing more than one task at a time
  • Difficulty solving problems or making decisions
  • Forgetting recent events or conversations
  • Taking longer to do more difficult mental activities

Early symptoms of dementia can include:

  • Difficulty with tasks that take some thought, and learning new information
  • Getting lost on familiar routes
  • Language problems, such as trouble with the names of familiar objects
  • Losing interest in things previously enjoyed, flat mood
  • Misplacing items
  • Personality changes and loss of social skills, which can lead to inappropriate behaviors 

As dementia worsens, symptoms become more obvious and they interfere with the ability to take care for self.

Symptoms may include:

  • Change in sleep patterns, often waking up at night
  • Difficulty with basic tasks, such as preparing meals, choosing clothing, or driving
  • Forgetting details about current events
  • Forgetting events in one’s own life history, losing self-awareness
  • Having hallucinations, arguments, striking out, and violent behavior
  • Having delusions, depression, agitation
  • More difficulty reading or writing
  • Poor judgment and loss of ability to recognize danger
  • Using the wrong word, speaking in confusing sentences and using wrong words
  • Withdrawing from social contact

People with severe dementia can no longer:

  • Perform basic activities of daily living, such as eating, dressing, and bathing
  • Recognize family members
  • Understand language

Treatment: 
Currently, there is no cure for Alzheimer’s. But drug and non-drug treatments may help with both cognitive and behavioral symptoms. Researchers are looking for new treatments to alter the course of the disease and improve the quality of life for people with dementia. There are medications, behavioral therapy, and alternative therapies that are being used with some success.

Related Links to Neurocognitive Disease

Parkinson.org 

ALZ.org/

HDSA.org

NIA.nih.gov

Memory.UCST.edu/dementia

PsychCentral.com/disorders 

* All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.