Understanding Dementia: Key Symptoms, Causes, and Treatments

What is Dementia?

Dementia is a general term for a decline in memory, thinking, and other cognitive abilities severe enough to interfere with daily life. It refers to a group of symptoms caused by abnormal brain cell deterioration, which progresses at a faster rate than normal aging. People suffering from dementia will gradually lose their cognitive abilities, and go through sudden personality changes. This affects adults at any point in their lives, although it is evidently more prominent in elderly people over the age of 65 years old. An estimate of 6.2 percent of people within this age group are suffering from this illness in Singapore. Unfortunately, no cure currently exists for this progressive condition, making early detection and management crucial.

Dementia Symptoms

Dementia is a cognitive disorder that leads to various symptoms affecting mental function, behavior, and physical ability. Key symptoms include:

• Memory loss
• Slower thinking and reduced mental sharpness
• Difficulty with language (e.g., using words incorrectly or trouble speaking)
• Trouble understanding and poor judgment
• Mood changes
• Difficulty with movement
• Challenges in performing daily activities
• Loss of interest in usual activities
• Emotional and behavioral management problems
• Difficulty with social interactions and loss of interest in relationships
• Personality changes, including a loss of empathy
• Hallucinations (seeing or hearing things that others do not)
• Difficulty remembering events or understanding situations, leading to misconceptions
• Trouble with planning and organising
• Dependence on others for help with decision-making and daily tasks
• In the late stage, a person may lose the ability to care for themselves and communicate

These symptoms progressively worsen over time, significantly impacting a person's quality of life. Recognising early symptoms can aid in diagnosis and intervention, while advanced stages may require constant care and assistance.

Dementia Causes

Dementia refers to a decline in brain function, resulting in symptoms that affect memory, thinking, and behavior. It is not a single disease but a group of conditions caused by various diseases.

Many types of dementia are linked to the abnormal buildup of proteins in the brain. These protein deposits disrupt the function of nerve cells, causing them to become damaged and eventually die. As nerve cells die, it leads to the shrinking of different brain areas, further impairing cognitive abilities.

Progressive Types of Dementias

Dementias that are progressive get worse over time. Types of dementias that worsen and aren't reversible include:

Alzheimer's Disease

Alzheimer's disease is the most common cause of dementia. It is thought to be caused by the abnormal buildup of two proteins called amyloid and tau. Amyloid deposits, called plaques, accumulate around brain cells, while tau forms tangles inside the cells. As these deposits damage brain cells, there’s also a decrease in neurotransmitters like acetylcholine, which are crucial for communication between brain cells. Symptoms of Alzheimer's disease include:

• Memory problems, such as regularly forgetting recent events, names, and faces
• Asking questions repetitively
• Increasing difficulties with tasks and activities that require organisation and planning
• Becoming confused in unfamiliar environments
• Difficulty finding the right words
• Difficulty with numbers and/or handling money in shops
• Becoming more withdrawn or anxious

Vascular Dementia

Vascular dementia is the second most common cause of dementia, after Alzheimer's. It is caused by reduced blood flow to the brain, damaging and eventually killing brain cells. This can happen due to narrowing or blockage of small blood vessels inside the brain, or as a result of a stroke, where the blood supply to part of the brain is suddenly cut off. Symptoms of vascular dementia are similar to Alzheimer's, although memory loss may not be as obvious in the early stages. Symptoms can develop suddenly or gradually over time and may include:

• Stroke-like symptoms, such as muscle weakness or temporary paralysis on one side of the body (these symptoms require urgent medical attention).
• Movement problems, such as difficulty walking or a change in walking patterns.
• Thinking problems, including difficulty with attention, planning, and reasoning.
• Mood changes, such as depression and a tendency to become more emotional.

Dementia with Lewy Bodies

Dementia with Lewy bodies shares many symptoms with Alzheimer's disease and is caused by the buildup of tiny clumps of a protein called alpha-synuclein inside brain cells, known as Lewy bodies. These clumps disrupt brain cell communication, leading to cell death. People with Lewy body dementia often experience:

• Periods of being alert or drowsy, or fluctuating levels of confusion
• Visual hallucinations (seeing things that aren't there)
• Slower physical movements
• Repeated falls and fainting
• Sleep disturbances

Frontotemporal Dementia

Frontotemporal dementia (FTD) is a significant cause of dementia in people under 65. It is caused by an abnormal buildup of proteins, including tau, in the frontal and temporal lobes at the front and sides of the brain. This protein buildup damages nerve cells in these areas, leading to brain cell death and the shrinking of these regions. Early symptoms of frontotemporal dementia may include:

• Personality changes, such as reduced sensitivity to others' feelings, making individuals seem cold and unfeeling.
• Lack of social awareness, including inappropriate jokes or a lack of tact, though some people may become very withdrawn and apathetic.
• Language problems, such as difficulty finding the right words or understanding them.
• Becoming obsessive, such as developing fads for unusual foods, overeating, or drinking.

Mixed Dementia

Mixed dementia refers to a combination of more than one type of dementia. The most common combination is vascular dementia and Alzheimer's disease, but other combinations are possible. In this type of dementia, it can be difficult to determine how much each type is contributing to the person's symptoms. People with mixed dementia typically experience more severe cognitive decline due to the combined effects of both conditions. 

Treatments for Dementia

Currently, there is no cure for dementia. However, there are medications and other treatments that can help manage symptoms and improve quality of life.

Medications for Dementia

Most treatments are designed to address symptoms of Alzheimer's disease, the most common type of dementia. These medications can temporarily reduce symptoms but do not stop disease progression. Common treatments include:

• Acetylcholinesterase Inhibitors
  These drugs prevent the breakdown of acetylcholine, a chemical that helps nerve cells communicate. Common examples include Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Reminyl), which are used for mild to moderate Alzheimer's. Donepezil may also help treat more severe Alzheimer's. These medications can also be effective for dementia with Lewy bodies and Parkinson’s disease dementia. Side effects may include nausea and loss of appetite, which usually improve after a few weeks.
• Memantine
  Memantine (Ebixa, Marixino, or Valios) is used for moderate to severe Alzheimer's, dementia with Lewy bodies, and mixed dementia (Alzheimer’s and vascular dementia). It works by blocking excessive glutamate activity in the brain. Memantine is suitable for patients who cannot tolerate acetylcholinesterase inhibitors. Common side effects include headaches, dizziness, and constipation, but these are typically temporary.

Risk Factors for Dementia

Dementia risk factors are conditions that increase the likelihood of developing dementia. Some factors are unchangeable, such as:

• Age: The risk increases with age, though dementia is not a normal part of aging.
• Genetics: Certain genetic factors contribute to less common types of dementia.
• Air Pollution: Evidence suggests air pollution may affect brain health and increase dementia risk.

Other modifiable risk factors include:

• Hearing loss
• Untreated depression
• Loneliness or social isolation
• Physical inactivity

Research indicates that addressing these modifiable factors could prevent about 40% of dementia cases. Healthy lifestyle choices can reduce the risk:

• Diet: A balanced diet low in saturated fats, sugar, and salt reduces the risk of high blood pressure, diabetes, and obesity, all linked to dementia.
• Weight: Maintaining a healthy weight reduces the risk of Alzheimer’s and vascular dementia.
• Exercise: Regular physical activity lowers the risk of cardiovascular diseases and cognitive decline.
• Alcohol: Limiting alcohol intake to 14 units a week reduces stroke, heart disease, and brain damage risks.
• Smoking: Quitting smoking helps prevent artery narrowing, high blood pressure, and cardiovascular diseases that contribute to dementia.
• Depression: Treating depression may reduce dementia risk, as untreated depression can lead to cognitive decline.

By modifying these factors, individuals can significantly reduce their dementia risk.

Can Dementia Be Prevented?

While there's no guaranteed way to prevent all types of dementia, research suggests that adopting a healthy lifestyle can significantly reduce the risk of developing dementia in later years. A healthy lifestyle not only supports brain health but also helps prevent cardiovascular diseases, such as stroke and heart attacks, which are known risk factors for Alzheimer's disease and vascular dementia.

Explore Expert Dementia Care at Gleneagles Hospital

If you or a loved one is experiencing symptoms of dementia, Gleneagles Hospital offers specialised care and treatment options tailored to individual needs. With a team of experienced healthcare professionals, we provide comprehensive assessments and treatments, including the latest medications and therapies, to help manage dementia symptoms and improve quality of life. Contact us today to schedule a consultation and learn how we can support your journey toward better brain health.