Will dementia ever be reversible?
Dementia: Brief Overview
- Important forms of dementia:Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia
- Symptoms: With all forms of dementia, mental performance is lost in the long term. Other symptoms and the exact course vary depending on the type of dementia.
- Affected: Mainly people over 65 years of age. Most dementia patients are women because, on average, they get older than men.
- Causes: Primary dementias (like Alzheimer's) are independent diseases in which nerve cells in the brain gradually die - the exact reason for this is unknown. Secondary dementias are, for example, the result of other diseases (such as alcohol addiction, metabolic disorders, inflammation) or medication.
- Treatment: Medication, non-drug measures (such as occupational therapy, behavioral therapy, music therapy, etc.)
- Can Dementia Be Cured? Primary dementias cannot be cured. However, the right treatment can delay the course. Secondary dementia can sometimes be cured if the cause is identified and treated early on.
What is dementia
The term dementia does not refer to a specific disease, but rather the common occurrence of certain symptoms (“syndrome”), which can have a wide variety of causes. In total, the term covers more than 50 forms of disease (such as Alzheimer's disease or vascular dementia).
This is common to all forms of dementia persistent or progressive impairment of memory, thinking and / or other brain functions. Often there are additional symptoms (e.g. in interpersonal behavior).
Primary and Secondary Dementia
Under the term "primary dementia"All forms of dementia that are independent clinical pictures fall. They have their origin in the brain, where more and more nerve cells die.
The most common primary dementia (and the most common dementia in general) is Alzheimer's disease. In second place is vascular dementia. Other primary forms of dementia are frontotemporal and Lewy body dementia.
As "secondary dementia " denotes dementia that are caused by medication or other illnesses such as alcohol addiction, thyroid disorders or pronounced vitamin deficiencies. Secondary forms of dementia are rather rare (approx. Ten percent of the illnesses).
There are also Mixed forms dementia disease processes, especially mixed forms of Alzheimer's disease and vascular dementia.
Pseudodementia is not "real" dementia and is therefore neither one of the primary nor one of the secondary forms of dementia. It is a symptom - mostly of major depression.
Cortical and subcortical dementia
Another classification of the clinical pictures is based on where the changes occur in the brain: The cortical dementia is associated with changes in the cerebral cortex (Latin: cortex cerebri). This is the case with Alzheimer's disease and frontotemporal dementia, for example.
As subcortical dementia In contrast, one describes dementia diseases with changes below the cerebral cortex or in deeper layers of the brain. These include subcortical arteriosclerotic encephalopathy (SAE), a form of vascular dementia.
However, this classification is not without problems because there are numerous mixed and transitional forms. For example, dementia with Lewy bodies can manifest itself either as a cortical or as a mixed form.
The term dementia syndrome is often equated with "dementia". It is understood as a general intellectual decline, for example memory and orientation disorders as well as language disorders. The patient's personality often changes over time.
A distinction must be made between pseudodementia and dementia syndrome. This term includes temporary brain disordersthat are simulated by an inhibition of thought and drive. Most often, pseudodementia develops in the context of severe depression. If the depression is treated properly, the symptoms of pseudodementia will usually subside.
You can find out more about dementia syndrome and pseudodementia in the article Dementia syndrome.
Senile dementia and senile dementia
Because older people in particular suffer from dementia, it is often referred to as senile dementia. However, this term is not to be equated with “senile dementia”: the latter means “senile dementia of the Alzheimer's type” (SDAT) - a manifestation of Alzheimer's disease in old age. In contrast, there is present-day Alzheimer's disease, which usually occurs as early as the 5th or 6th decade of life.
Today, present and senile dementia of the Alzheimer's type are usually collectively referred to as Alzheimer's disease or dementia of the Alzheimer's type (DAT).
12 risk factors for dementia
This affects the risk of dementiaThe genes are to blame! This only applies to a very small proportion of dementia patients. Often other risk factors play a role, especially age, of course. You can influence some of these - and thus reduce your likelihood of mental degradation.
Hearing lossWhen seniors hear worse and worse, their social life suffers. And the brain also bears traces of it: those affected reduce their intellectual abilities much faster than those of their peers with good hearing - by up to 24 percent. The advice of the US researchers who discovered the connection: Don't take hearing loss lightly and put on a hearing aid early on.
Sleeping pills and Co.Drugs for incontinence, sleep disorders or depression seem to increase the risk of dementia in higher doses or with longer use - even after they have been discontinued. Researchers advise prescribing anticholinergic drugs in the lowest possible dose, regularly checking the success of the therapy, and stopping treatment if the drugs do not show the desired effect.
Acid blockersAcid blockers are often used against heartburn. Seniors who took acid blockers such as omeprazole and pantoprazole for a long time in a study were 44 percent more likely to develop dementia than subjects who had not received proton pump inhibitors. However, it is still unclear whether the drugs or an unknown common factor actually increased the risk of dementia. Either way, the inhibitors should only be taken when absolutely necessary.
Vitamin D deficiencySunbathing may protect against Alzheimer's and other dementias. The reason for this: The body produces vitamin D in sunlight. According to a study, people with vitamin D deficiency had a 53 percent increased risk of developing dementia. In the case of severe deficiency, the probability even increased by 125 percent. Vitamin D can be found in some foods, such as fish, but you produce almost 90 percent of what you need yourself.
stressDivorce, death of a partner, mentally ill relatives - great emotional stress increases the risk of dementia. This is true at least for women, shows a long-term study by the University of Gothenburg. The risk of Alzheimer's alone increased by 15 percent per stressor. One possible explanation is that stress leads to hormonal changes that negatively affect the central nervous system.
Unstable personalityThose who are emotionally less stable, for example particularly nervous, anxious, moody, insecure and sensitive to stress, seem to have a significantly higher risk of Alzheimer's than emotionally stable people. Psychologists refer to such a trait as neuroticism. The dementia particularly affected women who were quickly stressed and at the same time particularly closed to other people.
lonlinessBeing alone and feeling lonely are two different things. Those who are lonely suffer from being alone. It is precisely this feeling that is apparently a risk factor for dementia. Anyone who reported this mental state in a study with 2,000 participants had a 2.5 times higher probability of developing dementia later. Timely countermeasures help here, for example by trying to consolidate and expand your social network.
Diabetes and high blood pressureDiabetes and high blood pressure are bad for the blood vessels. Therefore, diabetics are at higher risk for dementia. And on average they develop senile dementia more than two years earlier than non-diabetics. High blood pressure in turn increases the risk of so-called vascular dementia, according to a study by the George Institute for Global Health by up to 62 percent if high blood pressure occurs between the ages of 30 and 50. If, on the other hand, it occurs for the first time between the ages of 80 and 90, it actually protects.
SmokeThose who smoke cigarettes regularly not only damage their lungs and increase their risk of cancer. The brain also suffers because the blood vessels are narrowed by nicotine and the like. Among other things, this makes the supply of oxygen and nutrients more difficult - also in the thinking organ. This in turn can lead to cognitive losses and ultimately to dementia. Incidentally, many smokers die before they can even develop dementia. Two more good reasons to quit smoking!
Air pollutionDirty air is also suspected of increasing the risk of dementia. A study with older women showed that those who live in urban areas with extremely high levels of air pollution have a 92 percent higher risk of developing dementia than those who live in rural areas with low levels of particulate matter. How exactly the microscopic particles get into the brain is still unclear, according to the study authors.
WeightToo obese or too skinny - neither is good when it comes to the risk of dementia. However, the researchers disagree when it comes to being slightly overweight in mid-life. While some see the likelihood increased in this case as well, other studies even report a protective effect. The answer - and a corresponding recommendation - are still pending.
depressionDepression and dementia often go hand in hand. That is why it was not known for a long time whether the depression was only a harbinger of dementia or a risk factor. An American study clarified this question in 2014: First comes the mental depression, then the mental decline. The following also applies: the stronger the symptoms of depression, the higher the subsequent risk of dementia. Experts say that anyone who is depressed should definitely be treated for this reason
Healthy lifestyle pays offResearchers have also explored what one can do to protect oneself from dementia: no cigarettes, no alcohol, a healthy diet, normal weight and exercise - these five lifestyle rules not only strengthen physical, but also mental health. The long-term study by Welsh researchers showed that it can actually reduce the likelihood of dementia by up to 60 percent.
In the case of dementia, mental performance is lost in the long term. In detail, the symptoms of dementia depend on which disease it is exactly - such as Alzheimer's or vascular dementia.
Dementia: "Enjoy your life!"
Three questions toDr. Radka Cerny, MD,
Specialist in neurology and psychotherapy
Can you stop dementia?
There is no cure for dementia. According to the latest studies, there is currently no substance on the market that really improves thinking or memory and / or slows the course of the disease. What is very possible, however, is to maintain the well-being of the sick and their relatives. Good care, if necessary pain relief, sleep aids and therapy for behavioral disorders help.
Should those affected be told the diagnosis?
Personally, I am very careful when diagnosing dementia. Apparent dementia can also hide severe depression, for which there is certainly medical help. From my point of view, it is problematic to make a serious diagnosis when there is no sensible therapy or cure. During the course of treatment, one can observe how the disease is progressing and, if necessary, name the diagnosis of dementia.
Do you have any special advice for those affected or their relatives?
If you are affected, move around a lot, cultivate friendships and hobbies, and try to do something meaningful for as long as possible! Enjoy your life! If you, as a relative, talk to the doctor about treatment and accommodation options at an early stage, you will understand the disease better and be able to provide targeted help. While taking care of everything, pay attention to your own needs and treat yourself to a change and time out.
- Dr. Radka Cerny, MD,
Specialist in neurology and psychotherapy
In her practice in Munich, the neurologist also offers her own head consultation, in which more comprehensive differential diagnostics are used to get to the bottom of memory and concentration disorders.
The onset of dementia symptoms in Alzheimer's (and many other forms of dementia) are problems with short-term memory: those affected become increasingly forgetful, often misplace things and find it difficult to concentrate. Sometimes common terms suddenly no longer come to mind during a conversation. Orientation problems in unfamiliar surroundings are also the first signs of dementia of the Alzheimer's type.
Advanced dementia symptoms in Alzheimer's patients affect long-term memory. Patients find it increasingly difficult to remember the past. At some point they can no longer recognize people close to them. In the late stages of dementia, patients also degrade physically and need help with all activities.
Read more about the symptoms, causes, diagnosis and treatment of this most common form of dementia in the Alzheimer's disease article.
Vascular dementia is the result of circulatory disorders in the brain. The symptoms of dementia are often similar to those of Alzheimer's. However, the exact clinical picture of vascular dementia depends on where in the patient's brain the circulatory disorders occur and how severe they are.
Possible symptoms include problems with listening attentively, speaking coherently, and finding your way around. These signs of dementia are also present in Alzheimer's disease, but often occur earlier and more violently in vascular dementia. In addition, memory can be retained longer in vascular dementia.
Other possible signs of vascular dementia include gait disorders, slowing down, bladder emptying disorders, difficulty concentrating, changes in personality, and psychiatric symptoms such as depression.
You can read more about the symptoms, causes, diagnosis and treatment of this second most common form of dementia in the article Vascular Dementia.
Lewy body dementia
Lewy body dementia also manifests itself with dementia symptoms similar to Alzheimer's disease. However, many patients show hallucinations (hallucinations) in the early stages of the disease. In return, the memory is usually retained longer than with Alzheimer's.
In addition, many people with Lewy body dementia show symptoms of Parkinson's disease. These include stiff movements, involuntary tremors and an unstable posture. That is why those affected sway and fall more frequently.
Another peculiarity of this form of dementia is that the physical and mental condition of the patient sometimes fluctuates greatly. At times those affected are enterprising and wide awake, then again confused, disoriented and withdrawn.
You can read more about symptoms, causes, diagnosis and treatment of this form of dementia in the article Lewy Body Dementia.
Frontotemporal dementia - also known as Pick's disease or Pick's disease - shows a completely different course. Typical dementia symptoms are changes in personality and often strange behavior: Those affected are usually easily irritable, aggressive and behave tactlessly or embarrassingly. Excessive eating and apathy are also possible.
Due to the conspicuous and unsocial behavior of many patients, a mental disorder is often first suspected instead of dementia. Typical dementia symptoms such as memory problems only appear in the advanced stages of Pick's disease. In addition, the patient's language becomes impoverished.
You can read more about symptoms, causes, diagnosis and treatment of this rarer form of dementia in the article Frontotemporal Dementia.
Difference: Alzheimer's & dementia of a different kind
"What is the Difference Between Alzheimer's & Dementia?" Some people affected and their relatives ask themselves this question on the assumption that there are two different clinical pictures. In fact, Alzheimer's is just one form of dementia, and by far the most common. So, correctly, the question should be what the difference is between Alzheimer's and other forms of dementia, such as vascular dementia:
A typical difference between these two most common forms of dementia relates to the onset and course of the disease: Alzheimer's usually begins insidiously and the symptoms slowly worsen. Vascular dementia, on the other hand, often sets in suddenly and symptoms increase in spurts.
So much for theory - in practice, however, it often looks a little different. Each dementia can develop differently from patient to patient, which makes it difficult to differentiate. There are also mixed forms, such as Alzheimer's and vascular dementia. Those affected show features of both forms of dementia, which is why a diagnosis is often difficult.
You can read more about the similarities and differences between important forms of dementia in the article Difference Between Alzheimer's and Dementia?
Dementia: causes and risk factors
In most cases of dementia, it is a primary disease (primary dementia), i.e. an independent disease originating in the brain: In those affected, nerve cells gradually die off and the connections between the cells are lost. Doctors speak of neurodegenerative changes here. The exact reason varies depending on the form of primary dementia and is often not fully understood:
Alzheimer's dementia: causes
In the most common form of dementia, so-called plaques form in the brain. These are deposits of a diseased protein (beta amyloid). Doctors suspect that these plaques contribute to or at least promote Alzheimer's disease.
It is not known exactly why the plaques form. Rarely - in about one percent of cases - the causes are genetic: Changes in the genetic material (mutations) lead to plaque formation and the outbreak of disease. Such mutations make Alzheimer's dementia hereditary. In the vast majority of cases, however, you don't know exactly why someone has Alzheimer's.
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