Dementia: Causing, Diagnose and Treatment

 

 

     Dementia is a condition resulting from the deterioration of brain function, affecting memory, thinking, and decision-making in daily life. While it is most common in the elderly, dementia can also occur at younger ages in certain cases.

 

Causes of Dementia

The causes of dementia can stem from various factors, and many of these causes can either be treated or prevented. These include:

 

• Age-related brain degeneration
• Alzheimer’s disease
• Post-stroke conditions, such as brain hemorrhage or cerebral artery narrowing
• Brain hemorrhage or brain tumors
• Vitamin deficiencies, such as vitamin B12
• Infections that impact the brain
• Infections in the brain or meninges
• Chronic alcohol abuse
• Conditions resulting from oxygen deficiency

 

 

 

TMAO: A Cause of Brain Damage

     TMAO (Trimethylamine N-oxide) is a substance produced during the digestion of certain foods, such as meat and fats. Excessive consumption increases the risk of heart disease and cerebrovascular diseases. It also contributes to dementia and Alzheimer’s disease, as TMAO promotes inflammation in the nervous system.

 

• In the Case of Alzheimer’s TMAO may trigger the accumulation of toxic proteins in the brain, such as beta-amyloid (Aβ) and Tau-protein, which are primary causes of Alzheimer's disease.
• In the Case of Cerebrovascular Diseases TMAO can increase the risk of blood clots, narrowing blood vessels, and obstructing blood flow to the brain.

 

 

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Since TMAO is a significant factor contributing to disease, it can be used by doctors as a risk marker due to its high sensitivity and specificity, ensuring accurate results.

 

 

Symptoms of Dementia

     Most patients with dementia are often unaware of their condition, yet many close relatives notice the gradual onset of cognitive decline. Sometimes, patients exhibit symptoms of depression, and studies show that over 30% of these individuals may be at risk of developing dementia.

 

 

 

 

Stages of Dementia

1.  Early Stage - MCI (Mild Cognitive Impairment)

     This condition, also known as mild cognitive decline, affects memory, thinking, decision-making, and the ability to learn new things. This stage lasts for 7-10 years and is not yet considered dementia.

 

2.  Mild Dementia Stage

     In this stage, patients begin to experience symptoms that affect daily life, such as forgetfulness, difficulty concentrating, and problems with planning or managing complex tasks (e.g., struggling with bookkeeping).

 

3.  Moderate Dementia Stage

     Cognitive decline becomes more noticeable and affects work and social activities. Patients may get lost, have trouble remembering people, and require assistance with daily activities.

 

4.  Severe Dementia Stage

     At this stage, the occipital lobe (responsible for vision) deteriorates, leading to loss of sight or awareness. Patients may fail to recognize family members and may even experience hallucinations.

 

 

 

 

Dementia Diagnosis

1.  Initial Assessment

• Screening for Dementia involves tests to evaluate memory, cognitive abilities, and decision-making, such as the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA).
• Patient History Taking A Physician may begin by asking sample questions, such as recalling words, stating the current date, or drawing a picture. A history of the patient and family will also be taken to gather information about issues like forgetfulness, getting lost, or changes in behavior.
• Depression Assessment using tools like PHQ-9 or GDS may also be conducted, as depression shares symptoms with dementia, such as poor concentration and memory.

 

2.  Laboratory Tests

     Modern medical technologies allow doctors to differentiate Alzheimer's from other types of dementia and detect treatable conditions such as vitamin deficiencies, diabetes, infections, or abnormal proteins like P-tau, which are linked to Alzheimer's disease.

 

3.  Neuroimaging

• MRI technology is used to assess brain atrophy, particularly in the hippocampus and temporal lobe. It can also detect other abnormalities like cerebrovascular diseases, tumors, or brain injuries.
• PET scans are useful for diagnosing early-stage dementia and tracking protein accumulation in the brain, helping to distinguish Alzheimer's from other forms of dementia.
• SPECT scans assess blood circulation in the brain to determine which areas have reduced function.

 

Differentiating Between True and Pseudo-Dementia

     Patients with pseudo-dementia are often aware of their symptoms and may express concerns about memory loss or anxiety over potentially developing dementia. However, doctors need to differentiate pseudo-dementia from true dementia. Common causes of pseudo-dementia include stress, insomnia, anxiety, depression, and other psychiatric disorders that can cause cognitive difficulties.

 

 

 

 

 

Dementia Treatment

After diagnosis, doctors will develop a personalized treatment plan for the patient, which may include medications, cognitive rehabilitation, and family support. In addition to medical treatments, the following lifestyle changes can help:

 

• Regularly managing conditions such as high blood pressure, diabetes, and cholesterol
• Avoiding smoking, alcohol, and substances that can harm the brain
• Visiting a dentist every six months and brushing teeth properly to prevent bacterial infections that could damage blood vessels in the brain and heart
• Eating more fruits, vegetables, and white meat while reducing red meat consumption, such as fish and eggs
• Preventing falls by wearing well-fitting shoes with socks that help prevent slipping
• Maintaining a positive and calm mindset, fostering love, understanding, and warmth in the family

 

 

 

 

 

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Accepting one’s condition and avoiding excessive stress can greatly contribute to maintaining a level of happiness in life.