Dementia as global health issue

Dementia is considered as global health issue due to aging.  Number of people suffering with this disease is increasing day by day. Alzheimer’s disease accounted as leading cause of 60 % or more cases of dementia.

Dementia as global health issueDementia is defined as clinical syndrome that involves intellectual function deterioration. 

Globally, the estimated growth of this disease was 50 million in 2015 and this number will become 132 million by the year 2050.

Causes of dementia:

There are two main causes

  1. Reversible dementia also known as “pseudo dementia”. It is rare and found to occur at secondary level due to any other medical condition such as nutritional deficiency vit. B12, depression, endocrine disorder (hypothyroidism),  metabolic disorder, brain tumor, excessive accumulation of CSF (Hydrocephalus) or drug abuse (e.g., analgesics, hypnotics, psychotropics).
  2. Irreversible dementia is characterized by neurodegenerative and vascular processes in brain. is common cause of irreversible dementia is Alzheimer’s disease (upto 70 %). 

Clinical criteria: 

Progressive impairment in areas of cognition

 Cognitive deficiency

 

·  Memory (ability of mind to learn and remember information)

·   Executive function (decision making, reasoning and planning

·  Language (reading, speaking, writing)

·  Praxis (ability to accomplish purposeful movements

·  Visuospatial function (ability to identify objects and faces)

· Change in behavior, mood or personality

 

·  Represent dementia not due to delirium or any other psychiatric disorder

·  Interfere to perform daily functioning e.g., personal care, driving, managing finances

·  Decline social behavior, emotional regulation

 

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 Symptoms:

Symptoms of dementia varies from individual to individual.

  • Apathy
  • Agitation
  • Psychosis
  • Aggression
  • Delusion
  • Hallucination
  • Agnosia
  • Apraxia

Classification:

Neurocognitive disorder classified depending on the severity of symptoms.

Sub types:

4 basic sub types of dementia are as follows:

Alzheimer’s disease (AD)

·  Subtle onset and slow progressive decline

·  In early stage short term memory problem, diminished cognitive control in later stages

Dementia with Lewy body (DLB)

·  Associated with Parkinson disease

·  Fluctuation in cognition

·  Visual hallucination

Vascular dementia (VaD)

·  Sudden or successive onset

·  Usually correlated with stroke, hypertension, diabetes, coronary heart disease

·  In early phase slight memory impairment

·   Walk difficulties and falls

Fronto-temporal dementia (FTD)

·  Personality changes

·  Behavioral disturbances

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Alzheimer’s disease:

It is neurodegenerative disease caused by matriculation of two proteins β-amyloid plaques and tau tangles in brain areas which induces neuronal injury and death. This lead to cause decrease cholinergic transmission and give rise loss of memory and cognition. Neurons gradually die as it spreads and worsen symptoms of AD. More than thirty genes have been discovered in AD.

Genetics is considered important contributing factor for development of AD.  Three genes found to lead disease in dominant manner from parent to offspring.

Symptoms of Alzheimer’s disease:

Symptoms ranges from mild to severe.

Mild

Moderate

Severe

Memory loss of recent events as earliest symptom e.g., getting lost, disorientation, misplacing items ,mood and personality changes

It includes confusion and worse memory loss, worse mood changes, delusion, unable to recognize family members

Loss of ability to speak

Completely dependent

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Diagnosis:

  1. Neuropsychological testing
  2. Brain imaging to look for signs of AD
  3. Blood test to rule out other problems such as vitamin deficiency or thyroid diseases

Treatment:

Still the cure of AD is not available. Current medication only slow the progression of disease but cannot reverse it. Medication can be used to treat problems such as anxiety, sleep or depression

Conclusion

Although researches have done to find preventive measures or treatment for dementia but there is no sufficient evidence. Supplementation of selenium and vitamin E as antioxidant have also investigated for prevention of dementia but they did not play role in AD dementia.

Rabia Akram
Author: Rabia Akram

Physiologist

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Rabia Akram

Physiologist

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