Dementia - The nature of the disease closely scrutinized...
If we want to understand the clinical picture of dementia, we have to go further than the categorization that is common in society. We must begin to delve deeper into the subject and illuminate all of this, which today is simply referred to as "forgetting" in the context of dementia. Alterix goes into great detail about what dementia is in this article.
The linguistic classification: More than mere forgetting!
In general, we associate dementia with so-called forgetting: getting scatterbrained, missing appointments, not having names ready, leaving a handbag behind, misplacing keys. All of this happens in dementia, of course; all of the forgetting . But forgetting is not enough to describe dementia.
The word dementia means "without spirit" or "without mind." But if we look more closely at the word's meaning, we have to wonder if that really corresponds to the reality of dementia in life. Are people with dementia "without spirit" or "without mind"?
Let me tell you a story about this:
An old lady who lived with advanced dementia in a shared apartment for people with dementia was very absorbed in her world. Daily situations such as changing clothes in the morning and evening, washing, cleaning her teeth, cutting her nails, eating-all this was difficult and always involved a lot of good coaxing and "an opportune moment." When asked who she was, she answered with "I am ..." and then gave her first name. We often suspected that she was in the reality of her childhood or adolescent self. Her husband, her children, everything did not matter and she did not recognize her relatives. But out of nowhere she could quote Plato in Greek or the "Gallic War" in Latin flawlessly, recite poetry (wonderfully emphasized, by the way) and once or twice we caregivers were "quizzed" and woe betide us if we couldn't use our root forms! She was a senior teacher, educated, clever, with a lot of wit and at the same time could rant like a coachman.
Do we do justice to a person if we assume that dementia makes him or her "spiritless"?
How can someone who can quote ancient Greek off the cuff be "without a mind"? Does it do people justice if we reduce them to one characteristic of their being - forgetfulness? Is dementia a form of mindlessness? You guessed it. My answer is no.
No, because the spirit and the mind may be limited, but "without spirit"? No. What goes away is part of the memory: acquired knowledge, learned skills, acquired rules and conventions. Physical functions are gradually and partially lost or limited with the learned skills and rules. Emotions may be experienced more strongly. But the spirit, which we call the mind, does not just go away. What was important to the person - their rituals, their values, their habits and the feelings associated with them - very much remain. Here, memory even works in a way that can impress. Have you ever done crossword puzzles with a woman who has spent her life doing one puzzle magazine after another? I have, and I failed miserably! The lady couldn't have told you what month it was or who the people were that she lived with. I feel it is a severely truncated and almost degrading interpretation of dementia to simply attest to the people with dementia as being in a state without a mind.
You may wonder why I make such a point of questioning the term "without mind".... In the end, we will have to leave it for lack of an adequate description. For me, on the other hand, it is important to be mindful with language. Because as mindful as we talk about people, as mindful we will treat them!
People with dementia are often dependent on help and that makes them dependent. If we are mindful of how we name them and talk about them, we will be more mindful of the people themselves. Being mindful of people means listening and feeling better for what people need. It means engaging with people and respecting their needs. This is called building relationships with trust. Such relationships end up protecting not only the supposedly weaker person in a caregiving relationship, but both people in that relationship. Those who are mindful of others are also more likely to recognize their own boundaries, which in turn protects against toxic communication, but also very directly against violence in a care relationship. We will come back to all of this from time to time in various contexts in the further articles.
After looking at the word dementia and its meaning, we will now look at the diagnosis of "dementia": What does medicine say?
The medical classification: a range of possible classifications
Medically speaking, there is not one dementia, both causally and symptomatically. Rather, there are a number of changes that are assigned to the dementia spectrum because their symptomatology is similar. The current state of research and statistics on dementia are as follows:
Neurologists and psychiatrists are responsible for the diagnosis and monitoring of dementia. According to the definition of neurologists and psychiatrists in the network, dementia is "a disease-related, acquired deficit of performance of higher brain functions. Cognitive abilities - such as recognition, memory, language, learning and planning - as well as emotional and social abilities may be (increasingly) impaired. As a result, personality change and changes in mood may occur. The symptoms of dementia depend on the type of disease, as there are different forms of dementia with different causes. Often, these are non-curable, progressive diseases, but the course of the disease can be mitigated."
Different forms of dementia are distinguished:
- Alzheimer's dementia
- Vascular dementia
- Mixed forms of vascular & Alzheimer's dementia.
- Dementia with Lewy bodies
- Cognitive disorders associated with depression
- Other forms of dementia
Alzheimer's dementia with a proportion of about 40%: It is named after Alois Alzheimer, a psychiatrist who at the turn of the 19th/20th century discovered changes in a patient's brain in the form of nodules and calcifications and associated them with the disease symptoms of "confusion and old man's nonsense." His discoveries laid the foundation for modern brain research, especially the study of changes in the human brain with age.
Vascular dementia accounting for 10% of all dementias: The main cause of vascular dementia is changes in the vessels in the brain due to circulatory disorders, for which various underlying diseases can be blamed (e.g. strokes, diabetes mellitus, high blood pressure).
Mixed forms of Vascular and Alzheimer's dementia exist in 30% of cases.
Dementia with Lewy bodies with about 15% of all dementias: In this form of dementia, so-called Lewy bodies are located in the cerebral cortex, which are also found in Parkinson's disease. In addition to the other symptoms typical of dementia, there are perceptual disturbances, restrictions in mental alertness and movement problems and spatial perception disturbances typical of Parkinson's disease. This form of dementia affects more men than women.
Cognitive disorders in depression; also called dementia syndrome in depression: Sometimes concentration problems and impairments in memory and thinking skills act like symptoms of dementia. The most obvious difference is that symptoms regress with the use of antidepressants.
Other forms of dementia with different causes: These include Korsakow's syndrome (due to alcoholism) and dementia symptoms due to craniocerebral injury, brain tumors, hypothyroidism, inflammatory diseases of the nervous system such as MS or AIDS.
For all of the forms of dementia listed here:
- They have similar symptoms
- They cannot be cured, but they can probably be delayed or prevented to a certain extent.
- A correct diagnosis is important: On the one hand, to exclude other diseases that have a symptomatology similar to dementia. On the other hand, a thorough diagnosis also means finding the right form of therapy.
Experts agree that dementia is a chronic - that is, progressive - disease. It is often referred to as an "acquired" disease. This means that environmental influences, lifestyle habits such as diet, consumption of stimulants and drugs such as coffee, nicotine, sugar, etc. could have an impact on the changes in the brain. It is generally believed that certain factors favor the occurrence of dementia. This makes sense insofar as the above mentioned influences may of course have something to do with vasoconstriction and the so-called calcification. But not all smokers, all "diabetics", all alcoholics, etc. become demented, and likewise not all people who are exposed to unfavorable environmental conditions. It can therefore be assumed that, in addition to the above-mentioned, other individual factors play a role. These are on the one hand genetic factors, on the other hand life circumstances and biographical aspects. There are also studies that hold our fast society, our many electromagnetic influences and the much too fast technical development responsible for a certain influence on the development of dementia. This is another train of thought.
Conclusion
We will have to state overall that the causes of dementia are probably not monocausal. All of the above-mentioned causes are possible and, given the current state of research, it would be pointless to commit ourselves to one outcome. As to whether there is any form of prevention, this is another area where opinions differ. There is certainly no harm in living a healthy life, consuming stimulants sensibly, and getting plenty of exercise, preferably in the fresh air. Moreover, it is always beneficial to remain mentally flexible and not to become lonely! No one can say exactly which of the health promotion measures will ultimately delay dementia. A mixture of everything is optimal! One thing, however, seems certain: Dementia can perhaps be delayed both in its development and in its course sometimes more and sometimes less, but it can neither be completely stopped nor cured. Accordingly, a healthy lifestyle is already a reasonable start.
