Dementias

Dementia is an acquired memory impairment that is associated with at least one of the following cognitive functions: content of thought, capacity for abstraction, calculation ability, visual recognition, judgment, or language. The alterations must be of sufficient intensity to alter or interfere in the daily life of the patient, they must represent a loss with respect to a previous situation in time and they must not be related to an organic or psychological disease or its treatment.

The incidence of dementias increases gradually with age, and as life expectancy increases, it becomes more prevalent.

The term dementia encompasses a multitude of etiologies or dementias of different origin (Alzheimer's disease, Lewy body dementia, vascular dementia, mixed dementia, fronto-temporal dementia, dementia associated with Parkinson's disease, dementia associated with Down syndrome, etc. .); Specifically, more than 60 different types and etiologies of dementia have been described. Some of the types of dementia are treatable and reversible.

How is it produced?

Regarding reversible dementias, their etiology is the disease that produces it; Generally, by reversing the disease that has caused the dementia, the symptoms improve, often to the previous situation but sometimes presenting some sequelae. The most common types of reversible dementia are those due to brain tumors or vitamin B12 deficiencies, hypothyroidism, neurosyphilis or normal pressure hydrocephalus.

Regarding dementias considered non-reversible (in which treatment fails to reverse the symptoms), various risk factors are known: age, family history of dementias, certain chromosomal or genetic alterations, and Down syndrome.

Other risk factors of lesser known importance are race, history of head trauma, depression, some viral infections, cerebrovascular disorders, etc.

Symptoms

Depression usually has an insidious onset over time, with the patient presenting a slowly progressive loss of memory and some other symptom of cognitive loss in executive functions. Generally, memory loss affects short-term memory more, with which the patient has great difficulty in learning new things, while vividly recalling events that occurred years before.

As dementia progresses, memory deficits and deficits in other cognitive spheres are accentuated to the point that the patient has difficulty and inability to carry out activities of daily life, requiring another person for personal care and for your protection.

The sphere of behavior is also often altered in patients, being able to present mood disorders (depression, apathy, emotional lability, anxiety, restlessness, etc.), hallucinations or delusions, sleep disorders, disinhibition, stereotyped behaviors, etc. .

In the later stages of dementia, patients present total dependence for all activities, they totally lose language and relationship with the environment. Patients in advanced stages usually die from complications derived from their condition.

Diagnosis

Faced with a patient with a possible dementia, it will be essential to catalog the origin of the syndrome, to try to clarify the presence of a dementia with the possibility of being treatable and reversible. For this, it is important to go to professionals or teams with experience in the management of dementia disorders, who will carry out a comprehensive assessment of the patient.

The diagnosis of dementia is fundamentally clinical, although complementary examinations are often required to be able to establish a presumptive etiological diagnosis with greater reliability.

Treatment

The objectives of the treatment will be:

In reversible dementias:

• Reverse the disease that has caused the dementia in cases of reversible dementias.

In dementias for which there is no known effective treatment:

• Maintain for as long as possible the autonomy and quality of life of the patient, in terms of their independence to carry out activities of daily life, temporal-spatial orientation and control of possible intercurrent diseases.
• Take care of the safety of the patient, for their own protection and that of the people around them.
• The most used therapeutic measures are: pharmacological, psychotherapeutic and adaptation of the environment, both to try to maintain the patient's cognitive faculties for as long as possible and to control the symptoms that he presents (anxiety, depression, wandering, aggressiveness, etc.).