Dementia

Key facts

• More than 55 million people in the world currently suffer from dementia, more than 60% of whom live in low- and middle-income countries. Every year, approximately 10 million new cases are recorded.
• Dementia is caused by a variety of diseases and injuries that affect the brain. Alzheimer's disease is the most common type of dementia and may contribute to 60-70% of cases.
• Dementia is currently the seventh leading cause of death and one of the leading causes of disability and dependency among older people worldwide.
• In 2019, dementia cost economies globally US$1.3 trillion, with approximately 50% of these costs attributable to care provided by informal caregivers (such as family members and close friends), who provide care and supervision for an average of 5 hours per day .
• Women are disproportionately affected by dementia, and this effect is both direct and indirect. Women suffer from a higher number of disability-adjusted life years (DALYs) and death due to dementia, but at the same time they cover 70% of the hours of care provided to people with dementia.



Overview

Dementia is a term for several diseases that affect memory, thinking, and the ability to perform daily activities.

The disease gets worse over time. It mainly affects the elderly, but this does not mean that all people will develop it as they age.

Factors that increase the risk of dementia include:

• Age (most common among people 65 or older)
• High blood pressure (hypertension)
• High blood sugar (diabetes)
• Overweight or obesity
• Smoking
• Drink too much alcohol
• Physical inactivity
• Social isolation
• Depression.

Dementia is a syndrome that can be caused by a number of diseases that over time damage nerve cells and damage the brain, usually leading to a decline in cognitive function (i.e. the ability to think) beyond what would be expected from the usual consequences of biological aging. While consciousness is not affected, impairments in cognitive function are usually accompanied by changes in mood, emotional control, behavior, or motivation.

Dementia has physical, psychological, social and economic harms that are not limited only to people with dementia, but extend to those who care for them, as well as their families and society as a whole. There is often a lack of understanding and awareness of dementia, leading to stigma and barriers to diagnosis and care.

Signs and symptoms

Changes in mood and behavior sometimes occur even before memory problems occur. Symptoms get worse over time. Ultimately, most people with dementia will need others to help them with daily activities.

Early signs and symptoms include:

• Forgetting recent things or events
• Losing or misplacing things
• Disorientation when walking or driving
• Being confused, even in familiar places
• Inability to distinguish time
• Having difficulties solving problems or making decisions
• Having trouble following dialogue or having trouble finding words
• Experiencing difficulties in performing normal tasks
• Inability to visually estimate distances between objects.

Common changes in mood and behavior include:

• Feeling anxious, sad, or angry about memory loss
• Personality changes occur
• Inappropriate behavior
• Withdrawing from work or social activities
• Lack of concern for the feelings of others.

Dementia affects each person differently, depending on the underlying causes, other health conditions, and the person's cognitive performance before developing the disease.

While most symptoms get worse over time, others may disappear or not occur until the late stages of dementia. As the disease progresses, the need for assistance with personal care increases. People with dementia may not be able to recognize family members or friends, have difficulty moving, lose control of their bladder and vascular function, have difficulty eating and drinking, and exhibit behavioral changes such as aggression that cause distress to the person with dementia and to those around them.

Common forms of dementia

Dementia is caused by many different diseases or injuries that harm the brain directly and indirectly. Alzheimer's disease is the most common type of dementia and may contribute to 60-70% of cases. Other forms include vascular dementia, dementia with Lewy bodies (abnormal deposits of protein within nerve cells), and a group of diseases that contribute to frontotemporal dementia (atrophy of the brain's frontal lobe). Dementia may also occur after a stroke, with certain infections such as HIV, as a result of harmful use of alcohol, from repeated physical injuries to the brain (known as chronic traumatic encephalopathy), or from nutritional deficiencies. There are no clear boundaries between the different forms of dementia and a combination of forms often occurs together.

Treatment and care

There is no cure for dementia, but there is much that can be done to support both people with the disease and those who care for them.

People with dementia can take the following steps to always live well and live well:

• Ensure physical activity
• Participate in activities and social interactions that stimulate the brain and maintain the ability to perform daily activities.

In addition, some medications can help manage dementia symptoms:

• Cholinesterase inhibitors such as donepezil are used to treat Alzheimer's disease.
• N-methyl-D-aspartate receptor antagonists such as memantine are used for severe Alzheimer's disease and vascular dementia.
• Medications that control blood pressure and cholesterol can prevent further brain damage from vascular dementia.
• The use of selective serotonin reuptake inhibitors (SSRIs) can help with severe symptoms of depression in people with dementia if lifestyle and social changes don't work, but these should not be the first choice.

If people with dementia are at risk of harming themselves or others, medications such as haloperidol and risperidone can help, but should never be used as a first treatment option.

Self-care

For people diagnosed with dementia, there are things that can help manage symptoms:

• Stay physically active.
• Eat healthy.
• Stop smoking and drinking alcohol.
• Make sure to see your doctor regularly.
• Write down daily tasks and appointments to help remember important things.
• Maintain hobbies and do things that bring you joy.
• Try new ways to keep your brain active.
• Spend time with friends and family and participate in community life.

Plan ahead. Over time, it may be difficult for you to make important decisions about yourself or financial matters related to you:

• Identify people you trust to support you in making decisions and help you communicate your choices.
• Plan ahead to let people know your choices and preferences for care and support.
• When you leave home, take your ID, address and people to contact in an emergency.
• Call family members and friends for help.
• Talk to people you know to let them know how they can help you.
• Join a local support group.

It is important to recognize that providing care and support to someone with dementia can be difficult and impacts on the carer's health and well-being. If you are the person providing support to someone with dementia, reach out to family members, friends and professionals for help. Take regular breaks and take care of yourself. Try stress management techniques such as mind-clearing exercises, and seek professional help and guidance if necessary .

Risk factors and prevention

Although age is the strongest known factor that can cause dementia risk, it is not an inevitable consequence of biological aging. Furthermore, dementia does not exclusively affect older people – dementia with early onset (defined as onset before age 65) accounts for up to 9% of cases. Studies show that people can reduce their risk of cognitive decline and dementia by being physically active , not smoking, avoiding harmful use of alcohol , controlling their weight, eating a healthy diet, and maintaining healthy levels of blood pressure, cholesterol, and blood sugar. There are additional risk factors, including depression, social isolation, low educational attainment, cognitive inactivity , and air pollution .

human rights

Unfortunately, people with dementia are often deprived of the basic rights and freedoms available to others. In many countries, physical and chemical restraints are widely used in nursing homes and acute care settings, even when there are regulations to support people's rights to freedom and choice.

An appropriate and supportive legislative environment based on internationally accepted human rights standards is essential to ensure the highest quality of care for people with dementia and their caregivers.