What is dementia? A primer on this complex condition

Dementia can be a distressing and confusing subject to discuss at all ages, especially since it reportedly affects hundreds of thousands of Canadians each year. Dr. Sara Mitchell,neurologistat Sunnybrook Hospital, stopped by The Goods to share her expertise on this complex condition, to help fight fear with information.

What is dementia?

Dr. Sarah Mitchell: There are many misconceptions about dementia, and memory loss doesn't necessarily mean you have dementia. Dementia is a broad term that refers to a group of symptoms that affect the way someone's thinking, and that is interfering with their ability to function on a day to day basis. That's in contrast to Alzheimer's, which is a specific type of dementia, but there are many different types and causes of dementia. One called Frontotemporal Dementia is a behavioural condition that sometime affects men and looks like a mid-life crisis. It's commonly misidentified for that reason. They present personality changes, and changes in behaviour and in their ability to organize. It's not just memory loss that signals dementia.

Who is affected by dementia?

SM: Dementia can affect all kinds of people, but most think of it as a disease of the elderly. This is true to some extent. It is more common as we age, but we have to remember that it's not a normal process of aging. Many people can live a long and cognitively healthy life and never develop dementia, but yet there are tens of thousands of Canadians living with dementia under the age of 65. It tends to affect more women than men. 65% of the people living with dementia are women. The higher rate in women may possibly be due to survival rates women live longer, but other things could be contributing to this and research is ongoing.

What happens to your brain with dementia?

SM: Dementia is a neurodegenerative process. Neuro meaning brain, degenerative meaning getting worse slowly over time. What happens is that there are abnormal proteins that have been accumulated in the cells of the brain, called neurons. These cause the cells to malfunction, so they die off and you get brain shrinkage. In Alzheimer's this affects the memory structures first, the hippocampus. Through the stages you get progressive shrinkage of the hippocampus and the fluid filled structures increase around it.

Why does someone develop dementia?

SM: That's the million dollar question. We don't know what triggers this process. But we do know that the process starts in your brain decades before you get symptoms. But there is clearly a period when we can intervene. There isn't a firm answer to the cause of dementia, but the theories suggest that some of the causes, risk factors, and pre-dispositions that contribute to dementia are: depression, social isolation, high blood pressure, genetics, education, and repeated head trauma.

What's the difference between dementia and normal lapses in memory?

SM: Memory loss can be the most common presenting symptom. But there are many things that can cause memory loss and attentional lapses which can be perfectly normal and on the spectrum of normal aging. Then there are things that are out of keeping with normal aging, and that's when we get concerned. Usually this is when it's interfering with your ability to function, or it's so pervasive that your family and friends are concerned.

Is dementia easy to diagnose?

SM: It's not easy. It takes some investigation. Often the detection lies in the difference in function and behaviour to how one used to be. It's the comparison that gives us the information we need. If possible, a patient can be tested serially to establish a baseline, then later deterioration can be seen. Sometimes patients are tested against 'the norm' (normative data) for their education, age etc. Many things have to ruled out before dementia can be diagnosed, like depression, medication side effects, autoimmune disorders, and vitamin deficiencies.

If dementia is diagnosed, how do you treat it?

SM: Initially we want to make sure that there is nothing reversible because sometimes causes of memory impairment are reversible and treatable. But once you've been diagnosed with dementia or specifically Alzheimer's disease, there is no cure. However there is a lot of active research, so we are very hopeful we will get to one. Currently the mainstay of treatment is through different medications that target neurotransmitters in the brain to decrease the rate of cognitive decline and also to treat the behavioral symptoms as we can. But we're also using non-pharmacological approaches like diet, exercise, mental and social stimulation. And there are efforts to target abnormal proteins in the brain to prevent someone from ever developing the symptoms of this disease. That's where the hope is.

If you, a friend or family member has been diagnosed there are various methods for management that aim to create a calm, pleasing environment that revolves around a stable routine. Some successful therapies for Alzheimer patients include Music therapy and Pet Therapy. These forms of stimulation can have a positive effect on the comfort of an affected individual, and other management techniques are in development as our knowledge about dementia increases.