Dementia is a psychiatric syndrome that can be part of a variety of psychiatric disorders. It usually represents a progressive, chronic process in which various skills are gradually lost. Often, dementia patients become noticeable due to a diminishing short-term memory. Thinking slows down - cognitive abilities decrease - and emotional and social behavior, simply the understanding for it, is unlearned. Finally, the process of forgetting also affects the areas of the brain that are responsible for speech or motor skills.
The course can be individually different, but is usually similar in appearance of the individual symptoms. It is important, whether it is a degenerative disease or not. The most common disease with a dementia syndrome is Alzheimer's disease. Alzheimer's disease is chronic and continuously leads to a loss of brain capabilities. Other common diseases include frontotemporal lobar degeneration ( FTLD, the regression of parts of the frontal and temporal lobes of the brain) and vascular dementia ( vascular = vessel-related ).
A basic division into stages is difficult in ignorance of the underlying dementia. However, as the disease progresses, more skills are lost. What skills are first forgotten or forgotten seems to be similar in many cases of dementia.
In the course of dementia, two different types are described: a progressive disease or a progressively worsening dementia. In a dementia which is represented by relapses, these are often phases in which the patient is better off. Their deficits are not as strong as before, and most relatives hope for healing or stagnation of the disease - but these are usually disappointed.
In the first stage, mild dementia, the patient primarily forfeits his short-term memory abilities. While past experiences, dates or names can be invoked properly, those affected often forget small, recent information and collusion. The time orientation decreases, the patients forget the weekday or are mistaken in the date. The constant search for misplaced objects is conspicuous and can be a first indication of incipient dementia. The patient can, depending on the state of dementia, still independently manage the household, without needing additional care, but is increasingly unable to cope in strange places.
All symptoms gradually increase - patients initially realize that something is wrong and try to balance their deficits. These first changes in other health of the patient namely fully experienced. This causes many emotions in those affected, ranging from fear, frustration and depression to anger and aggressiveness.
It is a common phenomenon that first-stage dementia patients initially withdraw because they are ashamed of their inadequacies. It is not uncommon that people who want to help the most patient patients, is incomprehensible. It is important to be patient. Many people who develop dementia do not know this at the beginning and may even, for self-protection, a disease with medical evidence still not true.
The moderate severity of dementia is characterized by further loss of memory and first involvement of cognitive abilities. Now also events are forgotten or confused, which could still be kept at the beginning of the illness. Even familiar names and people are confused or are not spontaneously available. Even in a familiar environment, the orientation difficulties increase. Independent paths in unknown places are hardly possible. Patients can no longer focus well, which negatively impacts their computing and learning skills. Longer, in the beginning complex conversations can not be pursued or riddles can not be solved anymore.
With the progress of the disease, the self-sufficiency goes back: the body hygiene is neglected and actions in everyday life are no longer mastered. The state of disorientation becomes an integral part of the patient's life. The reason made is forgotten and the patient becomes increasingly helpless. There may be speech disorders or delusions. Sentences are rendered in a simplified way or repeated sentences are repeated several times. Mood swings complicate the handling of patients and the behavior of relatives is often negatively affected.
Restlessness causes the patients to become active at night, which poses a potential danger of falling. From a certain point, nursing support of the patient is inevitable, because he is no longer capable of a completely independent life. Even with a moderate dementia, it can come to incontinence and everyday life can only be mastered with support.
In the terminal stages of severe dementia, there is almost complete loss of memory. Spouses and children are no longer recognized. A temporal and local orientation is usually no longer possible and even information concerning the patient, can no longer be called.
At this time, vital functions such as continence, but also the ability to eat or drink independently have been lost for sure and make the patient a full-time nursing case. Linguistic skills are no longer used wisely and are eventually forgotten in the course of the disease.
All psychiatric by-effects of the previous phases have disappeared. The ability to walk can only be tediously used, if at all. Patients are bedridden in the terminal stages and do not perceive the environment or themselves. Death is usually due to a concomitant disease of immobility (pneumonia) or by senility (cardiac arrest).
In clinical practice, Alzheimer's disease and dementia are often put on the same level or even used synonymously. This is a misconception, because Alzheimer's disease is just the most common underlying disease, which includes in its symptoms a dementia syndrome - dementia. Alzheimer's disease is a primary dementia, which means that the clinical picture is caused by disease-related changes in the brain.
All primary dementias are not reversible to the current state of medicine, so they can not be regressed. In contrast, there is the group of secondary dementia, which can be improved by timely treatment.
Dementia is a phenomenon of old age and is increasingly becoming a common disease. Every 10 th German who has passed the age of 65 years already has cognitive deficits, which in some cases reach a dementia syndrome. Between the ages of 65 and 70, the incidence rate is 2%. Between the ages of 70 and 79, the rate rises to 6%, with women being slightly more affected than men. This gender-specific difference is confirmed again at age 85 and a total disease rate of 20% is established. To what extent the high rate of female patients is related to the higher average age of women is questionable.
Life expectancy is related to the time of the illness. Alzheimer's disease, which is present in 60% of dementias, causes death within 10 to 12 years. It is not the Alzheimer's responsible, but the condition accompanying diseases.
For example, bedriddenness increases the risk of developing pneumonia ( pneumonia ). Especially old people can quickly die from this. An example: If a person with 67 years of Alzheimer's disease, he has a probable life expectancy of 77 to 79 years. The older the patient is in his illness, the more likely side effects are that ultimately cause the death of the patient.
The duration of dementia always depends on the type of underlying disease. Patients usually die from a concomitant disease, which is caused by the increasing independence and immobilization, but also the high age of most patients. Common diseases here are inflammation of the lungs (pneumonia) or the draining urinary tract and in old age cardiovascular diseases or age-related cardiac arrest. Rarely does the dementia lead to the death of the person affected. Thus, the duration varies depending on the underlying disease and aggressiveness of the course sometimes between 3 and 20 years. A precise prognosis is hardly possible even with knowledge of the underlying disease.
The treatment options are rather limited in the presence of primary dementia with the cause of pathological changes in the brain. The prospect of a cure can not be given yet, however, a drug-related adjustment can be made symptom-driven, in order to minimize the burden on the patients and their relatives.
In this sense, anti-dementia drugs (medications for dementia) can be used as long as it indicates the underlying disease. If dementia is accompanied by depression or if other psychiatric symptoms such as paranoia or delusions appear during the course of treatment, relief can also be provided by means of medication (antidepressants and antipsychotics).
Conditions in which the patient is unusually restless or sleep disorders are also symptoms that can be alleviated by various drugs as needed. If dementia has not progressed too far, cognitive training may be considered. In doing so, the patient can continue to practice his / her abilities and thus possibly receive them longer.
There are dementias, which can be reversible. The course is determined by the disease process which underlies. If a treatment option is available and is started quickly, the resulting dementia symptoms can completely recede.
Only about 10% of all diseases with dementia syndrome are reversible with timely and appropriate treatment. These include causes of illness such as drug abuse, alcohol or drugs, brain tumors or bleeding, depression with pseudo-dementia and hormone-induced brain diseases.