Dementia (Cognitive Decline): What Is It, Types, Diagnosis, and Treatment

Dementia, also known as cognitive decline, is a global health issue that affects millions of people worldwide. According to the World Health Organization, more than 55 million people currently suffer from dementia. Dementia itself is not considered a standalone disease. Instead, it is referred to as a syndrome characterized by a decline in cognitive and mental functions. Dementia is a significant health problem worldwide, particularly affecting the quality of life of individuals in older age groups. Detailed information on dementia can be found in the continuation of this article.

What Is Dementia?

Dementia refers to the loss of mental functions. In other words, dementia is when a person's mental functions deteriorate to the extent that it affects their daily life activities and progressively worsens. The World Health Organization considers dementia one of the most significant causes of dependency in older individuals. While dementia typically affects older adults, it is not an inevitable consequence of aging. Additionally, dementia can occur in younger individuals due to various causes. Early intervention can prevent the onset and/or progression of dementia.

What Are the Causes of Dementia?

Dementia occurs as a result of damage to nerve cells in any part of the brain. Different regions of the brain have distinct functions, and when the nerve cells in these regions are damaged, cognitive functions such as calculation, memory, and speech are negatively affected. Additionally, behavioral disturbances, such as sudden irritability, can arise due to the damage to the cells.

There are different causes and subtypes of dementia. One of the leading causes of dementia worldwide is Alzheimer's disease. Some studies also suggest that genetic factors may contribute to the development of dementia. Other factors that can lead to dementia include:

• Neurological diseases affecting the system, such as stroke and Parkinson's disease
• Vitamin deficiencies, especially B12 and B6
• Chronic health issues such as kidney and liver failure
• Infectious diseases like meningitis and HIV
• Head trauma Additionally, brain tumors can cause dementia in both individuals under the age of 65 and those in older age groups.

What Are the Types of Dementia?

Dementia has different types depending on the location of the damage to brain cells. The most common form is the one associated with Alzheimer's Disease. Dementia is generally classified according to the underlying health problem. Based on this classification, the main types of dementia are as follows:

• Alzheimer's Disease: According to the World Health Organization, approximately 60-70% of dementia cases are linked to Alzheimer's Disease. The cause of Alzheimer's is believed to be two types of proteins, amyloid and tau. When these proteins accumulate around brain cells, communication between nerve cells is gradually lost. As a result, forgetfulness is usually the first symptom to appear. Alzheimer's is a progressive disease, and symptoms can worsen over time. In later stages, in addition to forgetfulness, symptoms such as speech disorders, walking difficulties, inability to recognize close family members, confusion with addresses, mental fog, difficulty learning, irritability, and aggression may also appear. Alzheimer's disease causes irreversible damage as it progresses, which can have life-threatening consequences. Therefore, when a noticeable change in mental function is detected, it is important to seek help from an expert doctor without delay.
• Vascular Dementia: Another type of dementia is vascular dementia, which occurs due to reduced blood flow to the brain caused by blockage or damage to blood vessels. Vascular dementia can start suddenly, following conditions like a stroke, or may not show any symptoms for a long time in some cases. The symptoms of vascular dementia include difficulty thinking, understanding, and speaking. The symptoms are closely related to the part of the brain where the blood vessel damage occurs. For example, if the damage occurs in the part of the brain responsible for memory storage, memory loss and forgetfulness may occur.
• Lewy Body Dementia: Research shows that Lewy body dementia accounts for about 15-25% of dementia cases. It occurs due to the accumulation of protein clumps called Lewy bodies in the brain, which leads to the degeneration of nerve cells. Major symptoms of Lewy body dementia include forgetfulness, speech disorders, and difficulty with visual perception. Unlike Alzheimer's disease, memory problems are less common in the early stages of Lewy body dementia.
• Frontotemporal Dementia: Frontotemporal dementia is a progressive health issue that develops due to the damage of nerve cells in the frontal or temporal lobes of the brain. The most distinguishing feature of frontotemporal dementia compared to other types is that it is more commonly seen in middle-aged individuals. Some studies show that the majority of adults diagnosed with frontotemporal dementia are between the ages of 45-64. Symptoms include changes in behavior, such as not showing the same concern for those around them, difficulty concentrating, and issues with speaking and understanding.
• Mixed Dementia: In some cases, two types of dementia, such as Lewy body dementia and Alzheimer's disease, may occur simultaneously. This is called mixed dementia.

Dementia Stages

Dementia is divided into three stages: early, middle, and late stages. The severity of the symptoms helps determine the stage of the disease. The dementia symptoms according to stages are as follows:

• Early Stage: In the early stage, symptoms are usually mild, so they may not be taken seriously by the patient or their loved ones. In this stage, symptoms such as forgetfulness, changes in behavior, difficulty choosing words, confusion about time, and misplacing familiar places may occur.
• Middle Stage: Dementia is a progressive health issue, and as it advances, the severity of symptoms increases. In the middle stage, there is an increase in forgetfulness and speech difficulties. The individual may have difficulty remembering family members and friends. In addition, in this stage, patients may struggle with personal care. The middle stage is also when behavioral changes are more apparent.
• Late Stage: This is the final stage of dementia, where patients become almost entirely bedridden. At this stage, in addition to memory, behavioral, and speech issues, nutritional problems may also arise.

How is Dementia Diagnosed?

Diagnosing dementia in its early stages can be difficult. A neurologist, who specializes in the diagnosis, will first take a detailed medical history of the patient. Information about the patient's age, work history, and more is important. Since some metabolic diseases can also cause dementia, the doctor will also assess whether the patient has other health issues. Routine tests, such as a complete blood count, may be used for diagnosis. Additionally, neuropsychological tests and imaging methods such as EEG, CT scans, and MRI are used for diagnosing dementia.

Dementia Treatment

There is no definitive cure for dementia, and treatment options vary depending on the underlying cause and the severity of symptoms. The general goal of treatment is to reduce the severity of symptoms and make daily life easier for the patient. Medications may be used to support memory and learning. If psychological disorders such as depression or sleep disturbances are present, treatment may be provided for these conditions as well. Therapy methods, such as speech therapy, may also be used when necessary.

Dementia is a progressive health problem that affects daily life. Early diagnosis can help alleviate the symptoms. If you or your loved ones notice symptoms like forgetfulness or confusion about places and time, don't hesitate to seek medical attention as soon as possible.