Updated on 05/01/2024
Senility, or in other words, dementia is the loss of cognitive functions due to a disorder in the brain. A cognitive deterioration that may be qualified as dementia should first impair more than one cognitive function. Furthermore, it should have the severity and frequency that will cause a significant impairment in the daily living activities that may be summarised as professional performance, independence in public places and in financial matters, use of basic tools, hobbies, house chores and self-care, and also progressive in most cases. While the most frequently observed type of dementia is Alzheimer’s Disease (AD), there are actually many other types.
There may be cognitive changes due to aging. Memory, learning and thinking can change with aging. However, memory loss and cognitive impairment to the extent that will disrupt daily living activities are never observed in normal old age.
Mini Mental Test is a screening test often used in the clinic. However, it should be kept in mind that false positive (depression) and false negative (early dementia) results may occur. If suspicion arouses with the screening test, patients should be taken for more detailed neurological and psychometric evaluation.
The most often observed type of dementia is Alzheimer’s Disease. Other dementia types are vascular dementia, Lewy body dementia, and frontotemporal dementia.
First of all, depression, which causes pseudo-dementia, should be included in the differential diagnosis of every patient. In addition, vitamin B12, B1 and B6 deficiencies, toxic causes such as lead and mercury poisoning, endocrine causes such as hypothyroidism, structural causes such as vasculopathies, subdural hematoma, normal pressure hydrocephalus and slow growing tumours, and central nervous system infections should be reviewed in the scope of differential diagnosis.
The incidence of Alzheimer's disease increases with age. While the frequency is 5% in the age of 70-74, it is 40% in the age of 95-99. As the population is getting older also in our country, it is expected that there will be approximately 2.3 million dementia patients as of the year 2050.
Plenty of evidence shows that what's bad for the heart is also bad for the brain. Well-defined risk factors for coronary artery disease and stroke are also risk factors for dementia. Identification, prevention and treatment of vascular risk factors in middle age, smoking cessation, providing supportive and satisfactory social relations and support, adequate sleep, balanced diet, hobbies that will keep cognitive activity alive and regular exercise are important in reducing risk.
The first 2-4 years of the disease are called mild/early stage. The earliest finding is the forgetting of new events, newly learned things. Other findings are impairment of time orientation and complex cognitive functions such as mathematical calculation, and difficulty in performing complex multi-step activities. Subject and question repetition may be mild difficulties in self-expression. Difficulties in writing and using tools may also begin.
The period of about 4-10 years is considered the middle stage. There is an increasing difficulty in dealing with problems. Progressive memory impairment impacts life in various areas. Disorientation, difficulty in establishing a cause-effect relationship begins. The risk of disappearance is high, there may be sleep disturbance, and behavioural symptoms become even more pronounced. Now the patient needs help in activities of daily living. In the middle-advanced stage, memory problems and confusion become more further evident.
Difficulty in recognizing relatives begins. The patient becomes unable to learn new information. Significant difficulty (such as in dressing) is observed in performing tasks with several steps. Some psychiatric symptoms may occur.
dvanced and final stage, the past and present times become jumbled, and the patient can no longer recognize their relatives at all. Verbal communication becomes severely impaired. Psychiatric symptoms may become much more pronounced. There may be falls, swallowing problems, urinary and faecal incontinence, and eventually they may become bedridden. They become completely in need of care.
Anticholinesterase inhibitors Donepezil, Rivastigmine, Galantamine and NMDA receptor antagonist Memantine are used in the treatment.