The Scando Review
The Scando Review


Dementia is an umbrella term for a variety of neurological conditions, the main symptom of which is a decline in brain function, caused by physical changes in the brain. It differs from what is known as mental illness, generally.

In 2013, new diagnostic criteria for dementia were developed and released.

In the Diagnostic and Statistical Manual of Mental Disorders, dementia is classified as a Neurocognitive Disorder (NCD) (DSM-5). Minor NCD and Major NCD are subcategories of the NCD category. The term "cognitive" refers to thinking and related processes, whereas the term "neurocognitive" has been applied to these disorders, to emphasise that brain disease and disrupted brain function results in NCD symptoms.

The Neurocognitive Disorder (NCD) category includes disorders in which the primary clinical deficit is in cognitive function and is acquired rather than developmental. Attention, planning, inhibition, learning, memory, language, visual perception, spatial skills, social skills, and other cognitive functions may be impaired.

According to DSM-5, dementia is a significant cognitive decline from a previous level of performance, in one or more cognitive domains. The cognitive deficits impair independence in daily activities. At the very least, assistance with complex instrumental activities of daily living, such as paying bills or managing medications, would be required. Cognitive deficits do not always occur in the context of delirium. The cognitive deficits are not the result of another mental disorder (for example major depressive disorder and schizophrenia).

DSM-5 lists six cognitive domains that can be affected by both minor and major NCD. These cognitive domains (along with their associated warning signs/red flags) are as follows:

➔    Complex attention

➔    Executive ability

➔    Learning and memory

➔    Language

➔    Perceptual - Motor - Visual perception / Praxis

➔    Social cognition

Common early symptoms of dementia

Different types of dementia can have different effects on people, and everyone will experience symptoms in their own unique way.

However, there are some common early symptoms that may appear before a dementia diagnosis. These are some examples:

➔    Memory loss

➔    Difficulty concentrating

➔    Finding it hard to carry out familiar daily tasks, such as getting confused over the correct change when shopping

➔    Struggling to follow a conversation or find the right word

➔    Being confused about time and place

➔    Mood changes

Types of Dementia

On diagnosis of a mild or major NCD, the potential causes should be investigated in order to assign a subtype. There is evidence of a causative disorder, such as Huntington's disease or HIV infection in many people with NCDs. In others, cognitive symptoms appear first, and progression reveals a causative disorder such as Alzheimer's or Lewy Body Disease. In many cases, particularly among the elderly, multiple causative factors exist, and the diagnosis should reflect this. Minor and major NCD subtypes in  DSM-5 include:

• Major or Mild Neurocognitive Disorder due to Alzheimer’s Disease

• Major or Mild Frontotemporal Neurocognitive Disorder

• Major or Mild Neurocognitive Disorder with Lewy Body Disease

• Major or Mild Vascular Neurocognitive Disorder

• Major or Mild Neurocognitive Disorder due to Traumatic Brain Injury

• Substance/Medication-Induced Major or Mild Neurocognitive Disorder

• Major or Mild Neurocognitive Disorder due to HIV Infection

• Major or Mild Neurocognitive Disorder due to Prion Disease

• Major or Mild Neurocognitive Disorder due to Parkinson’s Disease

• Major or Mild Neurocognitive Disorder due to Huntington’s Disease

• Major or Mild Neurocognitive Disorder due to Another

Medical Condition

• Major or Mild Neurocognitive Disorder due to Multiple Etiologies

• Unspecified Neurocognitive Disorder

What is Alzheimer's disease?

Alzheimer's disease is a progressive neurologic disorder that causes brain cells to die and the brain to shrink (atrophy). Alzheimer's disease is the most common cause of dementia, which is defined as a progressive decline in cognitive, behavioural, and social skills that impair a person's ability to function independently.

Alzheimer's disease-related dementia

Dementia caused by Alzheimer's disease is characterised by problems with memory, thinking, and behaviour, that impairs a person's ability to function in daily life.

Dementia caused by Alzheimer's disease can be further classified as follows:

1. Alzheimer's disease dementia, which will be diagnosed if the individual meets all of the core clinical criteria.

2. Alzheimer's disease dementia, which is suspected when there is an unusual or mixed presentation.

3. Alzheimer's disease dementia, probable or possible, with evidence of the Alzheimer's disease pathological process, to be diagnosed when biomarker evidence increases the certainty that the dementia is caused by Alzheimer's disease.

Symptoms of Alzheimer's disease

Alzheimer's disease is characterised by memory loss. Early warning signs include trouble recalling recent events or conversations. Memory impairments worsen as the disease progresses, and other symptoms emerge.

A person with Alzheimer's disease may initially be aware of difficulties remembering things and organising thoughts. A family member or friend is more likely to notice when symptoms worsen.

Alzheimer's disease-related brain changes cause increasing difficulty with:

Memory: Everyone has occasional memory lapses, but Alzheimer's disease memory loss persists and worsens, impairing ability to function at work or at home.

Alzheimer's patients may:

➔    Repeat statements and questions several times.

➔    Forget about conversations, appointments, and events, and inability to remember them later.

➔    Misplace possessions on a regular basis, frequently putting them in illogical or unlikely locations

➔    Get lost in familiar surroundings.

➔    Will eventually forget the names of family members and commonplace objects.

➔    Have difficulty identifying objects, expressing thoughts, or participating in conversations.

Reasoning and thinking: Alzheimer's disease impairs concentration and thinking, particularly when it comes to abstract concepts like numbers.

Multitasking is especially difficult, and managing finances, balancing cheque books, and paying bills on time may be difficult. A person suffering from Alzheimer's disease may eventually be unable to recognise and deal with numbers.

Making decisions and judgments: Alzheimer's disease impairs one's ability to make sound decisions and judgments in everyday situations. For example, a person may make poor or unusual choices in social interactions or dress inappropriately for the weather. Responding effectively to everyday problems, such as food burning on the stove or unexpected driving situations, may be more difficult.

Planning and carrying out routine tasks: Activities that used to be routine, such as planning and cooking a meal or playing a favourite game, become difficult as the disease progresses. People with advanced Alzheimer's disease frequently forget basic tasks like dressing and bathing.

Personality and behavioural changes: Alzheimer's disease causes brain changes that can affect moods and behaviour of a person. The following are examples of potential issues:

●      Depression

●      Apathy

●      Social withdrawal

●      Mood swings

●      Distrust in others

●      Irritability and aggressiveness

●      Changes in sleeping habits

●      Wandering

●      Loss of inhibitions

●      Delusions, such as believing something has been stolen

Neurocognitive Disorder (NCD) is not a disease that can be avoided. A number of lifestyle risk factors exist, however they can be modified. Changes in diet, exercise, and habits — steps to reduce the risk of cardiovascular disease — may also lower your risk of developing Alzheimer's disease and other dementia-causing disorders, according to research. The following are examples of heart-healthy lifestyle choices that may reduce the risk of Alzheimer's:

➔    Regular physical activity

➔    Eating a Mediterranean-style diet rich in fresh produce, healthy oils, and low-fat foods

➔    Following treatment recommendations for high blood pressure, diabetes, and high cholesterol

➔    If you smoke, seek help from your doctor to quit.

When to see a doctor?

Memory loss or other dementia symptoms can be caused by a variety of conditions, including treatable conditions. If you are concerned about your memory or other cognitive abilities, consult your doctor for a thorough evaluation and diagnosis.

If you are concerned about the thinking skills of a family member or friend, discuss your concerns and inquire about going to a doctor's appointment together.

Now put on your thinking hats and think about the following questions for a couple of minutes.

How would you explain the term “dementia” to your students?

Can you think of some factors that may contribute to dementia?

Can you think of ways to help a friend or relative who is suffering from dementia?

Write down your thoughts and discuss them with your students, children and your colleagues. Listen to their views and compare them with your own. As you listen to others, note how similar or different your views are to others’.

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Happy Teaching!