Understanding dementia

Symbolic representation of neurodegeneration of the brain in Dementia

Brain functions affected by dementia include

Dementia can affect many different functions of the brain depending on which areas of the brain have suffered damage.

Executive Function -
Neurodegeneration in the frontal lobe which regulates executive functions of the brain such as decision-making, problem-solving, setting goals, thinking, memory, behaviour, and movement can affect any of these brain functions. Executive functions that require planning and organising actions to accomplish a simple everyday task such as getting dressed by putting layers of clothing in the correct order may be impaired in a person with dementia.

Memory, learning, and language -
Any damage to the parietal lobe that regulates language, spatial awareness, and recognition can affect vital functions such as reading, writing, and drawing. Damage to the left parietal lobe can interfere with a person's ability to tell left from right. This is more common in Alzheimer's disease.
Damage to the temporal lobe that contains the hippocampus will affect memory, learning, hearing, and language. This can affect the formation of episodic memories (memories of experiences and events in life along with the emotions attached to them).

Emotions and behaviour - Communication between the limbic system that regulates emotions and the frontal lobes that regulate rational thinking and judgement influences a person's emotions and behaviour. Damage to these parts of the brain caused by dementia can make a person anxious and react aggressively to a threat that is not real. In another instance, a person may act uninhibitedly and behave inappropriately.

What is Dementia?

Broadly dementia is a term used to describe several different conditions all with similar symptoms. Dementia is a progressive neurodegenerative disease associated with impaired cortical functions such as loss of sensory and motor functions, and decision-making, and impaired cognitive skills such as those associated with language, memory, motor skills, and learning. The condition interferes with a person's ability to perform normal tasks of daily life. According to the WHO currently (2023) more than 55 million people have dementia worldwide and nearly 10 million new cases are reported every year.

Some risk factors for developing dementia::

age (more common in those 65 or older)
high blood pressure
high blood sugar /diabetes
being overweight or obese
smoking
excess alcohol
being physically inactive
depression and social isolation

Common types of dementia::

Alzheimer's Disease

Vascular Dementia

Dementia with Lewy Bodies (DLB)

Fronto Temporal Dementia

Mixed dementia: (Alzheimer's + 1)

Possible causes of dementia

Dementia can develop from several different factors or combinations of these factors which include inflammation, oxidation, blood sugar dysregulation, lipid dysregulation, lack of blood and oxygen to the brain, buildup of abnormal proteins and protein clumps, nerve cell damage and atrophy, and severe head injury among others.

Alzheimer's disease the most common form of dementia is caused by the buildup of two abnormal proteins called beta amyloids and tau. Clumps of beta amyloids known as 'senile plaques' form in the inter-synaptic space interfering with communication between the neurons. Tau deposits known as neurofibrillary tangles form within the microtubular pathways of the neurons blocking the transport of vital nutrients and neurochemicals, This leads to the breakdown of the nerve cell signalling network and nerve cell death. Research is still ongoing to understand what causes buildup of these proteins.
Vascular dementia is caused by a lack of blood flow and oxygen to the brain tissue. This can happen if a person suffers from a stroke or a series of mini-strokes. In dementia caused by a single stroke a crucial area of the brain is destroyed. In contrast, a series of mini-strokes cause tiny but widespread damage to the brain.
Another form of vascular dementia known as Binswanger dementia there is widespread damage to the blood vessels in the white matter located deep inside the brain. This is more common in people with high blood pressure and poor cardiovascular health.

Frontotemporal Dementia (FTD) is caused by the degeneration of nerve cells predominantly in the frontal and temporal lobes of the brain. There is a build-up of abnormal proteins in the brain causing brain cell toxicity and cell death. Again there is no clear understanding of why this happens. However, a significant 20% of the people with FTD seem to have inherited it from their parents.
Lifestyle factors that may contribute to dementia are lack of restorative sleep, poor nutrition, alcohol abuse, and lack of proper exercise.

Yoga can be a beneficial intervention for improving cognitive function

Research on effects of yoga on patients with mild cognitive impairment and dementia

Research into the effects of yoga on dementia has shown promising results, although the field is still evolving and more comprehensive studies are needed.

Cognitive Improvement: Several studies suggest that yoga may have a positive impact on cognitive function in individuals with dementia. Yoga's combination of physical exercise, meditation, and breathing techniques could potentially help in improving memory, attention, and overall cognitive abilities.
Stress Reduction: Yoga is known for its stress-relieving properties. It may help reduce stress and anxiety levels in both dementia patients and their caregivers. Lower stress levels might contribute to better cognitive function and overall well-being.
Improved Mood and Behavior: Some research indicates that yoga might positively influence mood and behavior in individuals with dementia. Regular practice might lead to reduced agitation and aggression and could potentially improve social interactions.
Physical Benefits: Apart from mental well-being, yoga's physical aspects, such as gentle stretches and movements, might improve flexibility, balance, and muscle strength. These could be beneficial in managing some of the physical symptoms associated with dementia.
Caregiver Well-being: While most studies focus on the effects of yoga on patients, there's evidence suggesting that yoga can also benefit caregivers. It may help reduce their stress levels and improve their coping mechanisms.

The progression of dementia can differ significantly among individuals, impacting responses to interventions like yoga. While yoga, as part of a holistic approach, may complement conventional treatments, it shouldn't replace them entirely. If someone is considering yoga for dementia management, it's advisable to consult healthcare professionals for guidance and personalized recommendations.

Community and Support

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Signs and symptoms of the most common causes of dementia

Since dementia is a progressive neurodegenerative disorder the symptoms keep getting worse with time to the point where a person experiences significant loss of brain function and consequently their personal independence.

Alzheimer's disease is the most common cause of dementia, the early-stage symptoms include
- Experience memory loss, and problems retaining information about recent events or conversations.
- Difficulty concentrating
- Confusion in carrying out normal everyday tasks for instance, not realising how much milk and sugar they put in their tea
- Difficulty in choosing the right words to express themselves.

During the later stages, the affected person can experience
- Confusion and disorientation making it difficult to travel using public transport or getting lost in familiar environments
- Personality and behaviourial changes showing up as aggression, and being demanding and suspicious of others around.
- Hallucinations and delusions
Symptoms of Vascular Dementia - If vascular dementia is caused by a single stroke the symptoms can manifest quickly depending on which part of the brain is affected or when caused by several mini-strokes the symptoms can show up gradually and worsen over time. Some of the main symptoms include -
- Stroke-like symptoms such as paralysis on one side of the body
- Cognitive problems such as slow thinking, poor attention span, organising, and planning
- Memory loss
- Depression and mood disorders
- Laughing or crying at inappropriate times
- Loss of bladder and bowel control
- Movement problems such as unsteady walking, or difficulty following a sequence of steps, for instance, to prepare a meal
Symptoms of dementia with Lewy Bodies (DLB) - This dementia can affect both the cortical and the subcortical brain.
The symptoms of Lewy Bodies in the cortical brain can include
- Problems in thinking, planning, and decision-making
- Problems with attention and memory
- Vision problems and hallucinations
- Loss of smell
- Feeling sleepy and drowsy during the day

Lewy bodies at the base of the brain can cause movement problems such as tremors, and slow and unsteady walk.

Effects of dementia on daily life

An individual can face many difficulties depending on how far their dementia has progressed and the severity of symptoms experienced. In the worst case scenario, the individual may not be able to look after themselves at all and may lose their independence altogether.
One of the most common experiences of dementia is the loss of memory which can cause many challenges With the loss of short-term or working memory, the person will find difficulty remembering recent conversations or events. The person may struggle in communicating as they cannot find the correct word/s to express themselves. They may fail to recognise people and places which can be emotionally disturbing. Or they may misplace things and suspect others including close family members of stealing causing anxiety and frustration for all concerned. Memory loss also makes them lose track of their medications and when they took them leading to problems in their treatment.
A person experiencing confusion and disorientation from dementia tends to get lost within their familiar surroundings. This difficulty is further compounded by memory loss as cannot remember where their home is. It is difficult for them to use public transport as for instance, they may not recollect where they are headed or what train or bus service they need to use. Even going to the bank and being able to use their banking card correctly can become challenging or impossible without assistance.
Day-to-day tasks of personal hygiene, taking a bath, using the toilet, getting dressed, preparing a meal, and some others that we take for granted can pose a big challenge to a person with dementia. In some cases of dementia, the person affected may have difficulty following a series of steps in order to get dressed or follow a recipe to cook their meal.

Effect on family and friends

Dementia can cause significant alterations in the affected person's reality, personality, emotions, and behaviour. The demands and care of the person affected are bound to affect their family, friends, and carer.

Family and friends may experience emotional upset when their loved one is affected and cannot remember them or relate to them as strangers. Looking after the person can make them feel exhausted physically and mentally. If they do not understand the condition properly they may fail to understand why a person is behaving aggressively, or being demanding, suspicious, frightened, or acting inappropriately, and without inhibition. And even if they learn about the condition it is still not easy to cope with additional chores and responsibilities in looking after the person.
Family and friends may find communicating with the person overwhelming and draining as the person cannot express themselves properly due to a lack of language, use of foul language, slow and slurred speech, inability to understand the meaning of the words being said, and after making all the effort to converse the person may not recall the conversation at all even a short time later. This can cause difficulty for friends and family.

Some possible interventions for dementia

As there is no cure for dementia, treatment is focused on reducing and managing the symptoms, delaying progress, and improving the quality of life for the person. Possible interventions for dementia include medical interventions via drugs, lifestyle interventions, and psychological interventions. The best results are observed, however, when these interventions are applied to produce a synergic effect.

Medical intervention via the use of drugs - Several drugs and cognitive enhancers are available today that can be used depending on the type of dementia and the symptoms experienced to slow down the degenerative process. Most of these drugs work by inhibiting an enzyme called acetylcholinesterase to prevent the breakdown of a chemical called acetylcholine in the brain that is responsible for nerve cell communication. Another drug named Memantine protects the nerve cells from damage by a chemical called glutamate that can interfere with nerve cell messaging. These drugs are only suitable for cases of Alzheimer's disease, dementia with Lewy bodies, Parkinson's disease dementia, and mixed dementia with AD and vascular dementia (AD being prominent).

For Vascular dementia, the drugs used are mainly to keep in check cardiovascular problems including high blood pressure, statins to regulate cholesterol, and drugs for diabetes.

This apart use of antidepressants, mood stabilisers, and antipsychotics may be considered if there are symptoms warranting their need.
Lifestyle interventions - Maintaining good health can pay long-term dividends to the affected person without any negative side effects. Engaging in an exercise programme and or sport of choice can keep the body and brain functioning optimally and cope better with the symptoms. Adopting a diet that provides the necessary nutrition and takes out any detrimental food and drinks such as excess sweets, high salt foods, processed foods, or foods with high saturated fats will minimise the effect of additional conditions present such as high blood pressure, diabetes, depression.
Psychological interventions - This can include talking therapies such as Cognitive Behavioural Therapy and counseling to understand the person and the problems they are facing so a relevant solution can be worked out.
Life review strategy with a scrapbook of pictures to help with memory retrieval and emotions attached to these memories.
Cognitive stimulation - the right temporal lobe that stores music, and matters related to creativity, such as arts and craft is least affected by dementia.

Being kind and considerate

A person with dementia is at a disadvantage with their language, expression of thoughts, and choice of right words. Changes in their personality and behaviour can make them feel agitated, embarrassed, disinhibited, and emotionally vulnerable. Unkind words and actions of others can affect how they feel about themselves, adversely impact motivation, and may trigger aggression, or make them upset or withdrawn. While the person may experience memory loss they may not lose the sense of who they are or were in the past. Words that belittle them or referred to in third person are likely to hurt their sentiments and worsen their symptoms.