Dementia: Risk Factors, Pathophysiology, and Treatment

This presentation discusses the risk factors, pathophysiology, and treatment of dementia. It highlights the impact of dementia on individuals and the importance of person-centered care. It also explores interdisciplinary units and rehabilitation for dementia patients.

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Pathophysiology: Cortical and subcortical neuronal organ
system is involved in the pathogenesis of the disorder [1].
In dementia, the common causes and pathophysiology is
often dependant on the nature of the dementia and its
common causes i.e. in vascular dementia, the loss of blood
supply to the brain leads to the loss of brain functionality
[3].
Pathophysiology
Risk Factors
Aetiology
Clinical
manifestations
Diagnostic tests
Treatment
There are several risk factors involved in dementia are: age, alcohol, atherosclerosis, diabetes
mellitus, hypertension, congenital reasons, psychological reasons, smoking etc [1]. These risk factors
are involved in the development of dementia and they enhance the chance of development of
dementia [1]. Age: Dementia is very common in the elderly and typically occurs in the old age [1].
Alcohol abuse is yet another common risk factor for dementia [1]. Regular consumption of alcohol
and unusually heavy amounts of alcohol consumption leads to the development of dementia in the
old age [1].
Risk factors: Dementia is a chronic illness and associated degeneration and loss of cognition [1]. Several
cognitive functions and attributed loss of functionality and behaviours in the elderly [1]. It is one of the most
crippling and prevalent conditions worldwide [1].
The development of dementia occurs at a stage earlier to
the manifestation in a clinical setting [3].
Aetiology: Dementia is commonly preceded by Alzheimer’s disease [1].
The accumulation of amyloid beta protein in the brain region leading to
the loss of cognitive functions, memory, and understanding are
common aetiological factors of dementia [1]. Clumps of proteins,
plaques, or tangles are formed in the brain in Alzheimer’s disease
leading to loss of brain functionality [2].The most common form of
dementia is vascular dementia which is caused by the interruption in
the supply of blood to the brain [1]. Dementia with Lewy bodies is also
a common occurrence and is due to the development of circular ‘Lewy
bodies’ or protein lumps that develop and accumulate in the brain [1].
The pathological characteristics of the
disease are only visible at an old age [3].
The treatment involves two
crucial aspects: clinical
(pharmacological and non-
pharmacological) and health
care interventions [3].
In Alzheimer’s disease and dementia with
Lewy bodies, there is an abnormal
deposition of protein lumps in the brain [3].
The primary clinical presentations include
loss of memory, cognition, speech,
behaviour, social living etc [3].
Diabetes mellitus: Research has enumerated that diabetes mellitus is
strongly associated with dementia in the elderly [1]. Several studies
have demonstrated that diabetes mellitus is a strong predisposing
factor for dementia [1]. Evidence suggesting a direct relationship
between diabetes mellitus and dementia is scarce; however, diabetes
without control is an important risk factor for several health
complications such as cardiovascular disease leading to vascular
dementia. The other risk factors include genetic predisposing factors
that lead to erroneous production of amyloid beta protein and its
accumulation in the brain leading to degeneration, hypertension,
mental or emotional issues, and lifestyle issues such as smoking
behaviour [1].
Pharmacological interventions mainly depend
on the stage of the disease [3]. Psychological
and social health organisations are important
contributors to the health of the patients [3].
Palliation is a crucial part of dementia
treatment [3].
Several interdisciplinary units are present for the
treatment and intervention for empowerment of the
patients for social living [3].
Due to such deposition, dementia occurs
in most aged adults [3].
Diagnostic tests: In dementia, nueroimaging is a
crucial diagnostic tool [3]. Blood tests such as
Thyroid function tests, serum vitamin B12,
complete blood count, blood urea nitrogen level
measurement, serum electrolytes, and
measurement of blood glucose, blood urea, HIV,
syphilis, RBC etc are carried out [3]. Computed
tomography scan is essential to eliminate
differential diagnosis [3].
Key

Dementia
I discuss here the case of Amanda, a 75 year-old female diagnosed with chronic Alzheimer’s disease-related dementia. She was subjected to MRI and CT for the
confirmation of the presence of plaques of amyloid beta protein. She presented with loss of memory, insomnia, inability to walk and read. It was a particularly trying case
in the duration of my practice as a registered nurse. I believe her inability to perform her daily activities was particularly disturbing to me and made me worry about her
getting around in her everyday life. Amanda was given antiamyloid therapy initially and was referred to several interdisciplinary help units such as speech therapy and
activities of daily life.
Dementia is an important chronic illness due to its prevalence globally [1]. It is a critical illness of long-term morbidity in the geriatric population [1]. It has a high degree
of effects on the lifestyles of the individuals and their qualities of life [2]. Dementia directly affects the social existence and life at home of the individuals with dementia
[2]. Dementia is characterized by a progressive degeneration of brain functionality due to physiological plaque formations in the brain [2]. Dementia is of several types of
which vascular dementia, Alzheimer’s disease-related dementia, and dementia with Lewy bodies are widely recognised forms of dementia [2].
Chronic nature of dementia and implications for health care: Dementia is a chronic disorder and can occur at early stages of life due to physiological reasons in an
individual [3]. However, the disease does not clinically manifest itself until later years of life [3]. At the stage where the disease presents during the later stages, it is at a
developed stage and is usually irreversible [3]. Due to the degeneration of the cognitive functionality of the brain, there is a physical loss of memory and intelligence [3].
Thus, the adaptability of the individual to the society is largely deteriorated [3]. The individual is then not disposed to take care of basic mobility and daily activities such
as walking, washing, etc [3].
Health care providers are often disposed to enable the individual to carry out their everyday activities [3]. Several interdisciplinary units of health care are present to
take care of the patient’s speech, cognition, and everyday activities [3]. The individual needs to be empowered to live at home and care for themselves [3]. Several
times, there are familial carers who care for the patient at home following the discharge of the patient from the hospital unit [3]. Since the disease is diagnosed at a late
stage, care and palliation are essential aspects of dementia treatment [3].
Nursing and dementia care: Dementia essentially entails several stages right from the onset of the disease to the initial diagnosis to the end of life, it is essential to
provide as much information as possible. Considerations such as the diagnosis at the time of initial presentation, treatment plan and advance mapping, health care
considerations, concerns relating to social behaviour and basic cognitive functions necessary for everyday activities, palliation, and care till the end of life are crucial
whilst nursing for dementia [3]. I was particularly mindful of every patient-related communication with Amanda as that information was crucial for her after-care.
Person-centered care: Person-centered care is a fast-evolving concept globally and is given much importance in dementia care [3]. The four primary strategies include:
moral value base for the provision of basic and fundamental rights for persons with dementia [3]. The consideration of the unique value of each individual, empathy to
the individual’s thoughts and perceptions of his or her surroundings, and finally the system of health care that provides for the emotional needs of the patient [3].
Amanda was exposed to person-centered care and we found it particularly helpful.
Interdisciplinary units and rehabilitation: As discussed previously, it is essential for the individual to be able to carry out daily activities [3]. Therefore,
interdisciplinary care units such as speech therapy, psychology and social help units, behavioural therapists, etc are intertwined and form an essential network for the
care of patients of dementia [3].

Reference list
1. Joan , L. & Lori, A. 2004. Dementia/Alzheimer’s Disease. Women’s Health Surveillance report, 4(Suppl 1): S20
2. Hinton, L., Franz, C.E., Reddy, G., Flores, Y., Kravitz, R.L., & Barker, J.C. 2007. Practice constraints, behavioral problems, and dementia care: primary care physicians perspectives. J
Gen Intern Med, 22(11):1487-1492
3. Callahan, C.M., Boustani, M.A,. Unverzagt, F.W., et al. 2006. Effectiveness of collaborative care for older adults with Alzheimer Disease in primary care: a randomized controlled
trial. JAMA, 295:2148–57
4. Crooks, E.A., & Geldmacher, D.S. 2004. Interdisciplinary approaches to Alzheimer’s disease management. Clin Geriatr Med., 20(1):121–139.