Dementia

Dementia is not a single disease. It’s an umbrella term for a set of diseases and conditions characterized by a decline in memory, language and other thinking skills that impact everyday activities, including Alzheimer’s Disease. These diseases are caused by damage to the brain cells, which interferes with the ability of those cells to communicate with each other. The symptoms of dementia start slowly, but over time, they will get worse. Dementia is not the same for everyone; it ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend on others for activities of daily living.

Dementia is not curable, but symptoms can be managed with speech and language therapy. Constant Therapy has been shown to help people living with dementia maintain their cognitive and language skills longer than they would have without therapy. Not everyone develops dementia as they age. While dementia is more common with advanced age, it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. 

The National Institute on Aging estimates that 6 million Americans live with some form of dementia. The most common forms include:

• Alzheimer’s Disease – 62% of individuals with dementia have Alzheimer’s. It is caused by the buildup of two abnormal protein structures in the brain called amyloid plaques and neurofibrillary tangles, which disrupts communication between brain cells.
• Vascular dementia – 20% of those with dementia have this type, which is caused by interrupted oxygen flow to the brain, causing brain cells to die.
• Lewy body dementia – 15% of those with dementia have this type. It’s caused by Lewy bodies which are abnormal structures found in the brain’s cortex, which is responsible for thinking, perceiving and understanding language.
• Frontotemporal dementia – 3% of those with dementia have this type. It’s caused by the degeneration of brain cells located in the frontal and temporal lobes of the brain, which control personality, judgment, emotion and language.

Additional detail on the multiple forms of dementia can be found here.

Note that the presence of any or all of these symptoms are not a sure indicator of dementia. A complete examination by a physician is required to be sure.

• Problems with short-term and long-term memory
• Problems with decision-making, problem-solving, and judgment
• Difficulty producing or understanding language
• Loss of ability to learn new information
• Loss of spatial abilities, and difficulties judging shapes, sizes and the relationship of objects in space
• Personality and behavior changes, for example, depression, apathy, withdrawal from usual activities, sleeping more than usual
• Confusion with time and place / getting lost in familiar places

Diagnosis typically involves physical and neurological exams, a thorough medical history and mental status evaluation. In many cases, the specific type of dementia may not be confirmed until after the person has died and the brain is examined. Some early signs of dementia include memory loss, confusion about time and place, and mood changes. If you are worried about dementia, please consult your neurologist. 

According to the National Institute of Neurological Disorders and Stoke at NIH, an assessment to diagnose dementia can include:

• Medical history and physical exam – Assessment of medical and family history, current symptoms and medication, and vital signs can help detect conditions that might cause or occur with dementia. Some conditions may be treatable.
• Neurological evaluations – Assessment of balance, sensory response, reflexes, and other functions help identify signs of conditions that may affect the diagnosis or are treatable with drugs. Doctors might also use an electroencephalogram, a test that records patterns of electrical activity in the brain, to check for abnormal electrical brain activity.
• Brain scans – Computed tomography (CT) and magnetic resonance imaging (MRI) can detect structural abnormalities and rule out other causes of dementia. Positron-emission tomography (PET) can look for patterns of altered brain activity that are common in dementia. 
• Cognitive and neuropsychological tests – These tests assess memory, language skills, math skills, problem-solving, and other abilities related to mental function.
• Lab tests – Testing blood and other fluids, and checking levels of various chemicals, hormones, and vitamin levels, can identify or rule out conditions that may contribute to dementia.
• Presymptomatic tests – Genetic testing can help some individuals who have a strong family history identify risk for dementia.
• Psychiatric evaluation – This evaluation will help determine if depression or another mental health condition is causing or contributing to an individual’s dementia symptoms.

No treatments currently exist to stop dementia from progressing, although some may help manage symptoms. Some studies suggest that certain drugs may help manage certain symptoms and associated behavioral issues.

In addition, people living with dementia often receive rehabilitation services including physical therapy, occupational therapy, and speech-language therapy. These therapies aim to maximize quality of life and communication success and maintain skills using a combination of compensatory and impairment-based approaches.

In speech-language therapy, exercises target cognition and communication using different approaches involving stimulating cognitive areas through activity (for example: participating in social groups, or activities around the house like sorting laundry), specific training for the underlying cognitive domain (for example targeting exercises in the areas of attention, memory or problem solving), and developing strategies to successfully participate in activities of daily living (for example, keeping a daily planner, setting alarms). As a caregiver, you can help by being empathetic and patient with your loved one with dementia. 

One promising scientific study looked at brain rehabilitation therapy sessions with an elderly resident with moderate dementia who resided in a special care memory unit. This individual used Constant Therapy on an iPad to target cognitive-communicative issues. The clinician reported that the resident achieved a higher degree of functional recovery and superior quality of life than would have been possible with more traditional therapeutic approaches alone.

An analysis of Constant Therapy users looked at individuals using the brain rehab app, who identified as living with dementia, and what tasks are assigned to them most frequently by their clinicians. This group of users completed an average of 220 exercises each on the app, for a total of 6.5 million exercises. 

1. Picture Matching: In this working memory task, the patient must recall the location of everyday pictures.
2. Symbol Matching: Targets various skills often affected by dementia, including attention, visuospatial processing, and executive functioning. With 10 levels of difficulty, higher levels provide an increased challenge by adding more symbols in the grid and more distractions.
3. Instruction Sequencing: Sequencing steps to daily activities often affect people living with dementia. In this executive functioning task, you are presented with the steps to daily activities, and must drag these steps into the correct order.
4. Clock Math: Dementia can affect an individual’s ability to do daily tasks such as reading a clock or calculating time. This task target skills in visuospatial processing, memory, and calculations. Clock Math has 3 levels of difficulty where individuals must calculate the time (e.g. what time will it be in a half hour).
5. Picture N-Back Memory: This memory exercises is specifically targeting an aspect of working memory called updating. There are 3 levels of difficulty. In Level 1, you must remember the order of the pictures from 1 picture ago. In level 3 you must recall 3 pictures ago.

See the full library of speech, language and cognitive therapy exercises here.

Dementia has a high impact on public health and is a priority for NIH-supported research. Although scientists have some understanding of dementia and the mechanisms involved, ongoing research may lead to new ways to understand the causes of the disease, diagnose, treat, or perhaps prevent or block disease development. For example, current research is looking at factors that might influence the development of dementia, including genetic factors, inflammation reduction, Tau – the protein found in neurons that can twist into tangles, and oxidative stress – chemical reactions that can damage proteins, DNA, and lipids inside cells.

Resources like Science Daily’s Dementia News and Science Direct / Dementia aggregate recently published studies on dementia.

Where can I find additional resources?

• Alzheimer’s Association
• National Institutes on Aging (part of NIH)
• National Institutes of Neurological Disorder and Stroke (part of NIH)
• American Psychiatric Association