What Is Dementia?

Dementia is a syndrome that is associated with a decrease in the ability of brain functions, such as reduced memory, decreased ability to think, understand something, consider, and understand language and decreased mental intelligence. This syndrome generally attacks older people over 65 years. Dementia sufferers generally will experience depression , changes in mood and behavior, difficulty socializing, until hallucinating. Patients are unable to live independently and need the support of others.

Keep in mind that not all people who experience memory loss or decreased brain function can be associated with dementia. Check with your doctor to find out the right conditions. Dementia cannot be cured, but early treatment can help relieve and slow the progression of symptoms, and avoid further complications.

Causes of dementia
Dementia is caused by damage to brain nerve cells in certain parts, thereby reducing the ability to communicate with other body nerves, and resulting in the appearance of symptoms in accordance with damaged areas of the brain.

There are various conditions in cases of dementia. There are types of dementia that develop progressively, and there are also other conditions that resemble demesia that occur due to certain reactions and can be suppressed.

Progressive dementia
Progressive dementia is a condition caused by damage to certain brain nerve cells and can worsen over time. This condition generally cannot be completely restored. Some types of progressive dementia include:

• Alzheimer's disease . Is the most common cause of dementia. The cause is still unknown, but some genetic disorders can increase the risk of this disease. Plaque is found in the brain in the form of clumping of beta-amyloid protein, as well as braid fibrous tissue formed by protein tau.
• Vascular dementia. Disorders of the cerebral blood vessels are the second leading cause of dementia. This condition can also cause strokes and other diseases associated with disorders of the blood vessels.
• Lewy body dementia. Lewy body is an abnormal clump of protein in the brain, which can also be found in Alzheimer's and Parkinson's.
• Frontotemporal dementia. A group of diseases characterized by degeneration of frontal and temporal brain cells, which are generally associated with behavior, personality, and language skills.
• Mixed dementia. Generally experienced by people aged over 80 years without a clear cause. Usually dementia is mixed including Alzheimer's, vascular dementia, and Lewy body dementia.

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Conditions that resemble dementia
There are other conditions that can cause dementia or cause symptoms that resemble dementia. Most of these conditions cause symptoms that are transient and can recover after treatment. However, some conditions cause persistent symptoms, such as Huntington's disease, Creutzfeldt-Jakob disease , Parkinson's disease and brain injury.

Other conditions that can cause dementia-like symptoms are transient and can recover with treatment, namely:

• Metabolic or endocrine abnormalities. Conditions such as abnormalities of the thyroid gland, hypoglycemia, deficiency or excess levels of sodium or calcium, to the inability of the body to absorb vitamin B12 can trigger symptoms resembling dementia or behavioral changes.
• Immune system disorders. This condition can cause fever or other side effects that can reduce the ability of the immune system to fight infection. Conditions such as multiple sclerosis can also trigger dementia.
• Medical reaction. Some interactions between drugs or vitamins can trigger dementia.
• Lack of nutrition. Conditions such as dehydration, lack of vitamins (especially B1, B6, and B12) or alcohol dependence, can cause symptoms resembling dementia.
• Poisoning. It is triggered by exposure to tin, heavy metals, pesticides, drugs and alcohol.
• Subdural hematoma. Blood buildup in the space between the durameter layer and the arachnoid layer in the skull cavity, caused by injury or head trauma.
• Anoxia (hypoxia). This condition occurs when tissue in the body does not get enough oxygen, such as in people with asthma, heart attacks, carbon monoxide gas poisoning and others.
• Normal-pressure hydrocephalus. Caused by widening of the ventricles in the brain, resulting in people having difficulty walking, urinating until memory loss.
• Brain tumor. Rarely happens, but can be a trigger for dementia to occur.

The other conditions that can trigger dementia include trauma or recurrent brain injury, Parkinson's disease , Huntington's disease , to Creutzfeldt-Jakob disease.

Risk Factors
By their nature, the factors that can increase the risk of dementia are divided into two, namely factors that are out of control and factors that can be controlled.

Risk factors for dementia that are out of control and cannot be changed include age, family health history, and health problems such as mild cognitive impairment and Down syndrome . While dementia risk factors that can be controlled or avoided include smoking and alcohol consumption, depression, sleep apnea , diabetes, obesity, high cholesterol, hypertension, and atherosclerosis (accumulation of fat in the arterial wall).


Symptoms of Dementia
People with dementia generally experience symptoms according to their causes, with cognitive and psychological changes as the main symptoms.

Symptoms that are generally felt in terms of cognitive include:

• Memory loss.
• Communication difficulties.
• Language difficulties and words.
• Difficult to solve problems or plan something.
• Concentration decreases.
• Difficult to assess the situation and make decisions.
• Difficult to coordinate body movements.
• Feeling confused.

While the symptoms that are felt in terms of psychology include:

• Depression.
• Restless.
• Changes in behavior and emotions.
• Feeling scared (paranoid).
• Agitation.
• Hallucinations.

In severe conditions, patients can experience advanced symptoms such as paralysis on one side of the body, unable to hold back urine, decreased appetite, and difficulty swallowing.

Consultation with a doctor should be done if someone has one or more symptoms of dementia, to get further examination.


Diagnosis of Dementia
Dementia is not easy to diagnose because of the many symptoms that can indicate a similar disease. In addition to asking about the history of the disease and the health of patients and families, a physical examination and a series of follow-up tests were also conducted, which included:

• Cognitive and neuropsychological tests. Check the ability to think, remember, orientation, assessment, concentration, to stringing languages.
• Neurological examination. Check motor skills, balance, taste, and reflexes.
• Scanning Check the condition of the muscles, tissues, and brain nerve electricity through CT scans, MRI, EEG, and PET scans.
• Blood test. Check for abnormalities that can affect brain function such as vitamin B12 deficiency, or decrease the function of the thyroid gland.
• Spinal fluid examination . To detect if there is an infection or inflammation of the nervous system.  
• Psychiatric test. Check if the patient has depression or other mental conditions that can affect brain health.

In the case of progressive diagnosed dementia, the doctor will refer to the theory of the 5 stages of development of the condition to determine the severity of dementia. The five stages include:

• Stage 1 : The ability of the patient's brain function is still in the normal stage.
• Stage 2 : Patients begin to experience decreased brain function, but are still able to live independently.
• Stage 3: Patients begin to have little difficulty doing daily activities, but still in mild intensity.
• Stage 4: Patients begin to need help from others to carry out their daily activities.
• Stage 5: The ability of the patient's brain function to drop dramatically and not be able to live independently.

Treatment of Dementia
Not all cases of dementia can be restored. Dementia treatment can be done to relieve the symptoms experienced and avoid complications. Treatment of dementia includes administration of medication, therapy, and surgery.

Drugs
Some types of drugs commonly used to treat symptoms of dementia are:

• Acetylcholinesterase inhibitors , to relieve symptoms of mild Alzheimer's disease, Lewy bodies and hallucinations as a cause of dementia. Side effects that may be experienced include nausea, vomiting, diarrhea and decreased heart rate. It is recommended to always monitor the heart condition through an ECG during treatment.
• Memantine , to slow down chemical reactions in the brain. Generally prescribed if acetylcholinesterase inhibitors do not help or dementia has entered intermediate severity. Possible side effects include dizziness, headache, loss of balance, constipation, and hypertension.
• Antipshycotic, to relieve the behavior of patients who are aggressive or experience severe agitation. Usually these drugs are consumed in a short time to avoid the risk of side effects such as drowsiness, cardiovascular problems, difficulty communicating, until the body is stiff, especially for people with dementia caused by Lewy bodies.
• Antidepressants, to relieve depressive symptoms that commonly occur in people with dementia.      

For symptoms that resemble dementia, the following supplements will be recommended:

• Vitamin E, to slow Alzheimer's and related dementia conditions. Vitamin E is usually consumed in low doses to avoid complications such as death, especially for people with heart disease.
• Omega 3 folic acid Even though further research is needed, omega 3 is believed to help reduce a person's risk of dementia.

Therapy
Some psychological therapies are performed to relieve symptoms of dementia, such as:

• Therapy for cognitive stimulation and reality orientation, in order to stimulate memory, problem-solving skills, language skills, relieve disorientation of the mind, and increase the self-confidence of patients.
• Behavioral therapy, to suppress uncontrolled behavior that occurs due to depression or hallucinations.
• Occupational therapy, to teach patients how to carry out their daily activities safely and adapted to their conditions, while also teaching them how to control emotions and prepare themselves for further development of symptoms in progressive dementia.
• Validation therapy, by showing empathy and understanding the condition of the patient so as not to experience depression. Although it can help relieve confusion and anxiety in patients, validation therapy does not yet have sufficient evidence in terms of its effectiveness.

In addition to the above therapies, there are also a number of supporting therapies that can be done at home, such as music therapy, aromatherapy, massage, playing with pets, to performing artistic activities.

During the therapy process, it is strongly recommended to modify home furniture to make it easier for sufferers to move and get rid of sharp objects so as not to endanger the sufferer.

Operation
In cases of dementia caused by brain tumors, brain injury, or hydrocephalus , surgery can be recommended. If there is no permanent damage to the brain, surgery can help restore symptoms.

Treatment of other conditions
The trigger conditions for dementia such as hypertension, diabetes and cholesterol disorders need to be treated so as not to cause further damage to nerves or blood vessels. Lifestyle changes such as reducing alcohol consumption and quitting smoking can also help.

Complications of dementia
Dementia can damage the functioning of the body's systems and potentially lead to complications if not treated properly, such as:

• Pneumonia, caused by choking on food in the respiratory tract and lung due to difficulty swallowing.
• Nutritional deficiency, caused by difficulty chewing and swallowing food.
• Decreased body function, resulting in sufferers relying on others for daily activities.
• Death, especially in patients with late stage progressive dementia due to the infection they experience.

Prevention of dementia
Dementia cannot be prevented, but there are several ways that can be done to reduce the risk, such as:

• Quit smoking.
• Exercise regularly.
• Maintain nutritional intake and adopt healthy eating patterns, such as low-fat and high-fiber foods.
• Reduce alcohol intake.
• Maintain weight.
• Increase vitamin D intake.
• Train the brain regularly, such as reading and playing puzzles.
• Maintaining health, such as controlling blood pressure, blood sugar levels, and cholesterol.
• Avoid injury to the head.

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