What is dementia?Dementia is a serious disturbance in short-term memory, accompanied by further deficits in the areas of consciousness and emotions. It usually develops gradually, i.e., it begins with limitations in the ability to remember and learn, then extends to large parts of the memory and finally also affects the long-term memory. People with severe dementia thus lose almost all learned skills and abilities in the course of the dementia disease. In many cases, dementia patients therefore require a similar level of care as very young children.
– Guide for those affected and their relatives: Living with dementia
Causes of disease
The causes of dementia, under which various forms of disease are grouped, have not yet been conclusively clarified. Doctors suspect that genetic disposition also plays a role in Alzheimer's disease, the most common form of dementia. It is a fact that dementia patients have an altered brain structure. The cause of dementia is therefore considered to be a defect in the nerve cells. The nerve cells lose size. This results in a lack of connections to neighboring nerve cells.
A defect in the nerve cells erases learned abilities
The memory and the thinking performance are massively limited by this, learned abilities are irretrievably deleted. At this stage, the brain is already no longer able to create new connections; instead, the brain structure changes. In this context, there is a significant deficiency of neurotransmitters and messenger substances produced in the brain, behavioral changes and memory loss set in. Instead of shrunken neurons, a dementia patient's brain develops patchy structures that the body tries to fill with protein deposits. However, protein overproduction stops the brain's oxygen supply, brain performance continues to decline, and dementia progresses inexorably.
The first signs of dementia do not immediately suggest such a severe neuropsychological disease. The first symptoms are, for example, limitations in the ability to learn or remember, as every person will show in the course of his or her life. Only if the symptoms persist can an incipient dementia be inferred.
Depression and irritability
At about the same time, other symptoms begin to appear that are initially more reminiscent of a depressive episode, such as moodiness, the loss of long-standing interests and hobbies, mild nervous irritability, and a flattened emotionality.
Restriction in communication
As the disease progresses, dementia manifests itself with restrictions in communication. Affected persons can no longer remember what has been said, forget agreements and lose their individual tone of voice. As the disease progresses, there are further deficits in the areas of language, word finding and spatial perception. Sufferers often no longer know where they are and appear disoriented, especially in changed or unfamiliar environments.
Full-blown dementia is also accompanied by motor difficulties. Sufferers move stiffly and slowly, tend to fall and may become bedridden by the end of the disease. Caring for patients with dementia requires a high level of competence and sensitivity, as those affected in the late stages usually recognize neither caregivers nor relatives and close confidants.
Since the brain-organic changes in dementia often occur at a very high age and are to be regarded as a kind of wear and tear, age is the greatest risk factor. Because women tend to have a higher life expectancy than men, they are also more frequently affected by dementia. Other risk factors include depression and other mental illnesses, high blood prere, obesity, smoking and diabetes mellitus. All these underlying diseases have a negative effect on the vessels. Favors structural changes in the brain.
Stages of dementia
Most forms of dementia progress gradually, so that the classification into the different stages of dementia as well as the transition is also rather fluid.
Mild dementia is manifested only by increased forgetfulness and problems with temporal orientation. Affected persons misplace objects, forget arrangements or make mistakes about the day of the week, but can still live completely self-sufficiently.
Affected individuals have more severe deficits in memory, calculation and recognition skills, communication and learning. Personal hygiene decreases, complex action sequences are no longer feasible. Disorientation and speech disorders increase, some patients suffer from delusions. Independence is limited.
The final stage is manifested by total memory loss, incontinence, impaired recognition and complete speech loss. Affected persons become bedridden and require round-the-clock care and nursing.