Dementia

There are several types of dementia, depending on the underlying cause:

• Alzheimer’s disease: the most common type, caused by abnormal protein deposits in the brain.
• Vascular dementia: due to reduced blood flow in the brain, often after strokes.
• Lewy body dementia: caused by abnormal protein deposits called Lewy bodies.
• Frontotemporal dementia: affects the frontal and temporal lobes of the brain, leading to personality and language changes.
• Other causes: conditions such as corticobasal degeneration, Creutzfeldt-Jakob disease (CJD), CADASIL (a rare genetic disorder), HIV, normal pressure hydrocephalus, thyroid disorders, vitamin B12 deficiency, and even brain tumours or infections.

The symptoms vary depending on the type and stage, but usually include:

• Memory loss affecting daily life
• Trouble recognising people or places
• Difficulty finding words or following conversations
• Difficulty performing familiar tasks (such as cooking)
• Poor judgment and problem-solving
• Movement problems or imbalance (in some types)
• Personality changes or unusual behaviour

Dementia is caused by damage to brain cells from diseases, injuries, or metabolic issues. Common causes include:

• Alzheimer’s disease
• Benign tumours (subdural haematoma or subfrontal meningioma)
• Cortical Lewy body disease
• Cerebrovascular disease
• Neurodegenerative diseases (corticobasal degeneration, CJD, CADASIL)
• Depressive pseudodementia
• Frontotemporal dementia (10%)
• HIV
• Hypothyroidism
• Normal pressure hydrocephalus
• Syphilis
• Vitamin B12 deficiency 

Doctors use a stepwise approach to identify dementia and its cause:

• Primary investigations
  • Complete blood count (CBC) and erythrocyte sedimentation rate (ESR)
  • Standard biochemical tests
  • Thyroxine (T4) level assessment
  • Vitamin B12 concentration levels
  • Serological testing for syphilis (e.g., VDRL and TPHA)
  • Chest X-ray (CXR)
  • Brain imaging via CT or MRI
  • Comprehensive neuropsychological evaluation
• Secondary investigations
  • Cerebrospinal fluid (CSF) analysis
  • Testing for HIV infection
  • Genetic analysis
  • Electroencephalography (EEG)
  • Volumetric MRI
  • Single-photon emission computed tomography (SPECT)
  • Brain tissue biopsy

Dementia cannot be cured. However, the following are used to bring about temporary relief from symptoms:

• Medicines for memory and thinking: Cholinesterase inhibitors and memantine
• Newer medicines (approved by the USFDA): Lecanemab (Leqembi) and donanemab (Kisunla) for early Alzheimer’s disease
• Supportive medicines: For depression, sleep problems, hallucinations, parkinsonism, or agitation
• Lifestyle support: Cognitive training, physiotherapy, speech therapy, and structured routines to improve quality of life

Consult a doctor if you or anyone you know shows:

• Persistent memory loss or confusion
• Sudden changes in personality or behaviour
• Difficulty in speaking, understanding, or completing daily tasks
• Repeated disorientation (getting lost in familiar places)

While not all types of dementia can be prevented, lifestyle measures may reduce risk:

• Stay physically active
• Eat a balanced, brain-healthy diet
• Avoid smoking and excessive alcohol intake
• Stay mentally active (reading, puzzles, learning)
• Treat depression early

For diagnosis and management of dementia, consult a Neurologist (specialist in brain and nerve disorders).