Dementia

Dementia is a progressive brain dysfunction that leads to a gradually increasing restriction of daily activities. The most well-known type of dementia is Alzheimer's disease. Dementia not only affects patients, but also those surrounding them, as most patients require care in the long-term. In our society of longer lifetime the probability of suffering from dementia increases with advancing age. Dementia predominantly occurs in the second half of our life, often after the age of 65 y/o. The frequency of dementia increases with rising age from less than 2 % for the 65-69-year-olds, to 5 % for the 75-79 year-olds and to more than 20 % for the 85-89 year-olds. About half of those affected by dementia suffer from Alzheimer's disease. The probability is higher for women and for people having a lower standard of education.

The most commonly known symptom of Alzheimer's disease is confusion. This behavior in particular causes us to become 'estranged' from others and to be unpredictable in our interactions. Confusion can also occur acutely, i.e. suddenly and limited in time (e.g. triggered by a hospital stay, directly after heart surgery etc). It is difficult to understand this estrangement, because everybody experiences similar situations from time to time: we forget, misplace, can not remember names, and cannot find our car in the car park and similar lapses. So both aspects are present: dementia is not familiar but also not entirely alien to us.

Other symptoms of Alzheimer are impaired memory and orientation, limitations of concentration, planning and judgment, personality changes and later also perceptual, speech and walking disorders; in the final stage, various other body functions such as swallowing and the excretion process are also affected. During the course of Alzheimer's disease, patients lose their independence in managing everyday life. There are effects on perception and social relationships; people become more and more dependent on care.

The slowly progressing destruction of nerve cells in the brain leads to the previously mentioned symptoms of Alzheimer's disease. It is a natural phenomenon to loose a certain number of nerve cells during ageing but this loss occurs much more rapidly in people suffering from Alzheimer's disease. As a result the brain of the patient does not function normally any longer.

In rare cases, the disease is caused by genetic changes (mutations) in the family. In these cases symptoms usually occur before the age of 60 and progress rapidly. All currently known mutations result in an overproduction of a protein which destroys the nerve cells. In most cases the exact cause remains largely unexplained; interaction of several factors probably leads to the onset. Everybody is at risk of developing this disease. Several genetic factors are known to increase the risk, without themselves being the cause. These include a (normal) variant of the gene apolipoprotein E which encourages the deposition of the harmful protein.

Alzheimer's disease can take very different courses. It is a slowly unfolding, progressive disease which is accompanied over time by changes in the appearance of the patient. The disease is typically divided into three stages: mild, moderate and severe or early-stage, mid-stage and late-stage Alzheimer. The mild stage is typically characterized by impairments of mental abilities as well as mood swings. In the moderate stage, behavioral disturbances usually increasingly develop, whereas physical problems are dominant in the advanced stage. The individual course of the disease is, however, very variable.

Improvements can be achieved through physical, emotional and also mental activation. In the early stage, training of thinking and memory functions should only be carried out carefully, otherwise there is the danger that the patient is always reminded of his/her diminishing mental abilities. This also applies to the formerly popular approach of reality orientation training.