Early signs of dementia

Early signs of dementia – Health Infomania.

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EARLY SIGNS OF DEMENTIA

Dementia is a chronic organic brain disorder characterized by impairment in neurocognitive function ie; irrationality which is slow in onset. However, it does not impairs the consciousness if the individual. Today we will discuss “early signs of dementia” in this article.

The word “Dementia” is derived from two Latin words;
“De” means apart or away.
“mentis” means mind.

It is usually a disorder of elderly and appears un the late life.  Alzheimer is its common type.

Diagnostic and statistical manual of mental disorders, 5th edition (DSM5) had replaced the term “DEMENTIA” with “MAJOR NEUROCOGNITIVE DISORDER”

DEFINITION:

According to Wikipedia encyclopedia;
“The progressive decline in cognitive functions (particularly affected areas like thinking, reasoning, memory, attention, language, and problem-solving) due to damage or disease in the brain beyond, what might be expected from normal ageing.”

According to the International statistical classification of diseases and related health problems, 10th edition (ICD10);
“A chronic progressive disease of the brain affecting higher cortical functions in multiple ways and resulting into disturbances or decline in intellectual functioning. For example; memory, thinking, orientation, comprehension, learning, capacity, calculation, language and judgement but not affecting consciousness commonly associated with deterioration in emotional control and social behaviour.”

CLASSIFICATION OF ORGANIC BRAIN DISORDERS

(International statistical classification of diseases and related health problems, 10th edition (ICD10);

F00-F09 Organic, including symptomatic, mental disorders

  • F00 Dementia in Alzheimer’s disease
  • F00.0 Dementia in Alzheimer’s disease with early onset
  • F00.1 Dementia in Alzheimer’s disease with late onset
  • F00.2 Dementia in Alzheimer’s disease, atypical or mixed type
  • F00.9 Dementia in Alzheimer’s disease, unspecified
  • F01 Vascular dementia
  • F01.0 Vascular dementia of acute onset
  • F01.1 Multi-infarct dementia
  • F01.2 Subcortical vascular dementia
  • F01.3 Mixed cortical and subcortical vascular dementia
  • F01.8 Other vascular dementia
  • F01.9 Vascular dementia, unspecified
  • F02 Dementia in other diseases classified elsewhere
  • F02.0 Dementia in Pick’s disease
  • F02.1 Dementia in Creutzfeldt-Jakob disease
  • F02.2 Dementia in Huntington’s disease
  • F02.3 Dementia in Parkinson’s disease
  • F02.4 Dementia in human immunodeficiency virus [HIV] disease
  • F02.8 Dementia in other specified diseases classified elsewhere
  • F03 Unspecified dementia

A fifth character may be added to specify dementia in F00-F03, as follows:

  • .x0 Without additional symptoms
  • .x1 Other symptoms, predominantly delusional
  • .x2 Other symptoms, predominantly hallucinatory
  • .x3 Other symptoms, predominantly depressive
  • .x4 Other mixed symptoms
  • F04 Organic amnestic syndrome, not induced by alcohol and other substances
  • F05 Delirium, not induced by alcohol and other psychoactive substances
  • F05.0 Delirium, not superimposed on dementia, so described
  • F05.1 Delirium superimposed on dementia
  • F05.8 Another delirium
  • F05.9 Delirium, unspecified
  • F06 Other mental disorders due to brain damage and dysfunction and to physical disease
  • F06.0 Organic hallucinosis
  • F06.1 Organic catatonic disorder
  • F06.2 Organic delusional [schizophrenia-like] disorder
  • F06.3 Organic mood [affective] disorders

 

  • .30 Organic manic disorder
  • .31 Organic bipolar affective disorder
  • .32 Organic depressive disorder
  • .33 Organic mixed affective disorder

 

  • F06.4 Organic anxiety disorder
  • F06.5 Organic dissociative disorder
  • F06.6 Organic emotionally labile [asthenic] disorder
  • F06.7 Mild cognitive disorder
  • F06.8 Other specified mental disorders due to brain damage and dysfunction and to physical disease
  • F06.9 Unspecified mental disorder due to brain damage and dysfunction and to physical disease
  • F07 Personality and behavioural disorder due to brain disease, damage and dysfunction
  • F07.0 Organic personality disorder
  • F07.1 Postencephalitic syndrome
  • F07.2 Postconcussional syndrome
  • F07.8 Other organic personality and behavioural disorder due to brain disease, damage and dysfunction
  • F09 Unspecified organic or symptomatic mental disorder.

Etiology and Risk Factors of DEMENTIA:

→ Associated with brain

► Neoplasms and other brain lesions:

 

  • Infections of the brain such as meningitis and encephalitis
  • Degenerative disorders of the brain like Huntington’s disease and Creutzfeldt Jacob syndrome.
  • Parkinson’s disease.
  • Neurovascular disorders like cranial hypertension, cerebrovascular accident associated with circulatory collapse or cranial haemorrhage, arteriosclerosis.
  • Head injuries and trauma such as subdural or epidural hematoma.

► Congenital

  • Down syndrome

► Nutritional

  • Deficiency of niacin (also called nicotinic acid, Vitamin B3), thiamine (Vitamin B1), cobalamin (Vitamin B12)
  • Vitamin A deficiency

→ Other systemic disorders

  • Cardiovascular disorders
  • Respiratory failure
  • Anemia
  • Shock
  • Thyroid disorders
  • Hepatic failure
  • Diabetes
  • Hypoglycemia
  • HIV-AIDS
  • Myxoedema
  • Addison’s disease
  • Syphilis

→ Drug-associated

► Associated with

  • Sedatives,
  • Analgesics,
  • Anticonvulsants,
  • Antipsychotics, etc.

► Intoxication

  • Intoxication to psychoactive drugs.
  • Lead poisoning.
  • Intoxication to mercury, manganese and other toxic compounds which could cross the BBB (blood brain barrier) and enter the cerebrospinal fluid.

→ Psychiatric factors

  • Hysteria
  • Catatonia
  • Depressive pseudodementia

EARLY SIGNS OF DEMENTIA:

  • Disorientation
  • Amnesia
  • Aphasia
  • Impaired judgement
  • Inability to calculate
  • Lack of abstract thinking ie, illogical thoughts
  • Mood swings
  • Mild to moderate depression
  • Paranoid delusions
  • Lack of interest
  • Impaired processing of incoming information
  • Disturbed occupational life
  • Stereotyping
  • Dizziness and drowsiness
  • Ataxia
  • Confused nature.
  • Agitation and anger
  • Disturbed cognition ie, thinking and reasoning
  • Impaired socialization
  • Withdrawal behaviour
  • Apathy or avolition
  • Isolation
  • Anxiety and restlessness
  • Agnosia
  • Dysphasia
  • Akinesia
  • Stiffness
  • Stooping
  • Sexual dysfunction

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DIAGNOSTIC CRITERIA FOR DEMENTIA

1. Memory impairment
2. Cognitive disturbances (one or more ):

(a) aphasia
(b) apraxia
(c) agnosia
(d) disorientation and difficulty in implementation of actions.
(e) cognitive deficits and decline

The impairment of cognition and memory is not associated with the following :

  • Central nervous system conditions
  • Systemic conditions
  • Substance-induced conditions

The disturbance is not associated with any psychiatric disorder such as Depression, Schizophrenia

STAGING OF DEMENTIA

Staging of dementia is done on the basis of clinical manifestations and the severity of the disorder;

III STAGE MODEL

⟹ EARLY STAGE (2-4 years)
⟹ MIDDLE STAGE (4-12 years)
⟹ LATER STAGE

VII STAGE MODEL

⟹ STAGE 1 NO APPARENT SYMPTOMS
⟹ STAGE 2 FORGETFULNESS
⟹ STAGE 3 MILD DEMENTIA
⟹ STAGE 4 MILD TO MODERATE DEMENTIA
⟹ STAGE 5 MODERATE DEMENTIA
⟹ STAGE 6 MODERATE TO SEVERE DEMENTIA
⟹ STAGE 7 SEVERE DEMENTIA

III STAGE MODEL

⟹ EARLY STAGE (2-4years)

  • Forgetfulness
  • Faded memory
  • Difficulty in abstract thinking
  • Mild changes in personality and daily lifestyle
  • Confusion
  • Disorientation
  • Lack of interest in the environment
  • Impairment of judgement
  • Low activity

⟹ MIDDLE STAGE (4-12years)

  • Isolation
  • Low response level
  • Confusion (comparatively increased than early stage)
  • Disturbed sleep pattern
  • Feels difficulty in following commands due to forgetfulness
  • Inability to initiate and carry out activities usually requires assistance.
  • Anxiety.
  • Irritative and aggressive
  • Wandering behaviour due to restlessness and confusion
  • Impaired cognition (comparatively increased impairment than early stage)

 

⟹ LATER STAGE

  •  Severe cognitive impairment
  • Lucidity
  • Severe impairment of abstract thinking
  • Emotional and physical restlessness and instability
  • Switches between apathy and aggression
  • Total social isolation
  • Inability to initiate and carry out activities, completely dependent on others
  • Inability to guise the family members and self-belongings
  • Incontinence of urine and bowel
  • Impaired nutritional pattern
  • Weight loss
  • Death may occur due to the severity or any complication like aspiration pneumonia, falls, burns, electric shock, etc.

 

Conclusion:

In this article, we briefly discussed “Dementia”, Classification, Etiology, Early signs of dementia, diagnostic criteria and the staging of dementia.

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