• What is Dementia?  What is the relationship between mental disorders diseases such as Alzheimer’s Vascular, Frontotemporal, Lewy Body, Parkinson’s, etc. and Dementia?  Is it too complex to understand?  Figure 1 indicates the major mental disorders that progress into dementia.  Can a normal aging person progress into dementia?

Figure 1: Mental Disorders Leading to Dementia

Dementia

          During the twentieth century, the cause of death for mental illness was documented as “Senile Dementia”.  This provided the medical profession an umbrella for signing death certificates.  Currently dementia is inappropriately being interchanged with Alzheimer’s Disease (AD), Lewy Body Disease (LBD) that includes Parkinson’s Disease (PD), Vascular Disease (VD), Frontotemporal Disease (FD).  The bottom line is that a portion of the population develop these mental disorders which progress neurologically, involving different parts of the brain, different proteins, different symptoms, but with a common end-result of mental decline, and the inability to self-sustain Activities of Daily Living (ADL).  ADL is the point were all mental disorders require continuous care of basic needs (like beginning of life), such as bathing, clothing, toileting, medicine management, walking, meals, feeding, entertainment, attention and love.  Disorder variations include behavior problems, wandering, delirium, hallucinations, paranoia, depression, violence, communication, and sleeping, etc.  This is the dementia stage.

          At this dementia stage, patients may continue decline through one or more of the other disorders, especially AD, Lewy Body or Vascular strokes, as well as normal aging.

Different Mental Disorders Abnormalities

  • Alzheimer’s Disease involves the agrgation of Beta Amyloid plaque (AB42) that accumulates to trigger Tau fibrils and tangles which cause the death of neurons in level two of the Entorhinal Cortex (EC). This results in memory loss and with progression, loss of the Neocortex’s executive function. This eventually leads to a dementia stage.
  • Vascular Disease involves blood supply to the brain resulting in strokes, as well as Cerebral Amyloid Angiopathy (CAA) triggering strokes, and small vessel disease.  The area of the brain is unpredictable. CAA is a build-up of amyloid plaque in arteries and veins in the brain.
  • In Parkinson’s disease, normal soluble alpha-synuclein constituents of the cell become insoluble and aggregate into spherical inclusion called Lewy bodies.  Lewy bodies role in Parkinson’s disease is unknown but is under investigation.  In the brain, Lewy bodies collect in the cells in the substantia nigra, a structure that orchestrates movement.
  • Frontotemporal Disease (FTD) affects the frontal and temporal lobes. Its familiar forms are caused by a mutation in the Tau gene.  Abnormal aggregates of Tau are found in the neuron of FTD nd Supranuclear Palsy (a movement disorder) patients, as well an glia cells and cortico-basoganglionic degeneration.  FTD familiar forms include Picks disease (Now called FTD), Aphasia (language issues), and later in decline and gouging of food.

Why Is Dementia Complex?

          Dementia is complex because the mental disorders leading to dementia (Fig.) affect different parts of the brain, different proteins, symptoms, progressions, and immune system responses.  These differences present independent challenges for funding, research, and care economics for families and institutions.  The key trigger between disorder diseases and dementia is the ability to perform activities of daily living.  Losing this ability is a major game changer for caregivers.  Like beginning of life, continual care is required when ADL is lost. 

          When a patient reaches the dementia stage, life can be as short as months, or as long as many years.  During the period a patient can unknowingly develop the other mental disorders.

         Dementia stage complexity occurs in normal aging. As life produces more centurions with normal neuron loss, they are no longer able to perform activities of daily living. This will require continuous care.  Dementia is an end-of-life syndrome where cure is not an option. Care becomes the only priority for a patient? 

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