Late-onset dementia - diagnosis and therapy

Generally, the continuous rise in life expectancy leads to an increasing number of senior citizens (3). Therefore dementia as leading neuronal alteration occurs and diagnosed more often, 36 million people in the world are living with dementia with a projected increase in 2030 to 66 million0 (2). Dementia is a syndrome that is the effect of extended brain disease. It can be described as any disorder where significant decline from one’s previous level of cognition, emotional, behavioral abilities causes interference in everyday life.

The progression of the disease may differ from person to person depending on individual alterations in general health and even genetic background. Neurodegenerative dementias, like Alzheimer’s Disease, vascular dementia, and dementia with Lewy bodies, are most common in the elderly. Leading conditions that may contribute to the disease and the progression, considered as risk factors such as:

  • cardiovascular events, alterations

  • obesity

  • diabetes

  • aging

  • head injury

  • genetics


What are the main characteristics of the disease?

  • in the beginning short term, later on, long term memory impairment,

  • language impairment,

  • changes in personality,

  • psychiatric syndromes

  • behavioral changes


Diagnosis

It is very important to define the clinical, biochemical, structural, and metabolic presence of the disease at the earliest stages before full-blown dementia (2). Family physicians have an increasingly important role in recognizing early signs and symptoms of the disease, ordering appropriate cognitive and even blood tests, formally diagnosing, and, finally, treating these patients.

The recent decade has seen significant advancements in molecular neuroimaging- magnetic resonance imaging (MRI), molecular neuroimaging with positron emission tomography (PET)- in understanding clinicopathologic correlation, and in the development of novel biomarkers (cerebrospinal fluid (CSF) analysis) (1). Consequently, the diagnostic tools became more sophisticated than before, which finally contribute to the earlier detection of those alterations which lead to the development of the disease.


Therapy

Presently there are no disease-modifying treatments for any of the neurodegenerative dementias. Instead, the clinician has several therapeutic tools to mitigate the cognitive and behavioral consequences of dementias (4).


Symptom modifications:

  • Pharmacological amelioration of cognitive symptoms such as deficits in memory, concentration, speed of mentation, and others.

  • Pharmacological management of neuropsychiatric symptoms (anxiety, depression, apathy, and agitation).

  • Nonpharmacological interventions to ameliorate cognitive and neuropsychiatric symptoms.


Harm minimization:

A dementia patient is vulnerable to deliberate and accidental harm. One goal of treatment is to protect the patients against these potential harms (Tisher and Salardini 2019). Adopting a healthy lifestyle including a healthy diet, regular exercise, and participating in regular health screening may help to minimize the chance of evolving or lengthen the development of the first symptoms.


References:

  1. Gale SA, Acar D, Daffner KR (2018) Dementia. Am J Med 131:1161–1169.
  2. Kindell J, Keady J, Sage K, Wilkinson R (2017) Everyday conversation in dementia: a review of the literature to inform research and practice. Int J Lang Commun Disord 52:392–406.

  3. Mitrečić D, Petrović DJ, Stančin P, et al (2020) How to face the aging world - lessons from dementia research. Croat Med J 61:139–146

  4. Tisher A, Salardini A (2019) A Comprehensive Update on Treatment of Dementia. Semin Neurol 39:167–178.