At the beginning of the 20th century, the term ‘insanity’ was used to designate all kinds of mental illness. In 1907, Alois Alzheimer described a new disease, which in principle is considered an atypical form of presenile dementia, in a patient with psychotic symptoms, behavioural disorders, depression and cognitive impairment.
Since then, research within neuropathology have contributed to our understanding of dementia. In particular, we now know that the degenerative diseases are characterised clinically by loss of neurological function, and pathologically by loss of neurons. In some of them, loss of neurons is accompanied by specific histopathological findings such as Alzheimer’s plaques and Lewy bodies.
For a long time, the names of dementia are either known as ‘senile’ and ‘presenile’, depending on the age of onset of the clinical picture remained as if they were nosological entities differentiated. Each form of dementia can cause difficulty with memory, language, reasoning and judgment – but the symptoms are often very different from person to person. Symptoms also change over time.
The differences between one form of dementia and another may only be recognisable to skilled healthcare providers who have experience working with people with dementia. Sometimes family members notice changes but mistakenly attribute them to ageing.
Needless to say, misconceptions of dementia and the people who are affected by it are a problem around the world. Stigma prevents people from acknowledging symptoms and obtaining the help they need.
Although Alzheimer’s or any form of dementia can only be diagnosed by a doctor and after a complete medical assessment, some early warning signs shouldn’t be overlooked. Early detection does matter, and if you notice any or more of these signs in yourself or your loved one, please see a doctor.
Neurocognitive disorders such as delirium, mild cognitive impairment and dementia, are characterised by decline from a previously attained level of cognitive functioning. These disorders have diverse clinical characteristics and aetiologies, with Alzheimer disease, cerebrovascular disease, Lewy body disease, frontotemporal degeneration, traumatic brain injury, infections, and alcohol abuse representing common causes.
This complexity is reflected in the variety of approaches to classifying these disorders, with separate groups determining criteria for each disorder on the basis of aetiology. As a result, there is now an array of terms to describe cognitive syndromes, various definitions for the same syndrome, and often multiple criteria to determine a specific aetiology. The DSM 5 provides a common framework for the diagnosis of neurocognitive disorders, first by describing the main cognitive syndromes, and then defining criteria to delineate specific aetiological subtypes of mild and major neurocognitive disorders.
Right now, researchers are focusing on identifying the cause of neurodegeneration. Research have identified two main groups of genes involved in mutations that result in an overproduction of a protein called tau, a hallmark of the progressive loss of neurons observed in the main forms of dementia.
There is currently no treatment that can alter the course of dementia or neurodegeneration. Although scientists have identified genes associated with the risk of dementia, there is little understanding of how those genes contribute to the cascade of events that lead to the brain cells to die.
There is still a significant amount of work that needs to be done to develop drugs that can be used effectively, but what the researchers are doing are definitely encouraging.
Dr Teraiza Mesa Rodriguez is a Psychiatrist in Venezuela. She sits on the board of the International Scientific Committee of Psiquiatria. She is also serves as a reviewer for the Journal of AIDS and HIV Research. Dr Mesa is an active member of the Venezuelan Society of Psychiatry and is also a member of the Venezuelan College of Psychopharmacology. You can connect with her on Twitter @Dra_TeraizaMesa