Dementia or Neurocognitive disorders

The term Dementia is derived from Latin stock, meaning without mind. According to DSM fourth edition, text revision, dementia refers to multiple cognitive deficits that involves memory impairment, and one or more of the following, viz. language disturbance (aphasia), impairment in carrying out skilled motor activities despite intact motor functions (apraxia), deficits in recognizing familiar persons or object despite intact sensory function (agnosia), impairment in planning, initiating, organizing, and abstract reasoning (executive dysfunction). DSM-5 replaced the term dementia with neurocognitive disorder, major or minor. It also obviated the need of memory impairment to qualify the definition of the disorder.

Alzheimer’s disease (AD) is the most common form of dementia and accounts for nearly 60-70% of all cases. As per a current estimate AD affects over 35 million people worldwide. 

Age is perhaps the most important risk factor, as prevalence rate doubles every five years after age 65. Other important risk factors are postmenopausal women, lower intelligence, fewer year of education, traumatic brain injury, and many medical and psychiatric conditions eg. Diabetes, hypertension, stroke, MI, dyslipidemia, obesity, chronic stress, depression etc. There are some genetic risk factors also like Presenilin 1&2, APP, APOE  genes etc.

The evolving  history of slowly progressive cognitive decline involving memory and other domains is the most important diagnostic clue which is aided by neuropsychological battery (MMSE, MOCA, FAB, Lobar function),  neuroimaging ( MRI, amyloid PET, FDG-PET) and biomarker (Abeta /tau in CSF)  to arrive at a proper diagnosis.

AD risk may be decreased by regular exercise, mental stimulation, socialization and better dietary habits with regular intake of low calorie, low fat diet rich in omega 3 fatty acids/DHA, vitamins (folate, B12, B3, C,E) and antioxidants; and regular servings of fruits and vegetables.

Donepezil, Rivastigmine, Galantamine, Mementine and Caprylidine triglyceride are FDA approved medications for the treatment of AD. Cognitive rehabilitation, involving problem solving and attention skills, has also been suggested to slow the progression of the disease and facilitate gain in skills.

So timely recognition of symptoms by the caregiver and physicians lie to the core of a ready diagnosis and institution of treatment and rehabilitation which help patients gain the lost  skills and lead a better and graceful life with fair degree of independence.

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