Many people think of dementia as a state of memory loss, but dementia does not simply mean memory loss.

Dementia is a disorder of multiple cognitive functions, and the most important symptom is memory loss, but in addition to this, it also causes a decline in the ability to speak or understand, impaired sense of time and space, personality changes, and a decline in calculation ability in daily life or social life. It refers to a condition that interferes with one's daily life.

As we get older, we sometimes forget things, and this is called forgetfulness. If forgetfulness is not severe, it is considered normal. However, memory loss caused by dementia is completely different from this general phenomenon. This is not an occasional symptom. It is persistent and gradually becomes more severe. This could result in you losing your job.

They may lose their sense of direction and get lost, or in severe cases, they may wander around the house without being able to find a bathroom. Eventually, they may forget to get dressed, wash their face or bathe, and may not recognize the faces of their family members.

As you get older, your memory declines and you become more prone to forgetfulness. Forgetfulness is mainly caused by remembering certain facts but having problems in the process of retrieving stored memories. If you are forgetful, you can often recall forgotten facts if you think about them step by step.

However, the memory impairment seen in dementia causes the person to forget that fact itself. “I had an important appointment, but where and at what time were we supposed to meet?” If this happens, you are forgetful, and if you say, “What? I never made that promise,” it may be a memory disorder caused by dementia.

Dementia is not just a simple memory disorder, but is accompanied by disorders of other cognitive functions that interfere with social and daily life. Cases where there is only memory impairment and no other disabilities are called mild cognitive dysfunction. About 20% of these people develop dementia, so continuous observation is necessary.

Our brain is responsible for human cognitive functions, and dementia occurs when brain cells die or their function declines. There are many causes that cause dementia. Among these, treatable causes of dementia include hydrocephalus, where water accumulates in the brain, hypothyroidism, meningitis, subdural hematoma, drug addiction, and depression. They account for approximately 15% of all dementia cases.

Meanwhile, dementias that can be improved with active treatment include vascular dementia, Alzheimer's disease, and alcoholic dementia, which are caused by ruptured or blocked blood vessels. On the other hand, encephalitis such as mad cow disease and Pick's disease cannot be treated.

The most common causes of dementia are Alzheimer's disease and vascular dementia. They account for approximately 75% of all dementia cases, and in Korea, Alzheimer's disease is the cause of about half of all dementia patients. Vascular dementia is the second most important cause and is caused by multiple blockages in blood vessels or a single reduction in blood supply to a specific part of the brain.

Symptoms of dementia include:

* Forgetfulness becomes worse.

* Difficulty learning new information or following instructions.

* Repeating the same story over and over again or asking the same question multiple times.

* Unable to find the right words and finish speaking or writing.

* Says things that don't make sense (talks gibberish).

* Losing or hiding items or accusing others of stealing them.

* Unable to recognize other people.

* Shows fear, nervousness, sadness, anger and anxiety (emotional changes are severe).

* Inability to do everyday tasks such as cooking, eating, driving, or taking a bath.

Alzheimer's disease is a degenerative neurological disease in which brain neurons gradually die as abnormal proteins (amyloid beta protein, tau protein) accumulate in the brain. Here, the meaning of degeneration refers to a case where cells are gradually damaged and symptoms gradually appear in normal people as they age.

Symptoms begin slowly, and in the early stages, people may not be able to remember recent events or perform tasks they are accustomed to. How quickly the disease progresses varies from person to person. However, as nerve cells gradually become damaged, the person becomes unable to concentrate, becomes easily confused, and changes personality.

You may also become impatient, wandering aimlessly from place to place, and your judgment may become blurred. As the disease progresses, people may have difficulty finding the right words when talking to others, have difficulty understanding conversations, and are unable to give simple instructions or solve complex problems. Eventually, patients with Alzheimer's disease become unable to live independently and become dependent on their guardians for everything.

Dementia is not a disease in itself, but refers to a condition in which cognitive functions such as memory, judgment, reasoning, and calculation ability decline due to various causes, and personality changes and abnormal behavior occur. Alzheimer's disease is the most common disease, accounting for about half of the dozens of diseases that cause dementia. As abnormal proteins (amyloid beta protein, tau protein) accumulate in the brain, nerve cells suffer irreparable damage, causing Alzheimer's disease.

Meanwhile, symptoms of dementia may appear when the amount of acetylcholine, a neurotransmitter responsible for communication between nerve cells responsible for cognitive functions, decreases or the junctions between cells are damaged.

When dementia symptoms are severe, even the general public can easily tell that it is dementia. However, in the early stages of dementia, it is not easy to determine whether it is dementia. To achieve this, neurological and neuropsychological tests must be performed along with a detailed record of the patient's symptoms.

Neuropsychological tests examine various aspects of brain function and must be performed by an examiner with specialized knowledge in testing memory, attention concentration, language ability, performance, calculation ability, and spatiotemporal sense. Through this, the presence or absence of dementia can be determined. You can find out the degree of dementia and the area of ​​the brain damaged.

Once dementia is diagnosed, various tests are performed to determine the cause of dementia, including brain blood flow tests using nuclear magnetic resonance imaging (MRI) and single photon emission imaging (SPECT), and brain cell analysis using positron emission tomography (PET). You can take a look at the lines. Blood tests (liver function, blood sugar, kidney function, anemia), electroencephalography (EEG), thyroid function test, and apo-E trait test are also performed. Through this, the cause of dementia can be identified and appropriate treatment can be administered. Brain nuclear magnetic resonance imaging or single-photon emission imaging is performed painlessly and takes about 40 to 50 minutes. This test can detect vascular dementia, brain tumors, hydrocephalus, and chronic subdural hematoma.

Alzheimer's disease may show brain atrophy or decreased blood flow, but in the early stages of the disease, there may not be any special abnormalities, so the patient's symptoms and neuropsychological tests are important tests. The APO trait test helps determine whether Alzheimer's disease is the cause of dementia in patients with dementia and, in cases of Alzheimer's disease, can predict the rate of worsening.

It is best to prevent vascular dementia in advance. By detecting and controlling various risk factors in advance, you can prevent strokes from occurring, and by doing so, you can naturally prevent vascular dementia. However, if a stroke has already occurred, active treatment is needed to prevent the stroke from recurring. This is because for patients with mild vascular dementia, symptoms improve to some extent with treatment.

Drugs used to prevent stroke recurrence include anticoagulants and platelet aggregation inhibitors, to which agents that improve blood circulation or brain function are added. Anticoagulants are mainly used to treat embolism, which occurs when a blood clot breaks off from a large blood vessel in the heart or neck area and blocks the blood vessel. Although it has a strong effect in preventing the formation of blood clots, it is not commonly used in patients over 75 years of age due to the risk of bleeding. Also, there is the inconvenience of having to undergo a blood test at least once a month to check the anti-coagulant effect.

Platelet aggregation inhibitors are drugs that inhibit platelet function and prevent aggregation from occurring. In Korea, aspirin, ticlopidine, and Disgran are commonly used drugs. The drug's relapse prevention effect only works while you are taking the drug, and if you stop taking the drug, the preventive effect disappears, so it is necessary to take it consistently for the rest of your life.

Recently, results showed that drugs called Aricept and Exelon, which are used to treat Alzheimer's disease, are also effective in vascular dementia, and are awaiting sales approval from the U.S. Food Safety and Health Administration (FDA), which is good news for patients with vascular dementia. .

Dementia is not always accompanied by memory impairment. A typical case that is not initially accompanied by memory impairment is frontotemporal dementia. One of the biggest characteristics of frontotemporal dementia is that 'personality changes' come first rather than memory impairment or loss of sense of direction in the early stages.

Of course, as it progresses further, other cognitive functions also decrease. In addition, the symptoms commonly seen in frontotemporal dementia are listed below. In other words, smile a lot and go out a lot. I can't sit still in the house and pace around. Repetitive behavior (for example, opening and closing the door frequently, going in and out of the bathroom unnecessarily, repeating the same words or songs all day, etc.), not being able to hold in urine or stool, etc.

Because there are many strange behaviors, it is often mistaken for other mental illnesses in the early stages. When strange behavior appears, it is important not to just assume it is mental illness, but to suspect this type of dementia and seek neurological treatment.

Hydrocephalus is a disease that mainly occurs in elderly people over 60 years of age. Inside the brain, there is a space called the ventricle, which is filled with a water-like liquid called cerebrospinal fluid. However, if the ventricle becomes overfilled with cerebrospinal fluid for some reason, symptoms of dementia, gait abnormalities, and urinary incontinence may occur.

These symptoms progress slowly, and strange gait may appear earlier than dementia symptoms. Although the patient actually has good leg strength, he or she feels that the legs are weak and gets tired easily when walking. The walking speed is slow, the stride length is short, the soles of the feet cannot be lifted off the floor, and the body cannot maintain its balance, so it appears that it keeps falling forward. Symptoms such as trembling hands, inability to make delicate hand movements, or difficulty writing well may appear later. Urinary incontinence, which is the inability to urinate well, usually appears later than other symptoms or may not be present.

Characteristics of dementia in patients with hydrocephalus include a significant decrease in concentration and memory, and performance impairment (frontal lobe disorder) that prevents the patient from performing complex actions. And most patients are quiet and indifferent, showing symptoms similar to depression.

The term 'dementia' refers to an overall decline in cognitive abilities. It denotes a reduction in intellectual functions due to acquired brain damage after reaching a normal level of mental capacity. In contrast, a condition where cognitive abilities are impaired from birth is referred to as 'Intellectual Disability'. To elaborate, dementia is not a single disease diagnosis, but a term encompassing symptoms resulting from various underlying causes where memory and other cognitive functions deteriorate due to acquired brain damage.

In our country, when memory declines with age, repetitive speech, forgetting recent events, failure to recognize people, or exhibiting unusual behaviors, it has been referred to as 'senility' or 'dementia'. Cognitive impairment in dementia typically presents with multifaceted features.

Cognitive impairments can be broadly classified into five categories:

1. Memory impairment

2. Language impairment

3. Spatial-temporal orientation impairment

4. Changes in personality and emotions

5. Frontal lobe dysfunction and other cognitive impairments.

Dementia is defined as either 'having three or more impairments among the five categories of cognitive impairment' or 'interference in daily or social life due to memory impairment and at least one other cognitive impairment'. Therefore, simple memory impairment alone is not classified as dementia

As dementia worsens, the ability to swallow decreases, causing food and water to be inhaled into the lungs, causing repeated pneumonia. And because they cannot move, they end up lying down, which often causes bedsores to occur. Because they cannot cover their urine at all, they often end up wearing urine strips, which often leads to urinary tract infections. Dementia progresses slowly, and on average it takes about 7 to 10 years from onset to death.

The cause of death in patients with dementia is rarely due to the dementia itself, but most cases ultimately result from complications mentioned above, such as pneumonia, bedsores, urinary tract infections, etc., which progress to sepsis, which occurs when bacteria spread into the blood and grow.

A detailed dementia diagnostic evaluation can tell you several things:

* What illness are you suffering from?

* Can the disease be improved or cured?

* What type of disability or brain dysfunction is there?

* Which areas of the brain can currently function normally?

* What changes are expected in the future?

* What are some ways to get help or support with patient care?