Dementia is not a single disorder, but rather a combination of age-related symptoms involving a loss of mental skills and deteriorating brain function. Dementia literally translates to “deprived of mind,” and may be the result of several different underlying conditions, some of which are treatable and some of which are not. Patients with dementia gradually lose memory, communication skills, the ability to reason, and the facility to complete the tasks of everyday living.
Causes of Dementia
The most common cause of dementia is Alzheimer’s disease, a condition in which nerve cells lose the ability to communicate with one another, and slowly die. Other causes of dementia include:
- Parkinson’s disease or Huntington’s disease
- Vascular dementia or stroke
- Chronic abuse of alcohol or drugs
- Nutritional deficiencies
- Infections (such as AIDS or Creutzfeldt-Jakob disease)
- Developmental abnormalities
- Severe depression
- Hormonal imbalance
- Traumatic or chronic brain injury
- Brain tumor
- Severe kidney, liver or lung disease
Symptoms of Dementia
The symptoms of dementia develop gradually and may not be noticed until they worsen. Symptoms may include:
- Memory loss
- Difficulty speaking
- Difficulty understanding words
- Changes in personality, mood or behavior
- Difficulty planning or performing sequential tasks
- Getting lost in familiar places
- Neglecting personal safety and hygiene
Types of Dementia
There are two basic types of dementia: cortical and subcortical, characterized by the part of the brain affected. In cortical dementia, the variety that includes Alzheimer’s and Creutzfeldt-Jakob disease, the cerebral cortex is affected. Patients with these disorders experience memory loss and aphasia, the inability to use language effectively. In subcortical dementia, the area beneath the cerebral cortex is affected. Patients with this type of dementia may have intact memory and language skills, but have trouble coming up with ideas or thinking quickly.
Treatment of Dementia
The success of dementia treatment depends a great deal on the root causes of the problem. Certain forms of dementia can be cured if caught before permanent brain damage has occurred.
When dementia results from nutritional lacks, such a vitamin deficiency, for example, vitamin supplements can bring the patient back to normal functioning. This is also true of the dementia resulting from hypothyroidism. Once the necessary thyroid hormone is administered, the patient’s brain function may improve greatly, assuming the condition has been diagnosed at an early stage.
In situations in which the dementia results from a brain tumor or hydrocephalus, surgical intervention can make a tremendous difference. There is also a condition known as pseudodementia, in which the symptoms of dementia result from severe depression. Once diagnosed, this disorder usually responds well to antidepressants.
For patients with Alzheimer’s disease and other organic forms of dementia, the prognosis is much worse. Although much research is being conducted to find successful treatments for the disease, there is no medication at present that will cure such dementia or reverse its symptoms.
Nonetheless, there are psychotropic medications available to help manage symptoms such as agitation and depression. Medications called cholinesterase inhibitors, such as Aricept® (donepezil HCI), have been demonstrated to have some positive effect on brain activity. Cognitive behavioral therapy, eating a proper diet, engaging in physical exercise and having social contact have also been found to improve daily functioning or slow the progression of the disease.
Types of Dissociative Disorders
While all dissociative disorders are characterized by an abnormal detachment from the sense of self or from one’s own memories or experiences, four distinct types of dissociation have been differentiated.
This type of dissociative disorder involves sudden extensive memory loss after a traumatic event and is most frequently diagnosed in children. The patient with dissociative amnesia blocks out terror or extreme pain with an involuntary loss of memory. The memory loss involved may be all-encompassing general amnesia, localized amnesia surrounding a period of hours or days, selective amnesia where only certain parts of an event are remembered, or systematized amnesia where certain aspects of the past are blotted out, such as anything pertaining to a particular person.
A rare type of dissociative disorder, dissociative fugue involves physical escape from highly distressing events. Though temporary, this disorder causes patients to become confused about their own identities and to perhaps assume new ones. In this fugue state, during which they are unsure of who they are, they leave work, home or school and travel for days, weeks or months.
Dissociative Identity Disorder
Dissociative identity disorder was formerly known as multiple personality disorder. This disturbance involves assuming different identities to cope with unbearable stress. People with this disorder experience splits in their identity, feeling themselves to be inhabited by more than one self. They often report feeling the presence of others, or hearing the voices of others, inside their own minds.
Patients with depersonalization disorder feel outside of themselves, observing their own behavior from a distance. The sense of detachment may come and go over a period of years, interrupting daily life, interfering with work or relationships, and leading to delusional thinking.
Symptoms of Dissociative Disorders
Many patients with dissociative disorders may be disquieted by their symptoms without really understanding their cause. They may be aware that they are having serious psychiatric difficulties, but have trouble expressing precisely what their symptoms are. Symptoms may include:
- Blurred sense of identity
- Memory loss surrounding certain periods, events or individuals
- Depression, anxiety, dread
- Detachment or depersonalization
- Sense that reality is distorted or unreal
- Inexplicable loss of periods of time
These symptoms are serious and require treatment since untreated they are life-threatening and may eventually result in suicide.
Diagnosis of Dissociative Disorders
Dissociative disorders are diagnosed and differentiated according to criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DMS), published by the American Psychiatric Association. In order for a positive diagnosis, the symptoms must be found not to be explicable as the result of prescription medication, substance abuse, or an underlying medical condition, such as temporal lobe epilepsy.
Treatment of Dissociative Disorders
Once a patient is diagnosed as suffering from a dissociative disorder, several treatment options are available, both to alleviate distressing symptoms and to undercover the causative trauma. These treatments include:
- Cognitive therapy
- Art therapy
- Medications for symptom relief, such as tranquilizers or antidepressants
Prevention of Dissociative Disorders
Early intervention involving counseling or psychotherapy after a traumatic event can sometimes help to prevent the formation of a dissociative disorder. It is considered healthy for the patient to deal with the trauma as soon after its occurrence as possible. In children, this can be achieved through play therapy or art therapy, rather than explicit discussion. For adults, too, it may be best for therapists to help the patient confront the trauma indirectly through hypnosis or art therapy in order to avoid retraumatization.