A few weeks ago I was on the SteemStem discord channel chatting with @saho, and his post about Mood disorders came up. This, in turn, prompted the interest of another fellow steemian whose dad has been diagnosed with vascular dementia. Coincidentally, that week, I had been reading about dementias and soon understood why that fellow steemian was keen to get more information on the subject.

You see, people living with vascular dementia are prone to react with excessive emotion to minor things and to experience mood swings. These emotions are something that, in some individuals, can even be conveyed through physical violence. Other possible symptoms of vascular dementia are delusions and hallucinations; which inevitably reminds me of my grandmother, who weeks before her death (at 82) reported seeing “a little boy running around the house”. Granny died less than two months after she started talking about the little boy and, other than hallucinations, she did not display any of the other characteristic signs and symptoms of vascular dementia, which contrarily to Alzheimer’s dementia (AD) generally has a sudden onset often following a stroke.

Some of other signs and symptoms are:

• Difficulties with concentration & communication
• Cognitive impairment, such as memory loss
• Epileptic seizures
• Symptoms of stroke, for example: paralysis of an arm
• Getting lost
• Symptoms of depression

An important thing to keep in mind here is that signs and symptoms will vary from person to person, because in this sort of dementia this is dependent on what area of the brain has been damaged.

But, what is Vascular Dementia?

Well, dementia is related to neurodegenaration and changes in brain function. Therefore, it is regarded to be a disorder of the brain. So, in vascular dementia this is a result of poor (or interrupted) blood supply to the brain. As you know, blood carries nutrients and oxygen, elements that neurons cannot function properly without. This lack of oxygen and nutrients will eventually cause the progressive death of brain cells, which may prompt the onset of vascular dementia.

What are the risk factors for vascular dementia?

The same as those for heart disease and stroke: smoking, diabetes, atherosclerosis, high-blood pressure and so forth.

Here, the only box my grandmother would have ticked was the smoking one, which she did for most of her life. Still, if I continue to speculate that her hallucinations were indeed a symptom of vascular dementia what might have happened to her was the onset of a progressive decline of both her cognitive and non-cognitive functions as a result of mini-strokes that were so small that the symptoms either went unnoticed or were temporary (a multi-infarct dementia).

Another possibility, of course, is that the naughty little boy she often saw running around was a real ghost 😲

Frontotemporal Dementia

Frontotemporal dementia is a very tricky disorder to be diagnosed, and this is mainly due to its early onset. Most cases of dementia are seen in individuals at the age of, or older than 65 years, but the onset of frontotemporal dementia can be even seen in people in their 50’s. Further, the fact that its first symptoms are mainly showed through non-cognitive functions makes it even harder for an early diagnosis to take place.

The reason for this is because neurodegeneration in this case happens in the frontal cortex to begin with, to then progress to the temporal cortex (in AD this happens the other way round). This is really delicate because the frontal lobe is where our personality “lives”, it is where our emotions are controlled and also managed.

So, what happens when the frontal lobe begins to show neurodegeneration and atrophy?

Bill’s Case

Bill was 55 years-old when at a BBQ in a friend’s house he got really upset with a young boy and pushed him against a wall. This was something completely out of his character and it was also the last episode that finally made his wife to seek medical help for him. Prior to that incident, for the past few months Bill had forgotten to go to dinners, meetings, dentist appointments, and on one occasion he burst in tears when his grandchild started to cry in his arms.

From those months onwards Bill just became more and more reclusive, he lacked emotions and found it impossible to relate to his family and friends. Also, every other time his children came over to visit him, he behaved in a rather coarse and disinhibited manner.

Bill is likely to live 10 to 15 years counting from the onset of his disease (which is pretty much impossible to say precisely when). Throughout those years it is expected his personality will radically change, that he will not be able to recognise people as well as things, and that his speech will become impaired.

Causes

This is a rare disorder. 50% of frontotemporal dementia cases are inherited and result from a chromosomal mutation in the gene that makes a protein involved in the normal functioning of neurons - tau protein (the abnormal formation of this protein is also one of the three characteristic pathological brain changes in Alzheimer’s dementia). As for those who do not display such genetic changes, like Bill, the cause of the disorder remains unknown.

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Next, we are going to briefly discuss Alzheimer’s dementia, the most frequent type of dementia, and a disorder that I saw developing in very different ways: one through the experience a colleague of mine (Clara) went through with her grandmother, and the other through witnessing how it progressed on my friend’s mother, who, here, we are going to call Mrs. Molly.

Alzheimer’s Dementia – Mrs. Molly & Clara’s granny

The last time I visited Mrs. Molly was in 2013, a few weeks before her 92nd birthday and three months before her death. As soon as I arrived she smilingly looked at me and said “hello my dear, did you bring my dress and called the driver? I am a millionaire, you know?” I smiled and handed to her a 50 piece-puzzle. Off she went to the garden where her daughter showed her what to do with the puzzle; which, while chomping on an apple she half assembled and half played with for the next hour. Meanwhile, she would not stop laughing and talking to herself, while her daughter and I caught up with things.

Mrs. Molly’s scenario however was much, much different from that of Clara’s grandmother who became hostile, depressive, lost her ability to control her bowels and bladder and needed help during meals. This is because the way dementia progresses vary from one person to the next, as I mentioned before. However, there were indeed some symptoms they had in common: they both had trouble sleeping, lost awareness of time and place, lost their sense of self, and became estranged to their family members and close friends.

When Mrs. Molly smiled at me and asked me those questions, she had no idea who I was, in the same way she, for nearly 2 years, had no idea who her loving, full-time carer daughter was. Oh! Mrs. Molly had never been a millionaire.

What happened to Mrs. Molly’s and Clara’s grandmother’s brain for them to become like that?

This is a rather complex process, which very briefly described could be seen as a web of interplaying factors involving:

1. The formation of plaques due to the presence of the longer version of the β-amyloid peptide, which when not removed effectively has the tendency to form clumps between brain cells.
2. The formation of tangles by a hyperphosphorylated form of tau. Tau is a protein that binds to microtubules in neuronal axons. But, tau containing many phosphate groups attached to it cannot bind to microtubules effectively. This of course prevents the normal function of the neuron which will subsequently die.
3. Severe loss of brain volume (due to neuron death).

The three processes mentioned above begin to take place in the hippocampus and medial temporal lobes. As you can see, this is why people with AD suffer from memory impairment, because those are regions of the brain that play an important role in consolidating (declarative) memories.

What Causes AD?

With regard to genetic factors it is believed that there are a few genes that contribute to the likelihood of developing AD (this is late onset AD, by the way - the kind of Alzheimer’s that appears after the age of 65). However, there is one particular gene that is seen as a potential risk for AD: the gene that produces the protein apolipoprotein E - ApoE. Individuals with the gene that produces the ApoE4 variant, when compared to the rest of the population, are at a higher risk of developing late onset AD.

Nevertheless, it is very important to keep in mind that the development of AD depends on the interaction of environmental, health and genetic factors. It is also important to have the understanding that old age does NOT necessarily come with AD, or any other type of dementia, for that matter.

And this is when the inevitable question arises:

My 78 year-old uncle is forgetful

Uncle Joseph forgets to take his medication, forgets to water his wife’s flowers, forgets where he put the invitation that the postman delivered. Gosh, the list goes on. That makes auntie T. absolutely mad; but then, she gets worried.

‘Abi, does Joseph have dementia?’

Naah ... look at the things uncle Joseph forgets! On the other hand, he doesn’t forget when his favourite football team’s game is on, or when his pension is going to be deposited in his bank account. More importantly, uncle Joseph can still make rational decisions, he still retains his social manners, and except when his football team is on a losing streak his mood is pretty stable. He is also constantly aware of who he is, who his family members are as well as his acquaintances.

What he has is normal age-related memory decline and a very sweet wife!

To learn more about the normal decline that aging brings to our cognitive functions, please take a look at @dysfunctional’s latest post: Understanding Brain Aging.

Early Diagnosis

Still, just in case there is an elderly family member of yours who, besides a certain level of memory loss, is also behaving out of character, losing awareness of where they are, or of time (day, month, year), it is important to have them examined by a clinician.

To screen individuals for dementia clinicians normally rely on the MMSE , the CDR and the FAST. An early diagnosis can sometimes delay the progress of this disease. Individuals diagnosed with AD can live for up to 10 years, a period which their cognitive abilities will progressively decline.

Prevention

You will be surprised to learn how simple it is to adopt measures that can help prevent the development of the types of dementias we discussed here:

• Adopt some form of intellectual activity – active reading, creative writing (hellooo, Steemit!)
• Reduce the amount of sugary/processed foods in your diet. There is evidence that Alzheimer’s represents a form of diabetes, in some medical circles it is even referred to as Diabetes Type 3 – this is material for a post on its own!
• Move that body – get up, tidy up your surroundings, go for a walk, dance with the children (and the husband), go for a bike ride, to the gym.
• Practice mindfulness – engage with the present moment, accept both your happy and sad moments, remain aware of what is around you, breath in .... breath out.
• Keep on learning new things – a new recipe, drawing, how to cultivate herbs, and make sure you share it with us here on Steemit.

So, which one of the measures listed above are you implementing on your daily routine? I don’t mean to show off or anything like that, but except mindfulness, I follow all the others 😎

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Reference List:

Cavalieri, M. Enzinger, C., Petrovic, K., Pluta-Fuerst, A. Homayoon, N., Schmidt, H. et al. (2010) ‘Vascular dementia and Alzheimer’s dementia – are in a dead end road?, Neurodegenerative diseases, vol. 7, nos 1-3, pp. 122-6.

Innes, A. (2009) Dementia Studies, London, SAGE Publications Ltd.

Klein, W.L (2006) ‘Synaptic targeting by AB oligomers (ADDLS) as a basis for memory loss in early Alzheimer’s disease, Alzheimer’s & Dementia, vol. 2, pp. 43 -55.

Image source – Pixabay & Winkimedia: 1, 2, 3, 4, 5, 6

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Dear Reader,

It has been a month since I last posted on my blog, and this is because I am struggling a little to deal with all the things I have going on at the moment. 😅 My routine will only get back to normal towards the end of May, when I will be back posting on a weekly basis. I am very much looking forward to that time.

I would like to thank each one of you who has left me comments and messages asking after me. You are just too kind ❤

I hope this post has enlightened you a little about this topic. And because I know this isn’t a topic that is often discussed, I would love to hear what you have learnt here about dementia. I will slowly, but surely, reply to your comments over the coming weeks.

Thank you so very much for taking the time to read my long post.

I wish you all a wonderful weekend! 😊