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Dementia - causes, symptoms, diagnosis and treatment

Dementia - causes, symptoms, diagnosis and treatment

What is dementia?

Dementia is a progressive neurodegenerative syndrome characterised by the deterioration of cognitive functions, such as memory, thinking, reasoning and the ability to carry out everyday activities. The cognitive decline is severe enough to affect the person's independence.

Dementia is not a disease in itself, but rather a general term describing a set of symptoms associated with several diseases. It usually affects older people, yet it is not part of the normal ageing process. Dementia occurs when the nerve cells of the brain are damaged or die, which disrupts communication between nerve cells and leads to the loss of cognitive functions.

The life expectancy of a person living with dementia can vary greatly, depending on the specific type of dementia and on the stage reached at the time of diagnosis. In general, people can live between 4 and 10 years after the diagnosis, although some live up to 20 years. General health and the quality of care are factors that significantly influence life expectancy. In the advanced stages, dementia can affect the ability to eat, drink and breathe, leading to complications that may be fatal.

Types of dementia

  1. Alzheimer's disease

This is the most common form of dementia, accounting for roughly 60-70% of cases. In Alzheimer's disease, abnormal proteins (amyloid and tau) build up in the brain, causing the death of nerve cells and the gradual decline of cognitive functions. Symptoms include short-term memory loss, confusion and difficulties with spatial orientation. As the disease advances, patients may experience behavioural changes and the complete loss of independence. The disease is progressive, with no curative treatment, and average life expectancy after diagnosis is around 8-10 years.

  1. Vascular dementia

This form of dementia follows strokes or other conditions that reduce blood flow to the brain. Without an adequate supply of oxygen and nutrients, brain tissue deteriorates. The symptoms of vascular dementia can vary depending on the affected brain area, but they usually include difficulties with planning and reasoning, confusion and balance disorders. The progression is often gradual, but it can advance abruptly after each new stroke.

  1. Dementia with Lewy bodies

This is a form of dementia characterised by the presence of Lewy bodies, abnormal clumps of protein in the brain. Symptoms include visual hallucinations, fluctuations in attention and alertness, and movement disorders similar to those in Parkinson's disease. People with dementia with Lewy bodies may show muscle rigidity and tremor alongside cognitive problems. Although motor and cognitive symptoms appear at the same time, the cognitive disturbances are usually predominant.

  1. Frontotemporal dementia

This form of dementia mainly affects the frontal and temporal lobes of the brain, which are responsible for behaviour, personality and language. Symptoms can include marked behavioural changes, loss of social inhibitions and difficulties with verbal expression. Frontotemporal dementia tends to appear in younger people, between 45 and 65 years of age, and it can progress rapidly. Unlike other types of dementia, memory loss is not an early symptom; behavioural and social impairment comes first.

Causes and risk factors for dementia

  • Genetic causes

Certain genetic factors can increase the risk of developing dementia, particularly in the case of Alzheimer's disease. People who inherit mutations of the APOE-e4 gene, for example, have a significantly higher risk of developing this condition. In hereditary forms of dementia, symptoms can appear at younger ages, especially with rare genetic mutations such as those involved in early-onset Alzheimer's.

  • Ageing

Age is the greatest risk factor for dementia. The risk of developing dementia rises exponentially after the age of 65 and, after 85, roughly one third of people live with some form of dementia. As we age, the brain undergoes natural changes, but in vulnerable people these changes can lead to accelerated cognitive deterioration.

  • Cardiovascular diseases

Conditions affecting the cardiovascular system, such as arterial hypertension, diabetes, hypercholesterolaemia and atherosclerosis, can increase the risk of dementia, particularly vascular dementia. A healthy lifestyle, including control of blood pressure and cholesterol levels, can reduce the risk of dementia related to vascular problems.

  • Head trauma

Blows to the head or severe head injuries can increase the risk of developing dementia later in life. Repeated brain trauma, as seen in athletes who play contact sports, is associated with an increased risk of dementia of the chronic traumatic encephalopathy (CTE) type, a degenerative condition that affects the brain.

  • Beta-amyloid protein plaques

One of the hallmarks of Alzheimer's disease, the main type of dementia, is the formation of beta-amyloid plaques in the brain. These plaques build up between nerve cells, interfering with neuronal communication and leading to the death of neurons. Research suggests that the excessive accumulation of beta-amyloid proteins is a major cause of cognitive deterioration and of the progression of Alzheimer's disease.

  • Free radicals and oxidative stress

Free radicals are unstable molecules that can damage brain cells through oxidative stress. They are by-products of metabolism and can be triggered by environmental factors such as pollution or an unhealthy diet. In the brain, oxidative stress can damage DNA and essential cell structures, accelerating brain ageing and contributing to dementia.

  • High glucose levels

Chronic hyperglycaemia, often associated with type 2 diabetes, is another important risk factor for dementia. Excess blood glucose can damage the blood vessels that supply the brain, limiting the flow of oxygen and nutrients. This vascular damage can lead to vascular dementia or worsen other forms of dementia, such as Alzheimer's disease. Keeping blood sugar at a healthy level is essential in order to prevent cognitive impairment.

The stages of dementia

  1. The early stage
    In the early stages of dementia, symptoms are often subtle and can be mistaken for normal ageing. The main signs include short-term memory difficulties, mild confusion and small changes in behaviour. Very often the people affected realise that they have cognitive difficulties and may become anxious or defensive. The ability to make complex decisions begins to decline, but many daily activities can still be carried out independently. At this stage the diagnosis can be hard to establish, yet early intervention is essential for slowing the progression of the disease.
  2. The moderate stage
    As dementia progresses, the symptoms become more obvious. Patients start to have significant difficulty with everyday tasks such as managing finances or cooking. Memory deteriorates further and people may forget important events from their lives or details about those close to them. Confusion, disorientation and behavioural disturbances become more frequent and patients begin to depend on the help of others. At this stage patients may have motor difficulties and personality changes, and constant supervision becomes necessary.
  3. The advanced stage
    In the advanced stages, dementia deeply affects both cognitive and physical functions. People can no longer communicate effectively and often no longer recognise their family and friends. Mobility is severely impaired and many patients become bedbound. Incontinence is frequent and patients become completely dependent on carers for all daily activities. At this point the disease often leads to severe medical complications, such as infections and malnutrition, which ultimately contribute to death.

Dementia is a complex condition with multiple causes and risk factors. Understanding this disease and identifying the signs early can help improve quality of life and delay its progression.

The symptoms of dementia

Dementia affects different areas of cognitive and behavioural functioning, and the symptoms vary depending on the type and stage of the disease:

  1. Memory loss
    One of the most common and earliest manifestations of dementia is memory loss, especially of recent events. The people affected may forget important details about conversations, events or appointments. They may also ask the same questions over and over, forgetting the answers they receive. In advanced stages, memory loss becomes more severe and people may forget even fundamental things, such as the names of those close to them or how to carry out basic activities.
  2. Confusion
    Confusion appears frequently in dementia, especially when it comes to orientation in time and space. The people affected may forget where they are or what day or time it is, and they may have difficulty recognising familiar places. This disorientation can lead to a feeling of frustration and anxiety, particularly when the patient does not understand why they cannot find their way around effectively.
  3. Communication problems
    Dementia can affect the ability to express and understand language. The people affected often forget words or use them inappropriately, which makes expressing ideas difficult. They may also have trouble understanding what is said to them, which can worsen confusion and social isolation.
  4. Difficulties with reasoning and decision-making
    As the disease progresses, patients may have significant difficulty making logical decisions or solving simple problems. Everyday tasks such as paying bills or cooking become increasingly complicated, and the people affected may make dangerous or irrational decisions, such as leaving the cooker on.
  5. Behavioural changes
    Dementia brings with it profound behavioural changes. The people affected may suddenly become irritable, anxious, aggressive or withdrawn. In other cases they may develop unusual behaviours, such as a lack of social inhibitions or the repetition of certain actions. These changes are stressful both for the patients and for those who care for them.
  6. Hallucinations and delusions
    Hallucinations, especially visual ones, are frequent in dementia with Lewy bodies, but they can appear in other forms as well. Patients may see objects or people that do not exist or hear imaginary sounds. Delusions are false beliefs or distortions in the perception of reality, for example perceiving loved ones as strangers or a familiar place as unknown.
  7. Sleep disturbances
    Sleep often becomes fragmented in dementia and the reversal of the day-night cycle (insomnia at night and drowsiness during the day) is common. This problem can aggravate cognitive and behavioural symptoms, and patients may develop agitated night-time behaviour known as "sundowning".
  8. Motor difficulties
    In the advanced stages of dementia, motor difficulties become increasingly obvious. The people affected may have problems with coordination and balance, which makes them prone to falls and other accidents. Muscle rigidity and tremor may also be present, especially in dementia with Lewy bodies or in advanced cases of Alzheimer's.
  9. Loss of initiative
    A decline in interest in activities that used to be enjoyable is common. People affected by dementia may become apathetic and withdraw from social activities or from their hobbies. This lack of initiative can be mistaken for depression, but in dementia it is rather a manifestation of the deterioration of the brain's executive functions.
  10. Personality changes
    Dementia can lead to dramatic personality changes. People who used to be extroverted may become withdrawn and silent, while calm people may become agitated and aggressive. These changes are often hard for those around them to manage and can worsen the psychological stress of carers.
  11. Difficulty concentrating
    The ability to concentrate on simple tasks can become impaired in people with dementia. This makes it hard to complete activities that require sustained attention, such as reading or watching a film. Patients can quickly become distracted or confused.
  12. Failure to understand risks
    Another major problem in dementia is the inability to assess risk. The people affected may make dangerous decisions, such as leaving home without telling anyone or trying to drive, even though they are no longer able to do so safely.
  13. Incontinence
    In the advanced stages, many people develop incontinence, losing control of the bladder or bowels. This can cause hygiene problems and additional complications, such as urinary infections, which worsen the general condition.
  14. Difficulty recognising people
    As dementia progresses, the people affected may forget the names of those close to them or even fail to recognise them altogether. This inability to identify family members or close friends can cause profound emotional distress both for the patient and for their loved ones.
  15. Changes in eating
    Some people with dementia may show significant changes in eating behaviour, either through loss of appetite or through compulsive eating. In some cases, patients may forget how to use cutlery or even how to swallow food properly.
  16. Problems organising and managing everyday tasks
    The ability to organise and complete daily tasks, such as paying bills or preparing a meal, becomes severely impaired as dementia advances. The people affected often forget the steps needed to complete an activity and may require constant supervision.

Diagnosis in dementia

Diagnosing dementia is a complex process that involves assessing a wide range of symptoms and running tests to rule out other possible causes of cognitive decline. The process includes:

  1. Medical assessment and history taking: Doctors gather detailed information about the patient's medical history, current symptoms and family history. This may also include conversations with family members or carers in order to assess behavioural and cognitive changes.
  2. Cognitive tests: These are standardised assessments that measure a person's ability to remember, think, plan and solve problems. Among the most widely used tests are the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), which measure cognitive functions across different dimensions.
  3. Laboratory tests: Blood tests may be needed in order to rule out other causes of the symptoms, such as hormonal problems or vitamin deficiencies (for example vitamin B12 deficiency).
  4. Neuropsychological assessment: This involves detailed tests that assess several aspects of cognition, including memory, attention, language and executive functions.
  5. Brain imaging methods:
    • MRI (Magnetic Resonance Imaging) and CT (Computed Tomography): These scans can detect structural changes in the brain, such as atrophy or strokes.
    • PET scan (Positron Emission Tomography): Used to observe metabolic activity in the brain and to identify amyloid deposits, which are characteristic of Alzheimer's disease.
    • qEEG (quantitative electroencephalography) and BrainMap: These techniques measure the electrical activity of the brain and can reveal abnormalities in the neural networks involved in dementia. BrainMap provides a detailed map of brain activity, helping to detect areas of cognitive dysfunction and to monitor how the treatment progresses. Unlike other methods, qEEG is non-invasive and can assess brain functioning in real time, offering important support in diagnosis and in personalising the treatment.

Treatment options for dementia

There is no curative treatment for dementia, but several therapeutic options can help slow the progression of the disease and manage the symptoms. Here are the main treatment options:

  1. Medication:
    • Cholinesterase inhibitors: These medicines are used to raise the levels of acetylcholine, a neurotransmitter essential for memory and learning.
    • Memantine: This regulates the activity of glutamate, another neurotransmitter involved in cognitive functions.
    • Medicines for behavioural symptoms: In some cases, antipsychotics, antidepressants or anxiolytics may be needed in order to manage symptoms such as agitation or depression.
  2. Cognitive and occupational therapy: These are therapies designed to help patients preserve their cognitive functions and daily living skills for as long as possible. Cognitive therapy involves activities that stimulate the brain, such as memory games and mental exercises, while occupational therapy focuses on improving independence in daily activities.
  3. Psychological support: Psychological support for patients and their families is essential in coping with the changes brought about by dementia. Counselling can help with managing emotions, while support groups can provide a sense of community.
  4. Neurofeedback: Neurofeedback is a non-invasive method of regulating brain activity, based on biofeedback, which helps patients train their brain to function more efficiently. By monitoring brainwaves in real time, neurofeedback allows the individual to learn how to self-regulate their brain activity. For patients with dementia, this technique can help improve concentration, memory and alertness. Neurofeedback is a promising, non-invasive alternative to drug treatments, with no side effects, that can improve quality of life and slow cognitive decline.
  5. Cognitive stimulation therapy: This includes various group activities designed to stimulate cognitive processes and to provide a form of social interaction.
  6. A healthy diet and lifestyle: The Mediterranean diet, rich in fruit, vegetables, fish and healthy fats, has been associated with a lower risk of cognitive decline. Regular physical exercise, quality sleep and stress management are also essential in supporting brain health.
  7. Photobiomodulation (PBM) is a non-invasive treatment method that uses low-intensity light to stimulate cell regeneration and to reduce inflammation in the brain. This technology emits red and near-infrared light waves that penetrate the tissues and reach the neuronal cells, activating self-repair mechanisms and improving mitochondrial function. Recent studies suggest that PBM can reduce the build-up of beta-amyloid plaques and tau proteins, the molecules responsible for the destruction of neuronal cells in dementia, particularly in Alzheimer's disease.

The benefits of photobiomodulation include improved cerebral blood flow, stimulation of neuroplasticity and reduction of oxidative stress, all of which contribute to slowing cognitive decline. Patients who have followed regular PBM sessions have reported significant improvements in memory, concentration and general wellbeing. Although it is relatively new in the field of dementia, photobiomodulation offers a promising alternative to traditional methods, as a non-invasive solution with no major side effects.

Neurofeedback for dementia - a non-invasive and effective solution

Neurofeedback offers a safe, non-invasive alternative to conventional treatments. With this technique, the electrical activity of the brain is monitored and adjusted in real time, which can lead to more balanced and efficient brain functioning. Neurofeedback helps improve memory and concentration and even reduces anxiety or agitation in dementia.

Brain training therapy: the optimal combination of neurofeedback, photobiomodulation and heart-brain coherence

The therapy Brain training is an advanced, integrative approach that combines the benefits of neurofeedback, photobiomodulation (PBM) and heart-brain coherence in order to obtain superior results in the care of dementia. While neurofeedback helps regulate brainwaves and improve cognitive functions by monitoring neuronal activity in real time, photobiomodulation supports this process by stimulating cell regeneration and increasing cerebral blood flow.

Adding heart-brain coherence techniques increases the effectiveness of the therapy even further. By creating harmony between the activity of the heart and that of the brain, patients can achieve better emotional stability, reduced stress and greater mental clarity, all of which contribute to a significant improvement in cognitive functions. This synergistic combination - neurofeedback for optimising brain activity, PBM for cell recovery and heart-brain coherence for emotional balance - makes Brain training a holistic, non-invasive approach. The improvements in memory, concentration and quality of life are notable, offering patients with dementia a more effective and longer-lasting recovery.

If you or someone dear to you is living with dementia, brain training therapy can offer a modern, safe treatment method that complements conventional therapy. Consulting a neurofeedback specialist can help you explore this innovative method, which is able to improve the quality of life of patients with dementia without the use of medication.

Reference:

  • Luijmes, R.E., Sjaak Pouwels and Jacko Boonman (2016). The effectiveness of neurofeedback on cognitive functioning in patients with Alzheimer’s disease: Preliminary results. Neurophysiologie Clinique, [online] vol. 46(3), pp. 179-187. doi:https://doi.org/10.1016/j.neucli.2016.05.069.
  • Irini Vilou, Aikaterini Varka, Dimitrios Parisis, Afrantou, T. and Ioannidis, P. (2023). EEG-Neurofeedback as a Potential Therapeutic Approach for Cognitive Deficits in Patients with Dementia, Multiple Sclerosis, Stroke and Traumatic Brain Injury. Life, [online] vol. 13(2), pp. 365-365. doi:https://doi.org/10.3390/life13020365.
  • ‌Trambaiolli, L.R., Cassani, R., David and Falk, T.H. (2021). Neurofeedback and the Aging Brain: A Systematic Review of Training Protocols for Dementia and Mild Cognitive Impairment. Frontiers in Aging Neuroscience (Front. Aging Neurosci.), [online] vol. 13. doi:https://doi.org/10.3389/fnagi.2021.682683.

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