Dementia: Causes, Symptoms, and Management

Key Takeaways:

Dementia involves a decline in cognitive function affecting memory, thinking, and daily life.
Common causes include genetic factors, aging, and certain medical conditions.
Early symptoms often involve memory loss, mood changes, and difficulty with communication.
Management includes medication, lifestyle adjustments, and caregiver support.
Preventive measures focus on healthy living and managing chronic diseases.

Introduction to Dementia

Dementia: Causes, Symptoms, and Management

Dementia refers to a group of conditions marked by a decline in cognitive abilities severe enough to interfere with daily activities.

Alzheimer’s disease is the most common type, but other forms include vascular dementia, Lewy body dementia, and frontotemporal dementia.

Causes and Risk Factors

Dementia can arise from several causes, with age being the most significant factor. Genetics also contribute, particularly in early-onset cases.

Medical conditions like hypertension, diabetes, and cardiovascular disease increase the risk, as do lifestyle factors such as smoking, poor diet, and lack of exercise.

Symptoms and Early Signs

Dementia symptoms vary, but common early signs include memory loss, especially of recent events.

Individuals may experience confusion, have trouble with language, and struggle with problem-solving. Mood changes, including depression, anxiety, and irritability, often accompany cognitive decline.

These symptoms progressively impair the ability to perform everyday tasks.

Diagnosis of Dementia

Diagnosing dementia requires a comprehensive medical evaluation. Doctors typically conduct cognitive tests to assess memory, language, and problem-solving abilities.

Brain imaging, such as MRI or CT scans, helps detect changes in brain structure. Blood tests and other assessments are used to rule out other possible causes of symptoms.

Treatment and Management

While there is no cure for dementia, treatments aim to manage symptoms and improve quality of life.

Lifestyle changes, including a balanced diet and regular physical activity, support overall brain health. When done properly, the ketogenic diet in particular can provide significant benefits on multiple fronts.

Caregiver support is essential, providing emotional and practical assistance to those affected.

Medications like cholinesterase inhibitors and memantine can help manage cognitive symptoms.

Coping with Dementia

Living with dementia requires adapting to new challenges. Establishing routines and using memory aids can help maintain independence.

Strong support networks, including family, friends, and professional caregivers, are vital. Legal and financial planning ensures future needs are met.

Prevention and Risk Reduction

Preventing dementia involves adopting healthy lifestyle habits.

Regular exercise, a diet rich in nutrients, and mental stimulation are key strategies.

Social engagement also supports cognitive health. Managing chronic conditions like hypertension and diabetes can reduce the risk of developing dementia.

FAQ

What is dementia?
Dementia is a condition marked by a decline in cognitive function, affecting memory, thinking, and daily activities.

What causes dementia?
Dementia can be caused by genetic factors, aging, medical conditions like hypertension and diabetes, and lifestyle choices.

How is dementia diagnosed?
Diagnosis involves cognitive tests, brain imaging, and medical evaluations to assess symptoms and rule out other conditions.

Can dementia be treated?
While dementia cannot be cured, treatments focus on managing symptoms, improving quality of life, and providing caregiver support.

What can be done to prevent dementia?
Prevention involves maintaining a healthy lifestyle, including regular exercise, a nutrient-rich diet, and mental and social engagement.

Research


Abbasi, U., Abbina, S., Gill, A., Takuechi, L.E., & Kizhakkedathu, J.N. (2021). Role of Iron in the Molecular Pathogenesis of Diseases and Therapeutic Opportunities. ACS Chemical Biology, 16(6), 945–972. https://doi.org/10.1021/acschembio.1c00122

Atkins, J.L., Pilling, L.C., Heales, C.J., Savage, S., Kuo, C.-L., Kuchel, G.A., Steffens, D.C., & Melzer, D. (2021). Hemochromatosis Mutations, Brain Iron Imaging, and Dementia in the UK Biobank Cohort. Journal of Alzheimer’s Disease, 79(3), 1203–1211. https://doi.org/10.3233/jad-201080

Bader, V., & Winklhofer, K.F. (2020). Mitochondria at the Interface between Neurodegeneration and Neuroinflammation. Seminars in Cell & Developmental Biology, 99, 163–171.

Bellou V, Belbasis L, Tzoulaki I, Middleton LT, Ioannidis JPA, Evangelou E. Systematic evaluation of the associations between environmental risk factors and dementia: An umbrella review of systematic reviews and meta-analyses. Alzheimers Dement 2017;13(4):406–18. doi: 10.1016/j.jalz.2016.07.152.

Benn, M., Nordestgaard, B.G., Tybjærg-Hansen, A. et al. Impact of glucose on risk of dementia: Mendelian randomisation studies in 115,875 individuals. Diabetologia 63, 1151–1161 (2020). https://doi.org/10.1007/s00125-020-05124-5

Bermejo‐Pareja, F., del Ser, T., Valentí, M., de la Fuente, M., Bartolome, F. and Carro, E., 2020. Salivary lactoferrin as biomarker for Alzheimer’s disease: Brain‐immunity interactions. Alzheimer’s &amp; Dementia, [online] 16(8), pp.1196–1204. https://doi.org/10.1002/alz.12107.

Carro, E., Bartolomé, F., Bermejo-Pareja, F., Villarejo-Galende, A., Molina, J. A., Ortiz, P., Calero, M., Rabano, A., Cantero, J. L., & Orive, G. (2017). Early diagnosis of mild cognitive impairment and Alzheimer's disease based on salivary lactoferrin. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 8, 131-138. https://doi.org/10.1016/j.dadm.2017.04.002

Cerasuolo, M., Di Meo, I., Auriemma, M.C., Trojsi, F., Maiorino, M.I., Cirillo, M., Esposito, F., Polito, R., Colangelo, A.M., Paolisso, G., Papa, M., & Rizzo, M.R. (2023). Iron and Ferroptosis More than a Suspect: Beyond the Most Common Mechanisms of Neurodegeneration for New Therapeutic Approaches to Cognitive Decline and Dementia. International Journal of Molecular Sciences, 24(11), 9637. https://doi.org/10.3390/ijms24119637

Crane, P.K., Walker, R., Hubbard, R.A., Li, G., Nathan, D.M., Zheng, H., Haneuse, S., Craft, S., Montine, T.J., Kahn, S.E., McCormick, W., McCurry, S.M., Bowen, J.D. and Larson, E.B., 2013. Glucose Levels and Risk of Dementia. New England Journal of Medicine, [online] 369(6), pp.540–548. https://doi.org/10.1056/nejmoa1215740.

Cunnane, S.C., Courchesne‐Loyer, A., St‐Pierre, V., Vandenberghe, C., Pierotti, T., Fortier, M., Croteau, E. and Castellano, C., 2016. Can ketones compensate for deteriorating brain glucose uptake during aging? Implications for the risk and treatment of Alzheimer’s disease. Annals of the New York Academy of Sciences, [online] 1367(1), pp.12–20. https://doi.org/10.1111/nyas.12999.

Davis, J.J., Fournakis, N., & Ellison, J. (2020). Ketogenic Diet for the Treatment and Prevention of Dementia: A Review. Journal of Geriatric Psychiatry and Neurology. https://doi.org/10.1177/0891988720901785

Daulatzai, M.A., 2016. Cerebral hypoperfusion and glucose hypometabolism: Key pathophysiological modulators promote neurodegeneration, cognitive impairment, and Alzheimer’s disease. Journal of Neuroscience Research, [online] 95(4), pp.943–972. https://doi.org/10.1002/jnr.23777.

Dineley, K. T., Jahrling, J. B., & Denner, L. (2014). Insulin Resistance in Alzheimer's Disease. Neurobiology of Disease, 72PA, 92. https://doi.org/10.1016/j.nbd.2014.09.001

DiNicolantonio, J.J., Mangan, D. and O’Keefe, J.H., 2018. The fructose–copper connection: Added sugars induce fatty liver and insulin resistance via copper deficiency. Journal of Metabolic Health, [online] 3(1). 
https://doi.org/10.4102/jir.v3i1.43.

Dugger, B.N., & Dickson, D.W. (2017). Pathology of Neurodegenerative Diseases. In Cold Spring Harbor Perspectives in Biology. Cold Spring Harbor Laboratory Press.

Fiest KM, Jetté N, Roberts JI, et al. The prevalence and incidence of dementia: A systematic review and meta-analysis. Can J Neurol Sci 2016;43 Suppl 1:S3–50. doi: 10.1017/cjn.2016.18. 

Gammella, E., Recalcati, S., & Cairo, G. (2016). Dual role of ROS as signal and stress agents: iron tips the balance in favor of toxic effects. Oxidative Medicine and Cellular Longevity, 2016(1), 8629024.

Garrett, L. R., & Niccoli, T. (2022). Frontotemporal Dementia and Glucose Metabolism. Frontiers in Neuroscience, 16, 812222. https://doi.org/10.3389/fnins.2022.812222

González-Reyes RE, Aliev G, Ávila-Rodrigues M, Barreto GE. Alterations in Glucose Metabolism on Cognition: A Possible Link Between Diabetes and Dementia. Curr Pharm Des. 2016;22(7):812-8. doi: 10.2174/1381612822666151209152013. PMID: 26648470.

Gorelick, P.B., Scuteri, A., Black, S.E., DeCarli, C., Greenberg, S.M., Iadecola, C., Launer, L.J., Laurent, S., Lopez, O.L., Nyenhuis, D., Petersen, R.C., Schneider, J.A., Tzourio, C., Arnett, D.K., Bennett, D.A., Chui, H.C., Higashida, R.T., Lindquist, R., Nilsson, P.M., Roman, G.C., Sellke, F.W. and Seshadri, S., 2011. Vascular Contributions to Cognitive Impairment and Dementia. Stroke, [online] 42(9), pp.2672–2713. https://doi.org/10.1161/str.0b013e3182299496.

Grammatikopoulou, M.G., Goulis, D.G., Gkiouras, K., Theodoridis, X., Gkouskou, K.K., Evangeliou, A., Dardiotis, E., & Bogdanos, D.P. (2020). To Keto or Not to Keto? A Systematic Review of Randomized Controlled Trials Assessing the Effects of Ketogenic Therapy on Alzheimer Disease. Advances in Nutrition, 11(6), 1583–1602. https://doi.org/10.1093/advances/nmaa073

Hertz, L., Chen, Y. and Waagepetersen, H.S., 2015. Effects of ketone bodies in Alzheimer’s disease in relation to neural hypometabolism, β‐amyloid toxicity, and astrocyte function. Journal of Neurochemistry, [online] 134(1), pp.7–20. https://doi.org/10.1111/jnc.13107.

Huo, T., Jia, Y., Yin, C., Luo, X., Zhao, J., Wang, Z., & Lv, P. (2019). Iron dysregulation in vascular dementia: Focused on the AMPK/autophagy pathway. Brain Research Bulletin, 153, 305–313. https://doi.org/10.1016/j.brainresbull.2019.09.006

Kalaria, R. N. (2018). The pathology and pathophysiology of vascular dementia. Neuropharmacology, 134, 226-239. https://doi.org/10.1016/j.neuropharm.2017.12.030

Krikorian, R., Shidler, M. D., Dangelo, K., Couch, S. C., Benoit, S. C., & Clegg, D. J. (2012). Dietary ketosis enhances memory in mild cognitive impairment. Neurobiology of Aging, 33(2), 425.e19. 
https://doi.org/10.1016/j.neurobiolaging.2010.10.006

Listabarth, S., König, D., Vyssoki, B. and Hametner, S., 2020. Does thiamine protect the brain from iron overload and alcohol‐related dementia? Alzheimer’s &amp; Dementia, [online] 16(11), pp.1591–1595. 
https://doi.org/10.1002/alz.12146.

Magaki, S., Raghavan, R., Mueller, C., Oberg, K.C., Vinters, H.V., & Kirsch, W.M. (2007). Iron, copper, and iron regulatory protein 2 in Alzheimer’s disease and related dementias. Neuroscience Letters, 418(1), 72–76. https://doi.org/10.1016/j.neulet.2007.02.077

Mohamed, W. A., Salama, R. M., & Schaalan, M. F. (2019). A pilot study on the effect of lactoferrin on Alzheimer’s disease pathological sequelae: Impact of the p-Akt/PTEN pathway. Biomedicine & Pharmacotherapy, 111, 714-723. https://doi.org/10.1016/j.biopha.2018.12.118

Moon, Y., Han, S.-H., & Moon, W.-J. (2016). Patterns of Brain Iron Accumulation in Vascular Dementia and Alzheimer’s Dementia Using Quantitative Susceptibility Mapping Imaging. Journal of Alzheimer’s Disease, 51(3), 737–745. https://doi.org/10.3233/jad-151037

Ohara, T., Doi, Y., Ninomiya, T., Hirakawa, Y., Hata, J., Iwaki, T., Kanba, S. and Kiyohara, Y., 2011. Glucose tolerance status and risk of dementia in the community. Neurology, [online] 77(12), pp.1126–1134. https://doi.org/10.1212/wnl.0b013e31822f0435.

Peloso GM, Beiser AS, Satizabal CL, et al. Cardiovascular health, genetic risk, and risk of dementia in the Framingham Heart Study. Neurology 2020;95(10):e1341–50. doi: 10.1212/WNL.0000000000010306.

Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: A systematic review and metaanalysis. Alzheimers Dement 2013;9(1):63–75.e2. doi: 10.1016/j.jalz.2012.11.007.

Raha, A.A., Biswas, A., Henderson, J., Chakraborty, S., Holland, A., Friedland, R.P., Mukaetova-Ladinska, E., Zaman, S. and Raha-Chowdhury, R., 2022. Interplay of Ferritin Accumulation and Ferroportin Loss in Ageing Brain: Implication for Protein Aggregation in Down Syndrome Dementia, Alzheimer’s, and Parkinson’s Diseases. International Journal of Molecular Sciences, [online] 23(3), p.1060. 
https://doi.org/10.3390/ijms23031060.

Rawlings, A.M., Sharrett, A.R., Mosley, T.H., Ballew, S.H., Deal, J.A. and Selvin, E., 2017. Glucose Peaks and the Risk of Dementia and 20-Year Cognitive Decline. Diabetes Care, [online] 40(7), pp.879–886. https://doi.org/10.2337/dc16-2203.

Roubroeks, J.A.Y., Smith, R.G., van den Hove, D.L.A., & Lunnon, K. (2017). Epigenetics and DNA Methylomic Profiling in Alzheimer’s Disease and Other Neurodegenerative Diseases. Journal of Neurochemistry, 143, 158–170.

Shi L, Chen SJ, Ma MY, et al. Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis. Sleep Med Rev 2018;40:4–16. doi: 10.1016/j.smrv.2017.06.010.

Siah, C. W., Ombiga, J., Adams, L. A., Trinder, D., & Olynyk, J. K. (2006). Normal Iron Metabolism and the Pathophysiology of Iron Overload Disorders. Clinical Biochemist Reviews, 27(1), 5-16. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390789/

Wands, J. R. (2008). Alzheimer's Disease Is Type 3 Diabetes–Evidence Reviewed. Journal of Diabetes Science and Technology (Online), 2(6), 1101-1113. https://doi.org/10.1177/193229680800200619

Wu, C., Shapiro, L., Ouk, M., MacIntosh, B. J., Black, S. E., Shah, B. R., & Swardfager, W. (2022). Glucose-lowering drugs, cognition, and dementia: The clinical evidence. Neuroscience & Biobehavioral Reviews, 137, 104654. https://doi.org/10.1016/j.neubiorev.2022.104654

Zhao, Z. (2019). Iron and oxidizing species in oxidative stress and Alzheimer’s disease. Aging Medicine, 2(2), 82–87. https://doi.org/10.1002/agm2.12074