The Pathophysiology Of Dementia: What Causes It?

Dementia can commonly be misrepresented as an illness in which you lose your memory. However, dementia can be a symptom of various conditions and not a disease unto itself. There are several ways dementia can materialize, with each illness affecting the body physiologically in varying ways. This process is generally known as pathophysiology, and its goal is normally to explain the changes that happen in the body when a disease is present. Some of the most common ailments leading to dementia can include Alzheimer’s disease, Parkinson’s disease, strokes, chronic traumatic encephalopathy, and Wernicke-Korsakoff syndrome. Although dementia cannot currently be cured, symptoms can be treated. A diagnosis of dementia in yourself or a loved one can be challenging to cope with, but in-person or online therapy may help.

What causes dementia?

Multiple diseases and events can bring about the onset of dementia. However, the degradation of cells in the brain, whether through biological or external means, is usually the specific reason why dementia develops.

Some diseases that cause dementia may include infections, like Creutzfeldt-Jakob disease, and the narrowing and damaging of blood vessels in the brain, perhaps from a stroke, which can cause vascular dementia. Genetic factors can also play a critical part in the formation of dementia, such as with Huntington's disease and Alzheimer's disease.

External factors, such as repeated head injuries and concussions, can be responsible for chronic traumatic encephalopathy (CTE) and dementia pugilistica. Sports that involve extreme physical contact can also be associated with these injuries. Alcohol use can be another non-biological source of brain degradation.

Even though they frequently have different roots, all these diseases tend to have one thing in common: They usually damage the brain, which can lead to dementia. Even though they have similarities, the mechanisms by which each of these ailments destroy brain cells can vary.

Pathophysiology of dementia-causing diseases

Understanding the pathophysiology of dementia can be essential, as it may lead to better treatment options. While there is currently no cure for dementia itself or many of the diseases that are connected to it, research can still be vital because it can result in medications to delay the progression of the symptoms or provide a cure. The following includes some of the most prevalent sources of dementia and what we know about them.

Alzheimer's disease

Perhaps the most well-known cause of dementia, this disease is often associated with older people and senility. It generally affects at least 12 million people around the globe, usually 60 years old or older, and that number is projected to increase by 700,000 by 2050.

The cause of Alzheimer's is not entirely understood yet, but research over the years has provided us with some clues to its origins. It's usually believed that genetic and environmental factors can play a role, along with lifestyle choices. Plaques in the brain, caused by the accumulation of the protein beta-amyloid, along with neurofibrillary tangles, are often associated with Alzheimer's cases. The amyloid structures can lead to adverse effects in the brain and cause cell death. 

Parkinson's disease

Parkinson's is normally the second most common condition resulting in dementia, usually in its more advanced stages. Parkinson's is mostly known for its motor symptoms, which may include:

• Rigidness
• Shaking
• Movement difficulties

In Parkinson’s disease, cell death can be connected to the build-up of proteins in the brain, known as Lewy bodies. These tend to gather in the basal ganglia, the substantia nigra, as well as the thalamus and the cortex, which usually causes a reduction in dopamine. Dopamine is a neurotransmitter that frequently plays several critical roles in the body, such as motor control.

Strokes/vascular dementia

Strokes can be a major cause of disability due to their profound impact on the brain. A stroke can be defined as an event where inadequate blood flow is provided to the brain, potentially causing cell death. This lack of blood supply can be thought of as the pathophysiology of vascular dementia. 

Dementia in stroke patients is usually created by the reduced blood supply from blocked vessels, which frequently leads to progressive cognitive impairment. This event can also happen in minor strokes. 

Chronic traumatic encephalopathy

Chronic traumatic encephalopathy (CTE) is a term that usually refers to repeated head injuries leading to brain degeneration. It's typically most common in athletes who can be prone to concussions during sports, such as boxing and American football. CTE has also been discovered in military veterans.

The dementia associated with CTE is normally known as dementia pugilistica. Pugilistica may be derived from the word pugilist, which can refer to a prizefighter, like a boxer. The pathophysiology of CTE usually involves Tau proteins that clump in the brain.

Chronic traumatic encephalopathy may appear very early in one's life, or it can appear many years later. This is generally different from other conditions in which dementia usually does not start showing signs until much later in life. Also, unlike other diseases, CTE may not be formally diagnosed until a patient is deceased.

Wernicke-Korsakoff syndrome/alcohol-related dementia

This condition can be seen as the merger of two separate diseases: Wernicke's encephalopathy and Korsakoff syndrome. Wernicke's can involve movement pattern and coordination issues, while Korsakoff's symptoms typically include memory loss, personality changes, and hallucinations.

Wernicke-Korsakoff syndrome (WKS) is usually caused by a thiamine (vitamin B-1) deficiency. This issue can arise from malnutrition and alcoholism. The pathophysiology of this condition normally involves sugar and energy. If there's not enough thiamine, the brain cells may not have adequate fuel to perform tasks.

Unlike some of the other diseases mentioned above, WKS can be treatable through thiamine supplementation, and people can make a full recovery if caught early enough. Alcohol abstinence is often required to prevent dementia symptoms from progressing, as alcohol can impact the body's ability to absorb and use thiamine, especially in the brain. Chronic alcohol use can shrink brain cells. Additionally, it can be highly toxic for other body parts and organs, such as the liver and the heart.

What treatment options are there for dementia?

Except for Wernicke-Korsakoff syndrome (in which most symptoms can be reversed, but not cured), dementia and its associated diseases are usually incurable and cannot be reversed. Treatment may not address the pathophysiology of dementia in the brain. However, it can be possible to treat its symptoms, often through prescribed medications and other interventions.

Please keep in mind that a proper diagnosis from a doctor is normally required to receive medication. This prerequisite can exclude chronic traumatic encephalopathy, which relies on symptoms because it currently cannot be diagnosed until one's death. However, regardless of the diagnosis, medication options are typically the same. A physician will also be able to provide information regarding dosages and side effects.

While not a direct treatment, making a home dementia-friendly can be essential. Doing this usually involves making the living space safe and organized. Furniture, loose rugs, and other obstructions should generally be moved to prevent accidents. Frequently used items should be labeled and easy to reach.

Some therapeutic activities that do not involve medication can include exercise, games, and puzzles. These can improve the patient's mood and keep the brain active. Social interaction during these activities is often encouraged as well.

Getting help as a caregiver

Benefits of online therapy

Online therapy can be a simple and accessible way to receive support as the caregiver of a person living with dementia. You may find it difficult to leave home and set up sufficient care for your loved one while you attend therapy, so the opportunity to attend sessions from the comfort of your home can be convenient. In addition, online therapy can make it easy to match with a therapist who has experience helping others come to terms with a dementia diagnosis.

Effectiveness of online therapy

A 2022 study investigated the efficacy of online cognitive behavioral therapy for family caregivers of people with dementia. It found that this online intervention generally decreased distress in the caregivers and empowered them to manage upsetting thoughts related to the dementia diagnosis.

Read below for some reviews of BetterHelp counselors from people experiencing similar concerns.

Counselor reviews

“Melissa has been wonderful to work with. She keeps up with me and helps me work through life situations. She's been instrumental in helping me through my Mother's health issues and subsequent death. She's provided me tools to use to work through my grief. I would recommend Melissa to anyone needing personalized counseling. She makes you feel like you are her only patient and follows up with me consistently. I can't say enough about how fortunate I feel to have been matched with such a wonderful therapist.” Read more on Melissa Russiano.

“I have enjoyed my sessions with Dr. Ash and have found them to be helpful. Being able to tell concerns and struggles and receive support and expert guidance is so important right now. I feel that I can't take care of those around me if I am not working to take care of myself. Dr. Ash is helping me to learn how to be more successful with self-care!” Read more on Bearlyn Ash.