The Pathophysiology Of Dementia: What Causes It?
By Marie Miguel
Updated September 25, 2019
Reviewer Wendy Boring-Bray, DBH, LPC
Many of us know someone who suffers from dementia. What can you do to help them? Understanding dementia and its causes is a good step towards being able to provide your loved ones the support they need.
Dementia is commonly misrepresented as being an illness where you lose your memory. However, dementia is a symptom of various conditions and not a disease in itself. There are several ways it can materialize, with each illness affecting the body physiologically in varying ways. This process is known as the pathophysiology and its goal is to explain the changes that happen in the body when a disease is present. This article will outline the pathophysiology of dementia, including some of the most common ailments that lead to it, and general treatment advice for the condition.
What Causes Dementia?
As previously mentioned in the introduction, multiple diseases and events can bring about the onset of dementia. However, in general, degradation of cells in the brain, whether through biological or external means, is the specific reason why dementia develops.
Some diseases that cause dementia 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 these diseases, such as with Huntington's disease and possibly Alzheimer's.
External factors such as repeated head injuries and concussions are responsible for chronic traumatic encephalopathy (CTE) and dementia pugilistica. Sports that involve extreme physical contact are also associated with these injuries. Alcohol abuse is another non-biological source of brain degradation.
Even though they have different roots, all these diseases have one thing in common: they damage the brain, which leads to dementia. Even though they have similarities, the mechanisms by which each of these ailments destroy brain cells vary.
Pathophysiology of Dementia-Causing Diseases
Understanding the pathophysiology of dementia is essential, as it leads to better treatment options. While there is no cure for dementia itself or many of the diseases that are connected to it, research is still vital because it can result in medications to delay the progression of the symptom, or better yet, provide a cure. The following are some of the most prevalent sources what we know about them:
Perhaps the most well-known perpetrators of dementia, this disease is often associated with older people and senility. It affects at least 12 million people around the globe, usually sixty years or older.
The cause of Alzheimer's is not entirely understood just yet, but research over the years has provided us with some clues to its origins. It's believed that genetic and environmental factors 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 associated with all cases of Alzheimer's. The amyloid structures produce adverse effects in the brain and cause cell death. Cases where proteins become abnormal are known as asproteopathy.
Parkinson's is the second most common condition that results in dementia, usually in its more advanced stages. Parkinson's is mostly known for its motor symptoms, which include:
- Movement difficulties
In this disease, cell death is connected with 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 causes a reduction in dopamine. Dopamine is a neurotransmitter that plays several critical roles in the body, such as motor control.
Strokes are a major cause of disability, due to its profound impact on the brain. A stroke can be defined as an event where inadequate blood flow is provided to the brain, causing cell death. This lack of blood supply is precisely the pathophysiology of vascular dementia. Dementia in stroke patients is created by the reduced blood supply from blocked vessels, which leads to progressive cognitive impairment. This event can also happen in minor strokes. The brain has an intricate system of vessels to provide blood and oxygen to it; however, it is also fragile.
Chronic Traumatic Encephalopathy
Chronic traumatic encephalopathy (CTE) is a term that refers to repeated head injuries which leads to brain degeneration. It's most common in athletes who can be prone to concussions during their sports, such as boxing and American football. CTE has also been discovered in military veterans. The dementia associated with CTE is known as dementia pugilistica. Pugilistica is derived from the word pugilist, which can refer to a prizefighter, like a boxer. The pathophysiology in CTE involves Tau proteins which clump in the brain, can make tangles, often around the sulcal depths.Chronic traumatic encephalopathy can potentially appear very early in one's life, or it can appear many years later. This is very from different from other conditions where dementia usually does not start showing signs until much later in life. Also, unlike other diseases, CTE can't be formally diagnosed until a patient is deceased.
Wernicke-Korsakoff Syndrome/Alcohol-Related Dementia:
This condition is the merger of two separate diseases: Wernicke's encephalopathy and Korsakoff syndrome. Wernicke's involves movement pattern and coordination issues, while Korsakoff's symptoms include memory loss, personality changes, and hallucinations.
Wernicke-Korsakoff Syndrome (WKS) is caused by a thiamine (vitamin B-1) deficiency. This issue can arise from malnutrition and alcoholism. The pathophysiology of this condition involves sugar and energy. If there's not enough thiamine, the brain cells do not have adequate fuel to perform tasks.
Unlike some of the other diseases mentioned above, WKS is treatable through thiamine supplementation, and people can make a full recovery if caught early enough. Alcohol abstinence is required to prevent the dementia symptoms from progressing, as alcohol impacts the body's ability to absorb and use thiamine, especially in the brain.
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Chronic alcohol abuse can shrink brain cells in addition to be being highly dangerous and toxic for other body parts and organs such as the liver and the heart. Whichever one of these illnesses your loved one is going through, remember you are not alone in this struggle. Support is available.
What Treatment Options Are There for Dementia?
Except for Wernicke-Korsakoff syndrome, dementia and its associated diseases are incurable and cannot be reversed. Treatment cannot address the pathophysiology of dementia in the brain; however, it is possible to treat its symptoms.
Acetylcholinesterase inhibitor drugs, like Rivastigmine, Donepezil, and Galantamine, are given to increase acetylcholine levels, a neurotransmitter associated with cognitive function. Similarly, Memantine can be prescribed alongside Acetylcholinesterase inhibitors. Instead of escalating levels, they help to reduce the glutamate levels in the brain. It's believed that excess glutamate can damage brain cells.
Additional medication can be supplied to address mood and behavioral illnesses that are comorbid with dementia. These conditions can include depression, anxiety, and psychosis. In these cases, antidepressants, anxiolytics, and antipsychotics can provide relief.
Keep in mind that a proper diagnosis from a doctor is required to receive medication. This prerequisite excludes 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 is essential. Doing this involves making the living space safe and organized. Furniture, loose rugs, and other obstructions should be moved to prevent accidents. Frequently used items should be labeled and easy to access.
Some therapeutic activities that do not involve medication are exercise and playing games and puzzles. These can help improve the patient's mood and keep the brain active. Social interaction during these activities is encouraged as well.
What Can BetterHelp Do for You?
Seeing a loved one struggling and having their memories slowly erased can be very difficult and emotionally challenging, especially if you are a primary caregiver. You may also feel confused and lost about what steps to take and what to expect. Consider enlisting the services of a licensed counselor and therapist. They can help answer any questions you might have about how you can assist a loved one with dementia, and they can also give you the support you need for your own mental health.
Even though you may feel alone at times, know this is not a burden you have to bear on your own. Read below for some reviews of BetterHelp counselors, from people experiencing similar issues.
"Erin has been incredibly helpful to me as I navigate a tough situation with my family. She's understanding and compassionate and non judgmental."
"Kristen Watkins has helped guide me through really challenging times in my life but she's done it with grace and comfort. She is the first person, and counselor, I've opened up to about my past and she has never made me feel inadequate or unheard. I can't wait to continue improving myself through the help of Kristen!"
The pathophysiology of dementia is about as diverse as the several different diseases that can cause it. It's a complex umbrella system difficult to manage for all parties involved, and a diagnosis of dementia can be a devastating blow for any family. Through BetterHelp, caregivers can have access to the support that they need. A reliable network is crucial for addressing the concerns of friends and family members as well as for providing the best care for the patient.
Even though there is no cure for dementia, you can ensure your loved ones live the happiest and most comfortable life possible, and that begins with making sure you have all the support you need- take the first step today.