Dear Doctor,

My 75-year-old grandfather is showing signs of dementia. What causes this? Can the condition be reversed or treated? Titus

Dear Titus,

Dementia is a broad category of brain disorders, which causes gradual, progressive decline in brain functions, particularly thinking and memory. There may be a gradual decline in language function and motivation. The symptoms may be severe enough to affect the daily functioning of the affected individual. It is a fairly common problem. Five per cent of persons over 60 years and 20 to 40 per cent over 80 years suffer from dementia worldwide.

It occurs due to several causes. Gradual degeneration and atrophy of the brain substance is a common cause. It can be due to gradual reduction in the blood supply of the brain substance. Degenerative diseases of the brain like Parkinsonism also cause slow dementia. Gradual loss of visual acuity, hearing loss, loneliness, physical weakness, and malnutrition are factors that can augment the problem.

The symptoms should be present for a minimum of six months, before it is labelled as dementia. It is diagnosed by cognitive tests and scans like CT and MRI of the brain. Other tests like complete blood count, stool examination, liver and kidney function tests are useful in excluding other treatable medical disorders causing similar symptoms. It has to be differentiated from psychiatric problems like depression and chronic infections of the brain.

Unfortunately, once dementia starts it cannot be reversed. Choline esterase group of drugs are used, but their efficacy is not certain. Moreover they cause uncomfortable side effects like dizziness, aggravation of asthma, nausea, vomiting, and dryness of mouth, running of nose, blurred vision, and etcetera. Cognitive and behaviour interventions done singly or in groups, help prevent further progress of the dementia. Constant care and support is needed for these individuals, so that they come to no harm in any way. Attention should also be given to their nutrition. A number of measures can help prevent development of dementia. Keeping oneself busy, being in company of family/friends, learning a new language or skills, doing crossword puzzles, are some activities that stimulate the brain and help in preventing the development or progression of the disease.