Dementia

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dementia, chronic, usually progressive deterioration of intellectual capacity associated with the widespread loss of nerve cells and the shrinkage of brain tissue. Dementia is most commonly seen in the elderly (senile dementia), though it is not part of the normal aging process and can affect persons of any age. In 2005 researchers reported that some 24.3 million people worldwide were living with dementia. In 2015 this figure rose to an estimated 47.5 million, a number that was expected to increase significantly by 2030, in part because of anticipated increases in life expectancy in many countries.

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The most common irreversible dementia is Alzheimer disease. This condition often begins with memory loss or with subtle impairments in other cognitive functions. These changes may manifest initially as simple absentmindedness or forgetfulness or as minor problems with judgment, language, or perception. As dementia progresses, memory loss and cognitive impairment broaden in scope until the individual can no longer remember basic social and survival skills or function independently. Language, spatial or temporal orientation, judgment, perception, and other cognitive capacities decline, and personality changes may occur. Dementia is also present in other degenerative brain diseases, including Pick disease and Parkinson disease. Alzheimer disease closely resembles another form of dementia known as limbic-predominant age-related TDP-43 encephalopathy (LATE). Although LATE is also marked by the deterioration of memory and cognition and declines in social skills, patterns of neurocognitive change and the rate of decline in LATE differ from Alzheimer disease.

The second most common cause of dementia is hypertension (high blood pressure) or other vascular conditions. This type of dementia, called multi-infarct, or vascular, dementia results from a series of small strokes that progressively destroy the brain. Dementia can also be caused by Huntington disease, syphilis, multiple sclerosis, acquired immune deficiency syndrome (AIDS), and some types of encephalitis. Treatable dementias occur in hypothyroidism, other metabolic diseases, and some malignant tumours. Treatment of the underlying disease in these cases may inhibit the progress of dementia but usually does not reverse it.

Because many instances of dementia are not necessarily a consequence of aging but rather are associated with lifestyle factors, certain behaviour actions can help delay or potentially prevent dementia. Guidelines for dementia prevention issued by the World Health Organization include engaging in physical activity, never smoking, limiting alcohol intake, eating a healthy diet, and managing weight. Particularly in persons age 55 or older, risk of dementia may be increased by the use of certain prescription drugs, especially anticholinergic agents, which are used to treat a variety of conditions, including allergies, bladder disorders, chronic obstructive pulmonary disease (COPD), and depression.