How is dementia progressing?
Diagnosis of dementia: clinical picture and course
Alzheimer's dementia is a degenerative disease of the brain, in the course of which cerebral nerve cells are irreversibly destroyed. The disease progresses differently in each person. In principle, however, three stages can be identified, which flow smoothly into one another. From the first symptoms to death, it takes between three and ten years, depending on the diagnosis.
Their creeping, almost imperceptible beginning is characteristic. At first, there are slight memory gaps and mood swings, and the ability to learn and react decreases. In addition, there are the first language difficulties. The sick use simpler words and shorter sentences or stop in the middle of a sentence and can no longer finish their thoughts. Local and temporal disorientation become noticeable. Those affected become less motivated and increasingly close themselves to new things.
At this stage the sick are aware of the changes that are going on in them. Many of them respond with anger, fear, embarrassment, or depression.
As the disease progresses, the symptoms become unmistakable, at the latest now you have to give up your job and driving a car. In everyday activities such as personal hygiene, using the toilet or eating and drinking, those affected are increasingly dependent on the support of other people. This stage is characterized by a severe memory impairment - close relatives can no longer be named, the sense of time and place is lost and the language becomes indistinct and empty of content.
People with dementia can hardly control their emotions, sudden mood swings, aggression and depression increase.
In the later stages, dementia patients are completely dependent on care and support from other people. Family members are no longer recognized, communication with words is impossible. Physical symptoms such as poor walking and swallowing disorders occur more frequently. Control of the bladder and bowel decreases. Occasionally, epileptic seizures can occur. Bed rest increases the risk of infection. The sick often die from complications such as pneumonia.
The causes of Alzheimer's disease have not yet been adequately researched. However, a number of changes in the brain that occur in Alzheimer's patients are known. In the case of the disease, nerve cells die and their connections to one another are destroyed.
This is associated with a decrease in brain mass (brain atrophy). In addition, protein deposits (plaques or fibrils) in the brain and a reduction in a messenger substance that is important for memory (acetylcholine) are observed. However, these changes do not yet provide any information about why the disease develops. An important research approach is therefore the search for so-called risk factors.
Genetic factors as the sole cause of the disease are only present in less than two percent of cases. Overall, they therefore play a subordinate role in the development of Alzheimer's disease. Dementia in first-degree relatives - parents, children or siblings - increases the individual risk only slightly. After severe head injuries, the risk is slightly higher.
On the other hand, mental activity has a positive effect: intellectually alert people are less likely to develop Alzheimer's disease than those who are hardly mentally active. In addition, a socially active life and intellectual demands in work, leisure and other social surroundings probably also have a positive influence.
The older people get, the greater the risk of developing dementia. While less than three percent of the 65 to 70-year-olds get Alzheimer's disease, around one in five is affected by the age of 85 and one in three from the age of 90.
Even if the causes of Alzheimer's dementia are not sufficiently well known, it can be deduced from relevant studies that physical exercise and a healthy diet, mental activity and social participation reduce the risk of developing it in old age. Since the neurobiological disease process begins 15 to 30 years before clinical symptoms appear, prevention is particularly relevant for those aged 40 and over.
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