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Alzheimer's / Dementia

Dementia: Symptoms, stages, and types

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Dementia is a common term used to describe multiple cognitive weakening symptoms such as forgetfulness. It is a symptom of multiple underlying diseases and brain disorders.

Dementia is not in itself a single disease but a generic term to describe symptoms of memory, speech, and thought loss.

While age increases the likelihood of developing dementia, it is not a normal part of ageing.

An overview of the most recent census shows that in 2010, 4.7 million people in the United States, aged 65 or older, were living with Alzheimer’s disease. Association for Alzheimer’s predicts that:

  • just over a tenth of people aged 65 years or more have Alzheimer’s disease
  • this proportion rises to about a third of people aged 85 and older
  • Alzheimer’s accounts for 60-80 percent of all cases of dementia

The article discusses possible causes of dementia, the different types and any treatments available.

Fast facts on dementia

  • there are an estimated 47.5 million dementia sufferers worldwide
  • one new case of dementia is diagnosed every 4 seconds
  • dementia mostly affects older people but is not a normal part of aging

Symptoms

Symptoms of dementia include memory loss, disorientation and changes in mood.
Symptoms of dementia include memory loss, disorientation and changes in mood.

A person with dementia can exhibit any of the following symptoms mainly due to memory loss.

Some signs may be detected by themselves, others may be identified only by caregivers or healthcare workers.

The indications used to compile this list are published in the journal American Family Physician by the American Academy of Family Physicians (AAFP) in the journal American Family Physician.

Potential dementia symptoms include:

  • Recent memory loss – a sign of this might be asking the same question repeatedly.
  • Difficulty completing familiar tasks – for example, making a drink or cooking a meal.
  • Problems communicating – difficulty with language; forgetting simple words or using the wrong ones.
  • Disorientation – getting lost on a previously familiar street, for example.
  • Problems with abstract thinking – for instance, dealing with money.
  • Misplacing things – forgetting the location of everyday items such as keys, or wallets, for example.
  • Mood changes – sudden and unexplained changes in outlook or disposition.
  • Personality changes – perhaps becoming irritable, suspicious or fearful.
  • Loss of initiative – showing less interest in starting something or going somewhere.

As the patient ages, late-stage dementia symptoms tend to worsen.

Dementia stages

Dementia is sometimes loosely divided into four stages:

mild cognitive impairment: marked by general oblivion. It affects many people as they age but for some it just leads to dementia.

Mild dementia: humans with moderate dementia may experience cognitive impairments that sometimes affect their daily lives. Symptoms include loss of memory, frustration, changes in personality, getting lost and difficulties in planning and performing tasks.

Moderate dementia: daily life becomes more challenging, and the individual may need more help. Symptoms are similar to mild dementia but increased. Individuals may need help getting dressed and combing their hair. They may also show significant changes in personality; for instance, becoming suspicious or agitated for no reason. There are also likely to be sleep disturbances.

Severe dementia: Symptoms have dramatically deteriorated at this point. There may be a lack of communication skills and the individual may need full-time treatment. Simple tasks become difficult, such as sitting and keeping one’s head up. Command of the bladder may well be lost.

Dementia types

There are several types of dementia, including:

  • Alzheimer’s disease is characterized by “plaques” between the dying cells in the brain and “tangles” within the cells (both are due to protein abnormalities). The brain tissue in a person with Alzheimer’s has progressively fewer nerve cells and connections, and the total brain size shrinks.
  • Dementia with Lewy bodies is a neurodegenerative condition linked to abnormal structures in the brain. The brain changes involve a protein called alpha-synuclein.
  • Mixed dementia refers to a diagnosis of two or three types occurring together. For instance, a person may show both Alzheimer’s disease and vascular dementia at the same time.
  • Parkinson’s disease is also marked by the presence of Lewy bodies. Although Parkinson’s is often considered a disorder of movement, it can also lead to dementia symptoms.
  • Huntington’s disease is characterized by specific types of uncontrolled movements but also includes dementia.

Other disorders leading to symptoms of dementia include:

  • Frontotemporal dementia also known as Pick’s disease.
  • Normal pressure hydrocephalus when excess cerebrospinal fluid accumulates in the brain.
  • Posterior cortical atrophy resembles changes seen in Alzheimer’s disease but in a different part of the brain.
  • Down syndrome increases the likelihood of young-onset Alzheimer’s.

Early signs

Early signs of dementia can include:

  • Changes in short-term memory.
  • Changes in mood.
  • Trouble finding the right words.
  • Apathy.
  • Confusion.
  • Being repetitive.
  • Finds it hard to follow a storyline.
  • Trouble completing everyday tasks.
  • Poor sense of direction.
  • Difficulty adapting to changes.

Causes

Dementia can be caused by brain cell death, and most dementias are associated with neurodegenerative disease-a progressive brain cell death that occurs over time.

However it is not clear whether the dementia causes the death of the brain cell, or the death of the brain cell causes the dementia.

However, as well as progressive brain cell death, such as that seen in Alzheimer’s disease, dementia may be caused, among other causes, by a head injury, stroke, or brain tumor.

  • Vascular dementia (also called multi-infarct dementia) – resulting from brain cell death caused by conditions such as cerebrovascular disease, for example, stroke. This prevents normal blood flow, depriving brain cells of oxygen.
  • Injury – post-traumatic dementia is directly related to brain cell death caused by injury.

Some types of traumatic brain injury-especially if repetitive, such as those received by sports players-have been linked to certain later-life dementias. However, evidence is weak that a single brain injury increases the likelihood of developing degenerative dementia such as Alzheimer’s disease.

Could also cause dementia by:

  • Prion diseases – for instance, CJD (Creutzfeldt-Jakob disease).
  • HIV infection – how the virus damages brain cells is not certain, but it is known to occur.
  • Reversible factors – some dementias can be treated by reversing the effects of underlying causes, including medication interactions, depression, vitamin deficiencies, and thyroid abnormalities.

Diagnosing dementia

Standard questions and exercises include the first step in assessing memory performance and cognitive health.

Research has shown that dementia can’t be diagnosed accurately without using the standard tests below, completing them thoroughly and documenting all the answers; however, diagnosis also takes other factors into account.

Cognitive dementia tests

Cognitive dementia measures of today are commonly used and were checked as a reliable way to indicate dementia. Since its establishment in the early 1970s, they have changed little. There are ten questions to the abbreviated mental test score which include:

  • What is your age?
  • What is the time, to the nearest hour?
  • What is the year?
  • What is your date of birth?

correct answer gets one point; the cognitive impairment indicates scoring six points or less.

The General Practitioner Cognition Assessment (GPCOG) evaluation provides an additional element to record parent and caregiver observations.

This kind of examination, developed for physicians, may be the first standardized assessment of the mental ability of a person.

The second part of the test samples someone similar to the patient and consists of six questions to find out if the patient has:

  • become less able to remember recent events or conversations
  • begun struggling to find the right words or using inappropriate ones
  • found difficulty managing money or medications
  • needed more help with transport (without the reason being, for example, injury)

If the examination does indicate memory loss, then regular examinations, including routine blood tests and a CT brain scan, are recommended.

Clinical tests can recognize, or rule out, memory loss treatable causes and help to narrow down potential causes, such as Alzheimer’s.

Mini-mental State Assessment (MMSE) is a cognitive test that measures:

  • orientation to time and place
  • word recall
  • language abilities
  • attention and calculation
  • visuospatial skills

MMSE is used to help diagnose dementia caused by Alzheimer’s disease, and also to assess its extent and whether drug therapy is appropriate.

Treatments

Death of brain cells can not be reversed, therefore there is no known cure for degenerative dementia.

Additionally, condition treatment such as Alzheimer’s disease focuses on providing care and treating symptoms, rather than their underlying cause.

However, if dementia symptoms are due to a reversible, non-degenerative cause, more damage to the brain tissue may be avoided or reversed by care.

Examples include accidents, effects of treatment and lack of vitamin.

Many medications can reduce the symptoms of Alzheimer’s disease. There are four medications licensed for use in the U.S., called cholinesterase inhibitors:

  • donepezil (brand name Aricept)
  • galantamine (Reminyl)
  • rivastigmine (Exelon)
  • tacrine (Cognex)

Another form of drug, memantine (Namenda), an antagonist to the NMDA receptor, may also be used, alone or in conjunction with a cholinesterase inhibitor.

Cholinesterase inhibitors can also help with Parkinson’s disease’s behavioral components.

Other quality-of-life care

Brain training “can help improve cognitive functioning and help deal with forgetfulness in the early stages of Alzheimer’s. This could include the use of mnemonics and other memory aids, such as computerized retrieval tools.

Prevention of dementia

It is known to connect certain risk factors with dementia. Age is the largest factor, however. Some risk factors are as follows:

  • Smoking and alcohol use.
  • Atherosclerosis (cardiovascular disease causing the arteries to narrow).
  • High levels of “bad” cholesterol (low-density lipoprotein).
  • Above-average blood levels of homocysteine (a type of amino acid).
  • Diabetes.
  • Mild cognitive impairment can sometimes, but not always, lead to dementia.

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Alzheimer's / Dementia

Uses of vitamin B-12 level test: Normal ranges, and results

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The amount of vitamin B-12 in the blood or urine is measured in a vitamin B-12 level test to determine the body’s overall vitamin B-12 reserves.

Vitamin B-12 is required for a variety of body functions, including neuron function, DNA and red blood cell formation.

Treatment is required if a person’s vitamin B-12 levels fall outside of the usual range. Vitamin B12 deficiency can cause neurological symptoms as well as fatigue, constipation, and weight loss. B-12 levels that are too high could indicate liver disease, diabetes, or another condition.

Continue reading to learn more about B-12 testing and what the results indicate.

Purpose of a vitamin B-12 level test

worried lady

The vitamin B-12 level test determines the amount of vitamin B-12 in your body. Doctors can use the data to see if low vitamin B-12 levels are causing symptoms.

If a person exhibits any of the following symptoms, a doctor may recommend a vitamin B-12 level test:

Vitamin B-12 insufficiency

Vitamin B-12 deficiency is thought to affect up to 15% of people in the United States, according to research. The following are signs and symptoms of a deficiency:

  • fast heartbeat
  • numbness and tingling in the hands and feet
  • poor memory
  • a sore mouth or tongue
  • confusion
  • dementia
  • depression
  • difficulty maintaining balance

Vitamin B-12 deficiency in infants can cause them to underachieve. They may have mobility issues in addition to developmental delays.

Pernicious anaemia

A vitamin B-12 level test may be required for people who have signs of low iron. Pernicious anaemia is caused by a lack of vitamin B-12 absorption, resulting in poor red blood cell causes.

It usually affects the elderly or people who are deficient in intrinsic factor. Intrinsic factor is a gastric material that binds to vitamin B-12 and allows it to be absorbed by the body.

The following are signs and symptoms of pernicious anaemia:

  • pale skin
  • weakness
  • weight loss
  • constipation
  • fatigue
  • loss of appetite

High levels of folate in the blood

The level of folic acid in the blood is known as serum folate. High levels of serum folate might disguise the signs and symptoms of vitamin B-12 deficiency, exacerbating the neurological symptoms.

They can also make you more susceptible to anaemia.

Symptoms of other illnesses

Vitamin B-12 levels that are unusually high can be a symptom of liver disease, diabetes, or certain types of leukaemia. The findings of a vitamin B-12 test may be used by a doctor to help them make a diagnosis.

Risk factors

Vitamin B-12 deficiency is more common in some people than in others, especially those with low stomach acid or other digestive problems. Stomach acid helps the body absorb vitamin B-12 more effectively by separating it from meals.

Low vitamin B-12 levels are more common in the following groups of people than in others:

  • people with conditions that reduce vitamin B-12 absorption, including celiac disease and Crohn’s disease
  • people who have had gastric bypass surgery
  • those who are breast-feeding
  • people who are taking medicines such as chloramphenicol, proton pump inhibitors, or H2 blockers
  • older adults
  • children
  • vegans and vegetarians
  • people with diabetes

How does the B-12 vitamin level test work?

Vitamin B-12 status is normally determined by a blood test, but home urine tests are now available. Vitamin B-12 levels can be checked as part of a routine blood test by a doctor.

Although fasting is not required before a B-12 test, it may be necessary if the doctor is utilising the test to check at other blood components.

It is important that patients inform their doctors about any medications or supplements they are taking, as some may have an impact on the outcome.

Acknowledging the results

The following are possible results:

  • Low. Vitamin B-12 levels below 200 pg/mL are considered low. This indicates that you may have a vitamin B-12 deficiency, pernicious anaemia, or an overactive thyroid. Neurological symptoms are common in people who have low vitamin B-12 levels.
  • High. Anything over 900 pg/mL is considered excessively high vitamin B-12 status. This result could indicate problems with the liver or kidneys, diabetes, or certain types of leukaemia.

Because the ranges of results differ from one laboratory to the next, it’s important to talk to a doctor about the results and what they signify.

To rule out vitamin B-12 deficiency, the doctor may measure levels of methylmalonic acid (MMA) and other chemicals. These lab results aid in the early detection of vitamin B-12 deficiency.

Vitamin B-12 deficiency treatment

Vitamin B-12 injections are frequently required by people who have low amounts of the vitamin. These shots are more successful at boosting vitamin B-12 levels than supplements, especially when people have medical issues that make supplements difficult to absorb.

High doses of vitamin B-12 supplements may help some people improve their B-12 status. Supplements are sold in the form of capsules or liquids in pharmacies, supermarkets, health food stores. It may also be beneficial to consume extra vitamin B-12-rich foods.

Treatment for high vitamin B-12 levels

There is no upper limit on vitamin B-12 consumption because high amounts do not cause problems. Having naturally high levels of vitamin B-12 in the body, on the other hand, could be cause for alarm, since it could indicate a serious underlying condition. Doctors will focus on treating the underlying medical condition rather than the vitamin B-12 levels.

Vitamin B-12  foods.

Eggs are rich in vitamin B-12.
Vitamin B-12 is abundant in eggs.

Although low vitamin B-12 levels are frequently caused by absorption problems and other medical conditions, some people may be deficient because they do not acquire enough vitamin B-12 through their food. This is especially true for vegans and vegetarians who have been vegetarian for a long time.

Vitamin B-12-rich foods include:

  • fortified plant-based dairy alternatives
  • fortified breakfast cereals
  • fortified nutritional yeast
  • fish and seafood
  • meat
  • eggs
  • dairy products

Vitamin supplements can help vegans and strict vegetarians make up for dietary deficiencies. Older persons should seek to achieve their vitamin B-12 needs through fortified meals and vitamin supplements, as supplements are simpler for their bodies to absorb than naturally occurring vitamin B-12.

Vitamin B-12 dietary recommendations

Vitamin B-12 is required in 2.4 micrograms (mcg) per day for adults and adolescents over the age of 14. During pregnancy, this rises to 2.6 mcg, and breast-feeding raises it to 2.8 mcg.

Conclusion

Vitamin B-12 is an essential nutrient that is necessary for good health. The status of a person’s vitamin B-12 is determined by a vitamin B-12 level test. This test may be recommended by a doctor to people who have symptoms of a deficiency or who are at risk of having low vitamin B-12 levels in their bodies.

Vitamin B-12 deficiency can be avoided by eating a well-balanced diet that includes many sources of the vitamin on a daily basis, or by taking supplements. If they have trouble absorbing vitamin B-12 from food, oral supplements or injections can help them avoid symptoms and consequences.

Sources:

  • https://academic.oup.com/qjmed/article/106/6/505/1538806
  • https://labtestsonline.org/tests/methylmalonic-acid
  • https://www.medicalnewstoday.com/articles/322286
  • https://academic.oup.com/nutritionreviews/article-abstract/71/2/110/1940320
  • https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
  • https://www.hsph.harvard.edu/nutritionsource/b-12-deficiency/

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Alzheimer's / Dementia

What are the signs and symptoms of Alzheimer’s disease in its early stages?

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Alzheimer’s disease is a type of dementia that affects mostly older people. Alzheimer’s disease strikes people before they reach the age of 65.

Alzheimer’s disease causes memory loss as well as a slew of other symptoms. It is a progressive condition, meaning that the symptoms will worsen over time. The most frequent type of dementia is Alzheimer’s disease.

Experts assume that early-onset Alzheimer’s disease accounts for fewer than 10 percent of all cases. It is usually caused by an inherited genetic trait. It usually appears in people in their 40s or 50s, but it can start as early as their 30s.

Although there is currently no cure, medication can help manage symptoms and slow the condition’s progression.

The symptoms, causes, and treatment options related to early-onset Alzheimer’s disease are discussed in this article.

Providing assistance to a loved one

People can help a loved one with Alzheimer’s disease in a variety of ways. They could, for example, try:

  • To gain a better grasp of the person’s situation, learn about Alzheimer’s disease.
  • speaking with the individual and partaking in activities that are enjoyable to both parties.
  • providing practical assistance, such as food preparation or transportation to appointments
  • through support networks, you can connect with other people.
  • keeping in mind that this is the same person.
  • enquiring about the person’s well-being.
  • talking to a counselor or another trustworthy person about your changing relationship is a good idea.

Causes

According to Genetics Home Reference, genetic factors are most likely to blame for early onset Alzheimer’s disease.

Some people are born with mutations in specific genes and acquire familial Alzheimer’s disease at a young age. The alterations cause the brain to create harmful proteins, which stack up in the brain and form amyloid plaques, which are clumps of protein.

The genes are passed down through the generations in an autosomal dominant pattern, which means that a person only has to inherit one copy of the mutated gene from a parent to acquire the condition. Frequently, the father suffers from the same condition.

Others don’t have these modifications, and it’s unclear why some people have the condition; nevertheless, additional genes may be implicated.

Symptoms and signs

Memory loss

Memory loss is the most common symptom of Alzheimer’s disease, but other changes can also occur. Other types of dementia can have symptoms that are similar to Alzheimer’s disease, and other illnesses can cause symptoms that are similar to Alzheimer’s disease.

The following are some of the most common signs and symptoms.

1. Impaired daily tasks due to memory loss

Memory loss is frequently the most visible indication of Alzheimer’s disease. A person may begin to forget communications or recent occurrences in ways that are out of character for them. They may ask the same question again, forgetting either the answer or the fact that they asked it previously.

People forget things as they become older, but with early-onset Alzheimer’s disease, this happens earlier in life, more frequently, and appears out of character.

2. Difficulty carrying out routine tasks

It’s possible that the person will struggle to complete a task that they’re used to. For example, they may struggle to:

  • prepare a simple meal
  • follow the rules of a familiar game
  • get to a grocery store, restaurant, or place of employment

As people get older, they may want assistance with new or unfamiliar items, such as the settings on a new phone. This, however, does not always imply a problem.

If, on the other hand, the person has been using the same phone for years and suddenly forgets how to make a phone call, they may be suffering from Alzheimer’s disease-related memory loss.

3. Difficulties with problem-solving or planning

Following directions, solving issues, and concentration may be challenging for the individual. They could find it challenging, for example, to:

  • keep track of monthly bills or expenses
  • follow directions on a product
  • follow a recipe

These issues are common in some people, but if they begin to occur when they did not previously, it could suggest early onset Alzheimer’s disease.

4. Vision and spatial awareness problems

Vision impairments associated with Alzheimer’s disease might cause it difficult for people to assess distances between objects. The person may have difficulty distinguishing contrast and colors, as well as judging speed and distance.

The combination of these eyesight issues can impair a person’s ability to drive.

Because normal aging impairs eyesight, it’s critical to see an eye doctor on a frequent basis.

5. Confusion over time and location

The person may be unsure of where they are or what time it is. Seasons, months, and times of day may be difficult for them to remember.

In a strange environment, they may become perplexed. They may become confused in familiar settings or wonder how they got there as Alzheimer’s disease worsens. They may also begin to wander and become disoriented.

6. Misplacing stuff frequently and being unable to retrace steps

Most people lose things from time to time, but they can generally find them by searching in logical places and retracing their actions.

Someone with Alzheimer’s disease, on the other hand, may forget where they put something, especially if it’s in an unusual location. They may also be unable to track down the missing object by retracing their steps. This might be upsetting and cause to the victim believing that someone is robbing them.

7. Issues with writing or speaking

Words and communication may also be a problem for the individual. They could have trouble following or contributing to a conversation, or they might keep repeating themselves. It’s also possible that the person has trouble writing down their thoughts.

They might come to a halt in the middle of a conversation, unsure of what to say next. They could also have trouble finding the right word or mislabel things.

It is not uncommon for people to have difficulty finding the proper word at times. They usually remember it after a while and don’t have the problem again.

8. Symptoms of reduced judgment

The person’s ability to make sound decisions may have shifted. For instance, they could begin by saying:

  • Spending a lot of time on chores that aren’t necessary.
  • displaying a lack of interest in personal grooming, including washing
  • putting items away in unexpected places, such as placing keys in the refrigerator

9. Mood swings or personality changes

A person with Alzheimer’s disease may notice a change in their mood. They may be irritated, perplexed, worried, or melancholy. They may also lose interest in activities that they previously enjoyed.

They may become annoyed by their symptoms or unable to comprehend the changes that are occurring. Aggression or anger toward others could be a sign of this.

10. Stepping away from social or work activities

As Alzheimer’s disease progresses, a person’s ability to participate in social or work activities may diminish.

Behavior changeAlzheimer’sAging
Memory lossForgetting things and repeating questions in a way that is unusualSlowly becoming more forgetful
Completing tasksDifficulty completing familiar tasks such as buying groceries or preparing foodPotentially needing help with new or unfamiliar things such as new technology
Problem-solvingDifficulty following instructions such as a new recipe or keeping track of billsBeing a little slower to react to things or juggle multiple tasks
VisionProblems with vision and spatial awarenessDecreasing clarity of vision that may make it harder to distinguish shapes from a distance
TimekeepingDifficulty keeping track of what day it is and becoming confused in an unfamiliar placeForgetting the reason for entering a room before remembering again
Misplacing itemsMisplacing items in unusual places and struggling to retrace stepsMomentarily misplacing items before remembering where to find them
CommunicationLosing track of conversations, repeating sentences, and struggling to write down thoughtsOccasionally struggling to find the right word or needing to concentrate harder to keep up with conversation
Decision makingSpending a long time doing unnecessary tasks and neglecting personal groomingBeing a little slower in decision making
Mood changesExperiencing low moods and feelings of irritableness, anxiety, confusion, and depressionSometimes feeling weary or becoming irritable when there is disruption to a routine
SocializingNo longer participating in social activities that previously brought enjoymentSometimes feeling tired and worn out by social interactions

Diagnosis

If a person develops one or more of the symptoms listed above, they should see a doctor very away. Early detection may assist to slow the condition’s progression.

Because there is no definite test for Alzheimer’s disease at this time, a doctor will diagnose it based on the symptoms that can be seen. They could try:

  • asking certain questions to the person, such as where they live, and evaluating their answers
  • conversing with family members to learn about the person’s actions.
  • taking into account the individual’s personal and family medical history
  • performing various tests to rule out other probable causes, such as blood tests and brain imaging

Treatment

Because there is presently no cure for Alzheimer’s disease, treatment focuses on symptom management. Among the treatment options available are:

  • cognitive stimulation therapy, which may help with memory, speech, and problem solving
  • support for living independently
  • treatments for insomnia
  • behavioral therapy to make life easier for the individual and their loved ones or caregivers
  • medications to help with memory loss and possibly slow the progression of the condition
  • counseling or medications to help manage depression or anxiety

Better therapy alternatives are constantly being researched.

Outlook

After being diagnosed with Alzheimer’s disease, most people can expect to survive for another 8–10 years, however the outlook varies from 1–25 years. It will be influenced by the person’s age at the time of diagnosis, with younger people often living longer.

Pneumonia, malnutrition, or body wasting are common causes of mortality.

Conclusion

Alzheimer’s disease has no cure at this time, however medication can help manage the symptoms.

Alzheimer’s disease is more likely to develop as people get older, but people with a family history of the disease may be at a higher risk.

Anyone who feels they or a loved one is suffering from Alzheimer’s disease should consult a physician.

Sources:

  • https://www.alz.org/national/documents/care_10waystohelpafamily.pdf
  • https://medlineplus.gov/genetics/condition/alzheimer-disease/
  • https://www.cdc.gov/aging/aginginfo/alzheimers.htm
  • https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
  • https://www.medicalnewstoday.com/articles/322240
  • https://www.alz.org/research/science/alzheimers_disease_causes.asp
  • https://www.alz.org/i-have-alz/helping-friends-and-family.asp
  • https://academic.oup.com/brain/article/138/9/2732/311444
  • https://www.nia.nih.gov/health/what-are-signs-alzheimers-disease
  • https://www.alz.org/alzheimers-dementia/what-is-alzheimers
  • https://www.alz.org/alzheimers-dementia/what-is-alzheimers/younger-early-onset

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Alzheimer's / Dementia

Is there a link between TBI and dementia?

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The question of whether traumatic brain injury causes dementia has long been debated, and the results of various research are sometimes contradictory. However, there is increasing evidence that severe brain injury can result in long-term brain damage.

brain scans
TBIs may cause progressive neurodegeneration in certain people, according to research conducted utilizing population studies and animal models.

Traumatic brain injuries (TBIs) cause the brain’s normal function to be disrupted. According to the Centers for Disease Control and Prevention, they are caused by a blow or jolt to the skull, or an injury that penetrates it (CDC).

In the United States in 2013, 2.8 million people had a TBI, with around 56,000 of them dying. Small children under the age of four, teens and young adults between the ages of 14 and 25, and people over the age of 75 were the age groups most impacted by TBI. Falls, being struck by an item, and automobile accidents were the most prevalent causes of TBI.

Headaches, blurred vision, slurred speech, and short-term memory impairments are just a few of the early symptoms. TBIs can potentially have long-term health consequences, including an increased risk of seizures and infections.

TBI has been linked to numerous kinds of progressive neurodegeneration, including dementia, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), and Parkinson’s disease, according to research, however the evidence is mixed.

Why is it so difficult to come up with irrefutable proof? What are the long-term prospects for TBI victims?

The latest findings

The researchers reviewed medical notes of working-age adults under the age of 65 who had mild or moderate to severe TBI and later got dementia, Parkinson’s disease, or ALS, using the Finnish Care Register for Health Care.

They detected a correlation between moderate to severe TBI and dementia, but no such association was found with Parkinson’s disease or ALS.

Importantly, they discovered that dementia rates in moderate to severe TBI patients were comparable to those in the general population. However, dementia primarily affects the elderly, indicating that TBI raises the risk from old age to working age.

Finland has a tax-funded healthcare system, hence the dataset utilized in this study was extensive. All acute TBI cases are treated in public hospitals, according to the authors, and hence would have been included in the research.

However, data was only accessible for TBI patients who had been hospitalized to the hospital with neurodegenerative symptoms afterward. Other individuals with a diagnosis of neurodegeneration may have been overlooked if they had not been hospitalized at the time, according to the authors.

The findings of the Finnish study matched data published in the Asian Pacific Journal of Public Health last year. Dementia rates were greater among Taiwanese TBI patients than among non-TBI patients in this study.

Another research, just published in the Journal of Alzheimer’s Disease, found no association between TBI and Alzheimer’s disease.

The scientists studied 706 seniors in the United States with and without TBI and discovered that TBI had no effect on cognitive deterioration. However, because TBI was self-reported rather than assessed in the research participants’ medical records, the results may not have been reliable.

The Annals of Physical and Rehabilitation Medicine released a systematic study earlier this year that struggled to identify a relevant link between TBI and Alzheimer’s disease.

Although the evaluation contained 18 trials, the authors were unable to categorize TBI according to severity. It may not have been able to establish a link between TBI and Alzheimer’s disease if mild and moderate to severe TBI were lumped together.

Other disease, on the other hand, has discovered clear correlations between TBI and Alzheimer’s and Parkinson’s disease.

TBI, neurodegeneration link supported

According to a recent study published in the journal The Clinical Neuropsychologist, people with histories of moderate to severe TBI began to experience symptoms and obtained their diagnosis 2.5 years earlier than non-TBI patients in an Alzheimer’s disease patient cohort. However, in this study, TBI was self-reported.

While there was no association between TBI and dementia or Alzheimer’s disease, there was a correlation with Parkinson’s disease, according to a study published in JAMA Neurology last year.

After their deaths, several of the research participants agreed to have their brains autopsied. Both mild and moderate to severe TBI patients displayed evidence of Lewy bodies, a hallmark of Parkinson’s disease, in their brains, as well as signs of cerebral microinfarcts in the moderate to severe TBI patients.

Importantly, while the majority of research participants were 65 and older, a third of mild TBI patients and almost half of moderate to severe TBI patients were 25 or younger at the time of their injury. This shows that TBI may have long-term neurodegenerative consequences.

The difficulty with this sort of study is that it relies heavily on association measurements. This implies that researchers use data to determine whether or if there is a relationship between TBI and neurodegeneration in a certain study group.

However, because cause and effect cannot be shown in these investigations, additional biological pathways may be implicated in producing neurodegeneration in these patients.

Animals are used by researchers to investigate what occurs in the brain after a TBI. The events that followed TBI are starting to be pieced together here.

How can TBI cause neurodegeneration?

A recent paper in Reviews in the Neurosciences detailed what is known about the neurological damage that occurs after a TBI to date.

Blood arteries, neurons, and other cell types are all damaged in the first insult. Neurons get overstimulated as a side consequence, resulting in oxidative stress and cell death. The brain’s water metabolism is also disrupted, resulting in edema.

The blood-brain barrier is compromised, enabling immune cells to invade the injured brain, which is ordinarily resistant to most drugs.

The brain can be permanently harmed by a combination of oxidative damage, neuroinflammation, edema, and poor blood flow.

A recent research published in The Journal of Neuroscience used a mouse model of brain damage to analyze the long-term repercussions of TBI in greater depth.

The areas surrounding the injury site suffered immediate damage. Importantly, persistent neuroinflammation was found to cause long-term damage in distant areas of the brain.

Long-term consequences following TBI were also detected in a mouse model of Alzheimer’s disease, according to a study published in Neuroscience Letters. There were no immediate alterations in the brains of older mice who had received TBI vs those who had not.

For the first week of the trial, both wounded and uninjured mice acquired senile plaques, a characteristic of Alzheimer’s disease. The mice, on the other hand, had much more plaques 28 days after the TBI. There was also a problem with spatial learning.

The researchers deduced that TBI hastens the onset of Alzheimer’s disease symptoms.

What do these findings imply for people who have had a TBI?

The need for long-term monitoring

While it is feasible to examine the cellular processes that occur after TBI in model systems, applying these findings to real patients is more problematic.

Many studies show that TBI has long-term repercussions on the brains of animals and people, but the amount of the damage and its consequences are unknown.

Regardless of their findings, most studies agree that TBI patients, particularly those who have suffered moderate to severe TBI, require long-term monitoring. There is also a request for more precise diagnostic criteria that would allow doctors to detect TBI-related neurodegeneration earlier.

This would allow doctors to keep a close eye on their patients and provide therapies or interventions as soon as possible, therefore delaying the process of cognitive deterioration.

More research is clearly needed, particularly studies that look into cause and effect and can relate the findings to large-scale, reliable demographic data.

It’s also important to keep in mind that not everyone who has had a TBI will develop progressive neurodegeneration.

A total of 1.6 percent of patients with a history of moderate TBI developed dementia in the Finnish research. Even while individuals with moderate to severe TBI were 90 percent more likely to be diagnosed with dementia, the rate was still just 3.5 percent.

While there is solid evidence that a TBI may cause long-term brain damage, concerns remain about why certain patients acquire progressive neurodegeneration and how many people are likely to be impacted.

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