A Crash Course in Dementia

On occasion, when I am so lucky, I teach a university course here and there. One of my primary objective with any course I teach (or guest lecture) is understanding the terminologies. I often feel that it is a good foundation to ensure we are all speaking about—and understanding—the same thing. I mean, one’s definition of an abstract concept of love, for example, may be very different from someone else’s. Laying down some ground, and explaining the terms, goes a long way to making sure that everyone is on the same page and there are minimal confusion.

So here are some key working definitions.

Cognition: Oh boy. A biggie. In short, it comprises of 2 aspects: 1) the mental processes that interact with the “material, social, and symbolic environment”; 2) the capacity to process and make sense of that environment*. Cognition is the way we organise, understand, and present ourselves. It is shaped by one’s internal networks of thoughts, feelings and visceral reactions, as well as by the external world, that is, the socio-cultural and environmental context in which we are situated. Things like where we grew up (and how) helps us shape our cognition. It’s an interaction of various influences that shapes our cognition, in which who we are, our fundamental self, and how we are supposed to filter what we are experiencing (for example, in Classical Western literature, men cried. This was normal. Nowadays? Not so much. Even things like what is ‘feminine’ or ‘masculine’ is dictated by this interaction).

Now, this is located in our brain, which also influences who and what we are. If our brain is working, our perceptions of reality is more closely aligned to our society’s understanding of the events. If it isn’t, then something is off.

And… just to add even more confusion: we aren’t entirely sure how the brain works. We get some of the mechanics of it and how it physically works, but the link between cognition and the brain is, for a lack of a better term, fuzzy.

Phew. I hope that this was clear.

Fun fact: Cognition comes from the Latin cognescere, or “to know, to be acquainted with”. Fun fact squared: this section includes a slight reworking of my thesis.

Dementia: It’s an umbrella term that is characterised in a decline in the cognitive/mental processes. It’s a category of diseases that affects the brain which reduces a person’s to reason, to remember, problem-solve, to communicate, or to think, among many many others. Dementia is believed to be caused by damage to the brain cells, which can be the result of a number of factors. Because cognition—and therefore behaviour—resides in the brain, most people with a form of dementia may experience some behavioural changes.

Note: Not all of these symptoms are caused by dementia. Some other conditions presents itself similarly, such as hypothyroidism, vitamin deficiency, depression, or sleep disorders. These are treatable, and often with the proper medication, the symptoms are reversible, and in some cases, curable. This is why it is important to get thee to a reputable medical professional for a simple blood test to determine what causes these symptoms.
(Here’s an excellent explanation, with a video at the bottom that explains dementia: http://alzheimer.ca/en/Home/About-dementia/What-is-dementia)

Alzheimer’s: Probably the best known, and most common form of dementia. Aside from 1-5% of cases, which has a genetic explanation, we aren’t sure what causes Alzheimer’s. There are a variety of hypotheses, none of which are tremendously important right now.

It was first identified by Dr Alois Alzheimer, and there are two hallmarks of this disease: first is ‘amyloid plaques’, that is tiny little deposits that, if there are too many of, are poisonous to the brain, causing it to essentially be toxic to itself. The second is what is called ‘neurofibrillary tangles’ (also called tangles). In healthy brains, fibres made up of tau protein create pathways or microtubules. These are responsible for transporting molecules, nutrients, and information between cells. These work, and the brain is constantly fired up like a central hub. You want these to work.

With Alzheimer’s, however, the tau protein, the building block of the fibres, become messed up, and these pathways in your brain becomes tangled (hence the name). When the microtubules (ie the pathways) becomes tangled, it starts to become unstable, unusable, and will disintegrate, and that particular hub which it served starts to collapse, because it’s not receiving its necessary molecules, informations, and nutrients.
When this happens, the brain to slowly die and shrink, which in turn causes more tangles, which causes more collapses and so forth.

What is important is that 60-80% of dementia cases are Alzheimer’s strikes people over the age of 65 (though not necessarily). A progressive disease, it has no cure but with medication, care, routine, and even therapy, it can slow down.

Vascular Dementia: Probably the second most common form of dementia, it’s when the blood supply to the brain is malfunctioning or is blocked. Because the brain does not receive adequate blood and oxygen, it slowly degenerates and dies. It is different from Alzheimer’s because it’s the blood supply that causes damage to the brain cells, rather than the pathways that are tangled up. This blood supply malfunction can be caused by either a stroke, a covert stroke (you-didn’t-even-know-you-had-a-stroke stroke), some environmental and lifestyle factors which may contribute to the blocking of the blood supply, or just sheer, plumb bad luck.

Unfortunately, once the brain starts to die, one cannot reverse the damage. However, with treatment, medication, and routine, one can slow the progress and even manage the symptoms.

Mixed Dementia: As the name implies, this is the type of dementia that shows a mixed characteristics, most often (most often but not necessarily) that of Alzheimer’s and vascular dementia. Often having the tangles and/or plaques of Alzheimer’s as well as the blood supply changes of vascular, mixed dementia can be difficult to diagnose as abnormal protein deposits of Lewy’s or Parkinson’s – or sometimes, all three. This makes it difficult to diagnose.

PART: Short for Primary-Age Related Tauopathy, PART is a designation that has only been around since 2014, and unfortunately, it has been mostly diagnosed posthumously. This means that while on the one hand, it’s tremendously exciting, because it hasn’t been studied and can give us new information on how the brain works, the ageing process, and how to manage neurological illnesses, such as dementia; it is an uncharted territory, the final frontier, so to speak. On the other hand, it really sucks because— unlike Alzheimer’s, which is much more studied—no one can really say how the illness manifests and what to expect.

It is characterised by the presence of neurofibrillary tangles (the disintegration of the microtubules) but without the amyloid plaques. It presents itself as Alzheimers, but it’s missing one of the key component, that is the toxic plaque in the brain. In other words, there isn’t that toxicity in the brain (that we know of), but that ‘information highway’ is just completely messed up. And as we know, when the microtubules are not functioning, they deprived the brain of the necessary nutrients and information, so that region of the brain slowly dies and shrinks. And, because it’s a new designation, the medication to slow down the process is more of a trial and error.

What we do know is that, like Alzheimer’s, neurofibrillary tangles causes cognitive decline. Your memory is shot, words are messed up and you cannot remember the word to describe what you need (so in Apa speak, ‘csoport’ or group of people often means ‘family’, which should be ‘család’. Or if he wants one of us to turn off the tele, he would say “there are people down there, and they need to leave, and we have to make them go dark.” It took a while to figure that one out!). Confabulation is another symptom, lack of hygiene, and there seems to be a weird form of Capgras delusion, but it’s with places, not people. The way he experiences himself, the way he communicates himself, and understands who he is–essentially, his reality–is severely deteriorating. As his brain is dying, his cognition is decaying.

There are also other causes of dementia, such as Parkinson’s, Lewy body, frontotemporal (that which tends to hit specific parts of the brain), Creutzfeldt-Jakob, or Corticobasal degeneration, but I have done very little research on them and don’t feel comfortable describing them.

Bottom line, dementia sucks and even with what we know, we know very little, which is why it is important to educate ourselves and if possible, to support various foundations and research.

References and for Support:

* Oleg Anshakov and Tamás Gergely, Cognitive Reasoning: A Formal Approach, Cognitive Technologies, (Heidelberg and Dordrecht: Springer. 2010), p. 1; Jeppe Sinding Jensen, “Framing Religious Narrative, Cognition and Culture Theoretically”, in Religious Narrative, Cognition and Culture: Image and Word in the Mind of Narrative, edited by Armin W. Geertz and Jeppe Sinding Jensen, Religion, Cognition and Culture, (Sheffield: Equinox Publishing, Ltd, 2011), p. 35.


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