Dementia & Alzheimer's Disease

Dementia is a reference to impaired memory and other cognitive deficits that accompany brain degeneration, as well as interference with normal functioning. There are more than a dozen types and causes of dementia.

Dementia is more prevalent among the elderly. However, it can occur at any point in life. In dementia, cognitive abilities are gradually lost, accompanied by brain degeneration. In people with dementia, there is an occurrence of abnormal progressive degeneration of brain tissue as a result of disease or injury.

Dementia is most common in late adulthood. The term Senile Dementia refers to dementia that begins after the age of 65. Alzheimer's Disease is the most common cause of senile dementia, but Parkinson’s Disease, Huntington Disease and Creutzfeldt-Jakob Disease are other common causes. Complications from high blood pressure and strokes may also cause it.

Scientific Studies

A large Canadian study has found an overall rate of senile dementia of around 8 percent, as well as a female-to-male ratio of about 2:1. Whereas 2 percent of 65- to 74-year-olds are estimated to have dementia, there is an increase in rate to 11 for 75- to 84-year-olds, as well as 34 percent for people who are 85 and above.

Impaired memory, in particular, for very recent events, is typically one of the first symptoms of dementia. Poor judgement, language problems and disorientation may appear gradually or sporadically, and people who develop dementia typically have distress episodes due to confusion. Their behaviour may become uninhibited, they may lose the ability to perform familiar tasks, and they may experience a significant physical decline in addition to cognitive impairments.

Comparing with adults aged 65 and older, those who are more frequently engaged in activities that stimulate cognitive functioning show a lower risk of subsequently developing Alzheimer's disease; but whether this truly reflects a causal relationship remains to be seen. However, one thing is certain: as people live longer lives, the need to find a cure for Alzheimer’s disease and other forms of senile dementia becomes a matter of urgency. Until then, many of us can expect our family members to become Alzheimer’s patients.

Caregiving

Being a caregiver for a spouse or elderly parent with dementia can, unfortunately, be a stressful and psychologically painful experience. Over half of the patients diagnosed with senile dementia show a combination of depression, anxiety, agitation, paranoid reactions, as well as disordered thinking, which may resemble schizophrenia. Ultimately, it could result in the inability to walk, talk, or recognise family members or close friends.

In-depth studies done in Finland, the United States, and Germany, have found that among adults above the age of 65 not suffering from dementia, 20 to 25 percent do have mild cognitive impairment. Combining cases of mild impairment and dementia, some experts have estimated that 79 percent of 65- to 74-year-olds; and 45 percent of people aged 85 and older, remain cognitively normal.

Though these are not pleasant statistics, they make it clear that even well into old age, cognitive impairment isn’t inevitable; and that even with the decrease of some mental abilities with age, more knowledge and wisdom could still be accumulated.        

Alzheimer's Disease (AD)

Alzheimer's disease is a progressive brain disorder which is the most common cause of dementia among adults over the age of 65, according to around 50 to 60 percent of such cases. An overall of 2 to 4 percent of the elderly is estimated to have AD.

The early symptoms AD, which worsen gradually over a period of years, include forgetfulness, poor judgement, confusion, and disorientation. Often, memory of recent events and new information is especially impaired. Forgetfulness by itself is not necessarily a sign of a person developing AD; however, memory happens to be the first psychological function that is affected, as AD initially attacks the subcortical temporal lobe regions—areas near the hippocampus, as well as the hippocampus itself—that help in the conversion of short-term memory into long-term memory.

Alzheimer's disease spreads across a person’s temporal lobes and then to the frontal lobes, as well as to other cortical regions. According to a German physician Alois Alzheimer, who first noticed the disease a century ago, patients afflicted with this disease have an abnormal amount of plaques and tangles in their brains. Plaques happen to be clumps of protein fragments which happen to build up on the outside of the neurons, whereas tangles are fibres that get twisted and wound up together within the neurons.

Neurotransmitter Systems

Neurons tend to become damaged and die, brain tissues shrink, and communication between the neurons is impaired as AD disrupts several neurotransmitter systems, especially the acetylcholine system. Acetylcholine plays a key role in synaptic transmission in several brain areas involved in memory, and drugs that help maintain acetylcholine functioning have had some temporary success in improving cognitive functioning in AD patients.

As AD progresses, working memory and long-term memory worsen. For example, if you read a list of just three words to a healthy 80-year-old and test his recall after a brief time delay, they tend to typically remember at least 2 words if not all three. On the other hand, a patient with AD will recall 1 or none.

Anterograde and retrograde amnesia become more severe and procedural, semantic, episodic, and prospective memory can all be affected. Patients may lose the ability to learn new tasks or remembering new information or experiences, as well as forget how to perform familiar tasks and have trouble recognising even close family members.

Genetic Causes

What causes AD and its characteristic plaques and tangles? According to scientific identification, several genes contribute to early-onset AD; an inherited form of the disease which develops before the age of 65 and as early as 30, but only accounts to about 5 to 10 percent of AD cases.

However, the precise cause of the more typical, late-onset AD remains elusive; but researchers have identified one genetic risk factor. This gene helps direct the production of proteins which carry cholesterol in the blood plasma, and high cholesterol and other risk factors for cardiovascular disease may likewise increase the risk of developing AD. A recent study found that even healthy elderly adults who carried this particular gene, as compared to peers that did not, performed more poorly on prospective memory tasks.

If you know anyone with AD, you are aware that it involves much more than memory loss. These patients experience language issues, disorganised thinking, and changes in mood as well as personality. Ultimately, they may lose the ability to speak and walk, and may also lose control over bladder and bowel functioning.

Schizophrenia: The Split Mind

According to Hogarty, schizophrenia is the most bizarre and, in many ways, the most puzzling of all psychological disorders. It is also one of the most challenging disorders to treat effectively. Despite many theories and thousands of research studies, schizophrenia remains one of the least understood disorders.

Schizophrenic symptoms include severe disturbances in thinking, speech, perception, emotion, and behaviour. Schizophrenia is one of a family of psychotic disorders which involve a certain amount of loss of contact with reality and bizarre behaviours and experiences.

The term 'Schizophrenia' was introduced by Swiss psychiatrist Eugene Bleuler in 1911. It literally means 'split mind'. This has led people to confuse it with Dissociative Identity Disorder (Multiple Personality Disorder). However, when Bleuler came up with the term 'Schizophrenia', multiple personalities were not on his mind. What he intended to suggest was that certain psychological functions such as emotions, thoughts, or languages; which are usually integrated with one another; were somehow split apart or disconnected in patients with the disorder.

Characteristics of Schizophrenia

Diagnosis of schizophrenia is based on evidence that such a person misinterprets reality and exhibits disordered attention, thought or perception. In addition, this individual will withdraw from social interactions, communicate in strange or inappropriate ways, neglect personal grooming, and behave in a disorganised fashion.

Schizophrenic thoughts tend to be delusional at times, which consist of false beliefs sustained in the face of evidence that normally could be sufficient to destroy them. An individual with schizophrenia may tend to believe that his brain is being turned to glass by ray guns operated by his enemies from outer space (a delusion of persecution or that Jesus Christ is one of his special agents or a delusion of grandeur). During the period of recovery, a patient with schizophrenia described several aspects of thought disorders.

The most wearing aspects of this disorder are the fierce battles going on inside their heads with unresolvable conflicts. Their minds can divide on a subject, and the two parts can subdivide over and over again until they feel as if their minds are in pieces. At other times, they may feel like they are trapped inside their heads, banging against its walls in a desperate attempt to escape.

As individuals progress into schizophrenic condition, their perception becomes disorganised and their discarded thoughts tend to become more pronounced. Unwanted thoughts constantly tend to intrude their consciousness. Some patients experience hallucinations; false perceptions with a compelling sense of reality. Auditory hallucinations, which are typically voices speaking to such patients, are the most common, but visual and tactical hallucinations may occur, too. The following is an individual's description of his hallucinations:

As of recent, my mind has played tricks on me, creating people inside my head who come out at times to haunt and torment me. They surround me in rooms, hide behind trees and under the snow outside. They taunt me and scream at me while devising plans to break my spirit. The voices tend to come and go, but the people never leave and are always real.

The language of schizophrenic people is often disorganised and may contain strange words. A patient's language, at times, may contain word assassinations based on rhymes or other associations, rather than meaning. Consider the following conversation between a psychologist and a hospitalised  schizophrenic patient:

After two weeks, the psychologist said to the patient, "As you say, you are wired precisely wrong. But why won't you let me see the diagram?" The patient answered, "Never ever will you find the lever; the external lever which will sever me forever with my real, seal, deal, heel. It is not in my shoe, not even in the sole. It walks away." (Rosenhan &Seligman).

Schizophrenia can affect emotions in a number of ways. Many individuals with schizophrenia have Blunted Affect. Manifesting less sadness, joy, and anger than most people do. Others have a Flat Affect, showing almost no emotions at all. Their voices are monotonous, their faces impassive. Inappropriate Affect can occur, too, as in the following case:

The psychologist noted that the previous patient smiled when he felt uncomfortable, and more so when he was in pain. He cried during television comedies and seemed to be angry when justice was served. He got frightened when complimented by someone, and roared in laughter upon reading of a young child being burnt in a fire.

Subtypes of Schizophrenia

Schizophrenia has cognitive, emotional and behavioural facets that can widely vary from case to case. The Diagnostic and Statistical Manual of Mental Disorders differentiates among four major subtypes of schizophrenia.

• Paranoid Schizophrenia, whose most prominent features are delusions of persecution, making them believe that others want to harm them, and delusions of grandeur, which makes them believe that they are of enormous importance. Suspicion, anger or anxiety may company their delusions, and hallucinations are also possible. 

• Disorganised Schizophrenia, whose central features happen to be confusion and incoherence, together with severe deterioration of adaptive behaviours such as social skills, personal hygiene, and self-care. Their thought disorganisation, at times, is so extreme that it makes it hard to communicate with them. At times, their behaviour appears to be silly and childish, with emotional responses that are highly inappropriate. Individuals with disorganised schizophrenia are usually unable to function on their own.

• Catatonic Schizophrenia is characterized by striking motor disturbances which range from muscle rigidity to random or recitative movements. Individuals with repetitive schizophrenia, at times, alternate between stuporous states, in which they seem to be oblivious to reality, and agitated excited, during which they can be dangerous to others. During this stuporous state, they may exhibit waxy flexibility, in which their limbs can be moulded by another into grotesque positions, which can be maintained for hours.

Undifferentiated Schizophrenia is a category assigned to individuals who exhibit some symptoms and thought disorders of the above categories.

In addition to these categories, many health workers and researchers divide schizophrenia reactions into two main categories on the basis of two classes of symptoms. One type is characterised by a predisposition of positive symptoms, which are bizarre behaviours like delusions, hallucinations, and disordered speech and thinking. These symptoms are called positive in the account of them representing the pathological extremes of normal processes. The second type features are negative symptoms, which is the absence of normal reactions such as the lack of emotional expression, loss of motivation, and an absence of speech.

The distinction between positive and negative symptoms seem to be an important one. Researchers have found differences in brain functions in both schizophrenics with positive symptoms and primarily negative symptoms. These subtypes show differences in life history and prognosis, too. The negative feelings are likely to be associated with a long history of poor functioning prior to diagnosis, and a poor outcome following treatment.


Schizophrenia affects around 1 percent of the world's population and 1.2 percent of Americans have schizophrenia. Some who are not hospitalised barely function on their own.