The hippodrome of dementia is flooded with diseases but the quartet of Alzheimer disease, dementia with Lewy bodies, Parkinson disease and Normal Pressure Hydrocephalus (NPH) is the gargantuan screenplay of degenerative disorders that has been the knelling bell for old population around the globe. In order to curtail these pestilential vulnerabilities, a sincere effort is needed by the neurologists and psychiatrists of the orb to ferret out pragmatic remedies for scintillating merriment in the eyes of affected people.
Dementia is defined as a progressive decline in two or more areas of cognition that is sufficient to interfere with work, social function, or relationships. The areas of cognition included in the definition are memory, language, abstract thinking, praxis, visuospatial or perceptual skills, executive function, personality & social behavior. Alzheimer’s disease is the prominent reason for dementia around the orb that affected approximately 5.8 million Americans in 2014. The patho-physiology is due to deposits of Amyloid A4 protein in the Cortex with neuritic plaques and presence of tain tau plus Ubiquitin proteins in Neurofibrillary tangles. Similarly, Dementia with Lewy Bodies (DLB) and Parkinson’s disease Dementia (PDD) are also the adumbrated portraits of Dementia that portray themselves with the Levodopa responsive Parkinsonism, Cortical symptoms and Autonomic disorder. The pathophysiology of these two disorders includes Progressive Cell degeneration in Substantia Nigra & Lewy body inclusions in Cortical neurons.
In the same arena of maladies, Normal Pressure Hydrocephalus (NPH) is a brain disorder that is often misdiagnosed as Alzheimer’s or Parkinson’s disease.4 An excess amount of CSF accumulates in the brain’s ventricles which represents itself in the form of a classic triad called Hakim’s Triad that includes Dementia, gait instability and loss of bladder control.5 The diagnosis of NPH is confirmed by MRI or CT-Scan and therapy includes spinal tap and VP shunt implant.
The first line of investigations to diagnose any disorder that can cause dementia is Serum chemistry, TFTs, VDRL, TPHA & MRI. The secondary investigations include CSF examination, HIV, Genetic testing, EEG, Volumetric MRI, SPECT & Brain biopsy. It is further added that dementia must be differentiated from Catatonia that is a state in which someone is awake but does not respond to other people and their environment. It is often observed in people with depression, Bipolar Disorder, OCD, Post-Traumatic Stress Disorder (PTSD) and experiences of past trauma. In such type of situation, the role of psychiatrist along with other clinical disciplines becomes indispensible to track down the true nature of ailment. It is therefore concluded that Dementia due to the quartet of degenerative disorders is a misery of the old and to produce gold out of the old is the responsibility of clinicians that are awaiting the new quantum leaps in therapeutic arena.
REFERENCES:-
(1) Oxford handbook of Neurology, 2nd Edition (Pakistan Edition, 2017), Chapter 5, Neurological Disorders, Dementia, page 198.
(2) Matthews, K. A., Xu, W., Gaglioti, A. H., Holt, J. B., Croft, J. B., Mack, D., & McGuire, L. C. (2018). Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015–2060) in adults aged≥ 65 years. Alzheimer’s & Dementia. https://doi.org/10.1016/j.jalz.2018.06.3063.
(3) Oxford handbook of Neurology, 2nd Edition (Pakistan Edition, 2017), Chapter 5, Neurological Disorders, page 202.
(4) NPH, Alzheimer’s Association, alz.org.
(5) NPH, Alzheimer’s Association, alz.org.
