Dementia: Classification and Aspects of Treatment

Abstract

The syndrome dementia is defined by evidence of a decline in memory, thinking, and emotional functions. In this article, dementia is delimited only by its symptoms; the etiology, the course, and the extensiveness of the disorder are not used as criteria of a dementia syndrome. In the descriptive diagnoses of dementia disorders, however, different aspects of the disorders are used. Descriptive diagnoses are (a) benign senile forgetfulness, (b) primary degenerative disorders, (c) secondary dementias, (d) cerebrovascular disorders with dementia, (e) reversible dementias, and (f) dementias with unknown etiology. Primary degenerative disorders include the subgroups (a) senile dementia of Alzheimer type (SDAT), (b) Alzheimer’s disease (AD), (c) Pick’s disease, and (d) Huntington’s chorea. The question whether SDAT and AD should be included in one group is discussed. Very interesting and stimulating treatment research is going on in the field of dementias. Although there has still been no real breakthrough, some results indicate that dementia symptoms may be influenced by treatment. At present, treatment strategies go along the following lines: (a) pharmacological treatment, (b) control of sleep apneas and circulatory disturbances, (c) brain tissue transplantation, and (d) psychotherapy and mental activation. The pharmacological manipulation of dementia disorders focuses on substituting failing neurotransmitter systems. The use of nootropic drugs and gangliosides is still at an experimental level. Findings of vitamin B₁₂ deficiency in late-onset dementia make vitamin B₁₂ substitution relevant. White matter disturbances such as incomplete infarctions are reported in brains from demented patients. Coincident findings of increased sleep apneas with severe hypoxemia make studies of circulatory disturbances of interest. Transplantation of brain tissue has already left the animal experimental level and been applied to patients with parkinsonism. In some investigations, it is shown that mental activation causes not only a mental improvement but also changes in cerebrospinal fluid indicating the stimulation of trophic factors.