Excessive alcoholism or severe malnutrition can also lead to dementia by causing a deficiency in Vitamin B1 (thiamine) through an inflammation of the stomach lining. This then leads to decay in the hippocampus affecting the patient’s memory. This is known as Korsakoff’s syndrome which has among its symptoms Ataxia (or loss of coordination).

These are just a sample of the different types of dementia, others can be caused by infections affecting the spinal chord such as AIDS dementia complex, some forms hydrocephalus (the accumulation of fluid in the brain), one or several head injuries (such as those sustained by boxers) or even illnesses located away from the brain such as kidney or liver diseases. Similar symptoms have been shown to occur as the result of hormone deficiencies and depression.

Once dementia has been diagnosed and the exact form identified, medical experts will usually go about an intervention. Most interventions however are palliative, aiming to manage or slow the progression of the disease rather than providing a cure, with dementia generally having a poor prognosis. Instead individual drugs can be prescribed to help tackle symptoms. For example, two types of medication can help counter cognitive difficulties: ‘Cholinesterase inhibitors’ (such as donepezil) work by preventing the breakdown of the chemical messenger acetylcholine, which is crucial for learning and memory; and ‘Memantine’, which works by regulating the activity of glutamate which is also involved in learning and memory. Additionally, antidepressants such as citalopram (Celexa) or fluoxetine (Prozac) may be used to improve a patient’s mood, or anxiolytics such as lorazepam (Ativan) can be used to combat anxiety or restlessness. None of these however is without side effects and so discretion should be made when prescribing such medication. Non-drug based interventions, such as informing carers how best to interact with and help the sufferer, are preferred (reference with all these drugs!).

Only a few forms of dementia have the possibility of recovery, two treatable iterations of dementia are Korsakoff’s syndrome and normal pressure hydrocephalus. For those suffering from Korsakoff’s syndrome Thiamine has been shown to be effective, as has limiting alcohol consumption (conversely however moderate consumption of alcohol has been shown to help protect against dementia).

Current research is now looking into stimulating the birth of new cells (neurogenesis) in order to replace those lost in dementia. This line of research has lead to experimentation with stem cells. Research into the area continues though dementia suffers from a lack of awareness and funding when compared to other illnesses such as Cancer. Since Terry Pratchett’s diagnosis however awareness has been raised. The author himself has donated £1,000,000 to the cause and a campaign ‘Match it for Pratchett’ is trying to raise the same amount in his honour.

To summarise then, dementia is a term that encompasses many different pathologies and symptoms with ‘Alzheimer’s’ and ‘vascular dementia’ describing the most common of these. Broadly it describes an abnormal decline in memory and cognitive ability that comes about as the result of cell malfunction and death leading to atrophy in various brain regions. Common causes for this are protein deposits in or around neurons, legions, or disruptions to the blood flow. Diagnosis depends on a report of syndromes sometimes in conjunction with tests and imaging techniques. Most forms of dementia are irreversible and terminal and interventions remain largely palliative while research into more long-term solutions continues.

Mack LeMouse

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