Dementia

In dementia, we witness the degeneration of brain cells and the abnormal behavior of a number of proteins that are normally present in the brain. It is not yet understood why those changes occur. What is known is that there are different changes observed that are associated with different symptoms.

There are a number of causes of dementia and a number of types as listed below. Depending on the causes of dementia and on the areas of the brain affected by dementia, the symptoms differ greatly between individuals. Those symptoms include personality changes, behavioural changes, mobility changes, cognitive changes and psychiatric changes. As the disease progresses, we may expect more diffuse manifestation of symptoms across those domains depending on the individual presentation.

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Dementia is more prevalent with age, however it is not a normal part of aging. Where a gradual slowing down of thinking or physical function may be considered a common trend in aging, dementia affects a whole range of functions including language, behaviour, personality, emotions and physical function. Diagnosis of dementia is determined by clinical symptoms and the presentation of those symptoms over time.

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There are two primary risk factors for dementia that we cannot change in genetics and ageing. There are also a number of modifiable risk factors that we can change to decrease our risk of developing dementia. The research suggests that many of those risk factors should be address early in life, even as early as in one's 30s.

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Modifiable risk factors:

Hypertension and blood pressure control;

Type 2 Diabetes management;
High cholesterol in mid life and obesity in mid life;

Nutrition;
Hearing loss in mid life;
Smoking;

Depression in late life;

Physical inactivity;

Social isolation.

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By the time a person experiences symptoms of dementia, the damages in the brain are already significant. This is one of the reasons why it may be difficult to find a cure. However, the research is focusing on understanding how to modify the course of the disease process as early as possible, before the brain damage has significantly progressed. In addition, there is also focus on preventing those changes from developing. This is an area where physiotherapy can assist through therapeutic exercise with its neuroprotective and neuroregenerative effects and its ability to reduce the risk of cognitive decline.

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ALZHEIMER'S DISEASE

Alzheimer's disease is a neurodegenerative disease which means that the cells of the brain, the neurons, are slowly lost over time. In Alzheimer's disease, there are two main changes in the brain. One is called a Beta-amyloid plaque. These plaques are made up of tiny filaments that deposit between the cells of the brain and are thought to either directly damage or have a toxic effect on surrounding neurons and their connections. The second major change is the neurofibrillary tangle. Unlike plaques, tangles occur inside nerve cells and are thought to 'gum up' the cell so that the cell doesn't work properly and eventually this causes the cell to die. (MOOC, 2020).

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FRONTO-TEMPORAL DEMENTIA
There are several diseases that cause fronto-temporal dementia.

Fronto-temporal dementia is characterized by damage and atrophy of the frontal cortex and the front part of the parietal cortex. There are two variants of fronto-temporal dementia based on where the changes occur and they display different symptoms.
In the behavioural variant (where the frontal lobe of the brain is primarily affected), a person presents primarily with personality and behavioral changes, impaired planning and judgement, apathy, loss of empathy, dis-inhibition and diet changes.
In the language variant (where the temporal lobe of the brain is primarily affected), a person may lose the ability to understand speech or the ability to produce speech.

Of the types of dementia, this is the type of dementia with the strongest genetic predisposition.

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DEMENTIA WITH LEWY BODIES
Lewy Body Disease is another cause of dementia.
Lewy Body Disease has many symptoms that are similar to Alzheimer's Disease such as loss of attention. However, in Lewy Body Disease cognitive changes tend to fluctuate and impairments in visuospatial awareness are more significant so a person will have difficulties with judging distances when walking or driving.

Visual hallucinations, sleep disorder (such as acting out dreams) and Parkinson's type features (such as tremor) are characteristic of Lewy Body Disease.

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VASCULAR DEMENTIA

Vascular dementia arises due to damage or blockage of blood vessels in the brain. This causes a lack of oxygen being delivered to the area of the brain those blood vessels feed. As a consequence, those brain cells become damaged.

Symptoms of Vascular Dementia may include a decline in gait, executive function such as logical thinking and changes in mood and behaviour. Because of the causes of vascular Dementia, the symptoms tend to follow a step-wise pattern with periods of deterioration interspersed with periods of stability.

Physiotherapy can help a person with Dementia in two main areas: decrease risk factors and management post diagnosis. Because every individual is different and every situation is different, you should always seek expert advice from a qualified therapist. What is included below should only be taken as informative rather than guide you through an exercise program.

 

EXERCISE THERAPY

A number of studies have investigated the effects of exercise on the brain in people with dementia, in healthy individuals and in animal studies. Emerging from these studies is the notion that exercise has neuroprotective and neuroregenerative properties meaning exercise can protect the brain and help the brain to optimally function. As a result, exercise may lead to improved motor and cognitive functions. Specialized physiotherapy input that incorporates tailored exercise has the potential to slow down the progression of symptoms and to improve your function. ​Exercise therapy may also include input to improve or maintain strength and balance.

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The type of exercise identified to have the below benefits is an individualised high intensity exercise program. This specialised exercise regime has been found to substantially increase the benefits in comparison to usual care exercise. The main positive effects suggested for such type of exercise are:

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COGNITIVE AND BEHAVIORAL BENEFITS
- Less cognitive and behavioral decline;
- Increased psychological well-being;
- Reduced apathy. This is key as apathy is associated with faster cognitive and functional decline, depression and increased mortality;
- Improved attention and abstract reasoning;
- Improving cognitive function.

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PHYSICAL AND FUNCTIONAL BENEFITS
- Improved balance;
- Improve gait speed, cadence, stride length, and lower limb strength with gains retained for several months;
- Decreased falls rate;
- Improved abilities to perform ADLs independently, lasting for several months;
- Less development of health-associated conditions (stress, sleep);
- Reduction of chronic disease  such as diabetes and cardiovascular disease.

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BRAIN RELATED CHANGES
- Increase in neurotrophins (proteins that promote the function of neurons in the brain);
- Enhancement of brain blood flow;
- Formation of new structures in the brain (angiogenesis, neurogenesis, synaptogenesis);
- Plasticity in the brain memory-related region (e.g., hippocampus);
- Reduction of neuroinflammation;
- Reduction of cells death.

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​Physiotherapy can also assist in adapting your movements in order for you to still be able to effectively complete a task or with recommending assistive devices to optimize movement and function such as mobility aids and postural supports.

As you can see, the treatment of Dementia must be a team approach. One of our focuses is to facilitate the formation of such team approach through a good network of practitioners and social and support groups including neurologist or geriatrician, nurse, occupational therapist, speech therapist, nutritionist or dietitian, counsellor.

 

Anna has completed the University of Tasmania MOOC Understanding Dementia Open Course and Preventing Dementia Open Course. Anna has a strong local network having worked with Dr Arup Bhattacharya and Sheree Ambrosini in their roles working with individuals with dementia in the Goulburn Valley as well as with numerous allied health and health care clinicians.

 

The services that we offer will of course be tailored to your needs. However, we are also working towards developing more support and therapy options through group therapy and we hope to be able to offer that to the community soon.