Dementia: The biology of the degenerating brain
Kokoro is BrainSightAI's citizen-scientist program. With Kokoro we want individuals who experience mental health disorders to share their lived experience and inform technological solutions; that are sensitive to the needs of the people they are designed for.
A recent session was hosted by neuropsychiatrist Dr. Abhimanyu Chandak. We discussed the neurological underpinnings of the brain. For someone like me who's fascinated by firing neurotransmitters and telomeres I learned quite a lot from this session. I mean how often do you get free access to a psychiatrist to ask them unlimited questions? He showed us the dorsal and ventral views of different lobes in the brain and how the brain changes with the onset of Dementia. Here is the presentation deck.
You can watch the hour long session here. What I enjoyed the most however were the barrage of questions that followed the talk. It's always nice to know that curiosity is alive! It assured me that the session was useful to participants. Considering India's projected Dementia caregiver burden is going to be 6.5 million by 2025- that's 4 years from now, it is important for everyone to know how to keep themselves fit and build on their cognitive reservoirs.
Here is the session's QnA
When we keep learning new things does that mean new neurons get formed in the brain?
Learning new things doesn’t lead to formation of new neurons, but activates the preformed circuits containing the steps involved in the new activity and creates and maintains these newly formed circuits.
Vandana Pattnaik, one of our attendee's commented
Having looked after my mum with dementia, what we realized was that once we started playing scrabble with her everyday starting with 2-3 letter words, she was able to make 5- 6 letter words over time. We also made her knit. This helped with calculations.
When there is pressure on our blood vessels as in the case of hypertension is it similar to a stroke?
A stroke can be due to multiple reasons. One of the mechanisms is the pressure on the blood vessels caused by chronic hypertension. Stroke is a major risk factor/cause for development of dementia (most commonly the vascular type).
Why does only the ventricular system exert hydraulic pressure as opposed to any arteries?
This is due to the difference in structural nature of the two. While arteries contain elastic tissue that is required to expand and contract as per requirement, the ventricles contain elastic tissue with plastic properties which allow it to take up space as it requires.
Can the damage of not being able to get the right words be reversed?
It is very difficult to say what can and can’t be reversed. There are too many factors involved and it differs from person to person.
The point is to put in our best effort.
How does hearing affect our memory and skills?
When patients are unable to hear well, they start to fill up the gaps with what they feel is right leading to confusing behaviors. Hearing is also a kind of stimulus and is required to keep the areas of the brain involved in hearing and speaking circuitry to remain active. It also leads to isolation and decreased responsiveness which can further cognitive decline.
Hence, treating a hearing impairment is very important in the elderly.
Does frontotemporal dementia occur at an earlier age?
Yes, studies have shown that frontotemporal dementia has an earlier age of onset, a stronger genetic loading and the phenomenon of anticipation (earlier age of onset in the next generation as compared to preceding generations).
As a caregiver, how can I help a person who can not find words to express themselves?
If a person is having trouble finding words to express themselves, the following can be tried
Visual cues - labels, pictures, etc.
Repeated use of the words in everyday sentences even when they are not required.
Using visual charts of expression - specifically for expressive loss
Motivating them to use the word. Even when they point at an object, first ask them to try to tell, else tell them what it is and ask them to repeat it.
How can I soothe someone who is frustrated, aggressive and stubborn from time to time?
If it is happening infrequently/occasionally we just have to agree with them and say that you will do what they say and they will forget about it in a while (fortunately or unfortunately). If the patient is aggressive frequently, then they probably require medication to be calmed down and that can be supplemented with the strategy shared above.
As the disease progresses, wouldn't learning new things be very difficult? Do you suggest this for the early stage only or even in moderately severe stages?
You are right. Learning new things is difficult as the disease progresses. Which is why learning completely new things is better in the mild stages of the illness. But, even in moderate to severe illness, we can help them relearn forgotten activities and that will serve the purpose of keeping the circuits functioning.
What kinds of social activity might be helpful in restoring cognitive reserves?
Cognitive reserve is a preventive concept. It is a useful thing to maintain in those at risk and those with mild impairments. Social activities like conversing with family and friends, visiting relatives, playing group games, other group activities (book clubs, etc.), volunteer work can help.
How does one motivate older people - who are so resistant to learning new things, get tired easily and don't want to step outside the house?
Positive reinforcements - food, praise and thank them often
Breaking down the tasks to small steps and using positive reinforcements in between.
How can we train elderly and dementia patients to learn to use technological products? Like some mobile applications or wearable devices? Won't they forget the use rapidly? Or would daily use with such technology help them make a long term memory for the same? Would it be even possible to do this learning in a moderately severe case?
While it is difficult, with persistence, repetition and positive reinforcement, it is possible to teach simple activities like making a call. It is also important for them to learn these simple tasks as they can be used in emergencies.
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