Description

ABSTRACT

Aim: - The aim of this review is for identification and appraisal od various studies of interventions that are created for the people to cope with dementia.

Design: - a narrative review

Method: - publications were identified using search engines like Google scholar, PubMed. Some of the non-English publications were excluded from the criterion. Quality was assessed using PEDRO.

Results: - 18 articles were identified which explained a lot about the interventions which were used for the people with dementia. Most of them were in favor of improving the functional status and declining the cognitive function with the help of exercise protocols and few of them were against this. On the Primary Outcome the people performing exercises showed improvement in their cognitive function and functional status. 

Conclusion: - The quality of the studies varies considerably. The various interventions that helps in the improvement of the cognitive functions of the brain by reactivating sensory and neural fibers proves to be effective in people with dementia. This study also supports the need to bring in the use of the educational training about the dementia to both dementia people and their caregivers. The use of the brain gyming, memory games and the very traditional games called the dhakonan games increases the efficacy of the brain. The exercise therapy for dementia people may also avert or delay and rehabilitate the outset of dementia. 

BACKGROUND

1.1-Definition

Dementia is not a normal part of aging, it is an acquired syndrome of progressive declination in the cognitive processing of the brain. It is accompanied by a departure from previous mental functioning causing interference in occupational, domestic or social functioning.Dementia is a common occurring phenomenon among the Geriatric population, and most dementia in the elderly is caused by neurodegeneration .Common dementias in the elderly are Alzheimer disease, dementia with Lewy bodies, vascular dementia, frontotemporal lobar degeneration, and Parkinson disease. It is the cause of disability among old people.

1.2-Prevalence and incidence

Incidence and prevalence are the occurrence rate or frequency of the disease, and those of dementia rise with age, making them more dependent and vulnerable. About 50milllion people worldwide live with dementia with nearly 10 million new cases each year, expected to be 131 million cases by 2050. Not only will the effect be on these patients, but also on their families and wider society. With India’s population of 1.35billion (2018), 10% is above 60 years. Glued to demographic ageing, is the problem of dementia and India is expected to have one of the biggest number of elders with dementia.

 The prevalence of dementia in the rural population in South India and that in North India showed a variation from 3.39 to 0.84%, respectively. There are few urban studies from several regions of India showing similar varying rates: From 2.44 to 4.1% in West India, 1.83% in North India, 0.8‐1.28% in East India, and 3.6% in South India. Dementia prevalence in Asia has previously been found to be lower than that of Western populations, but research studies show that age-specific prevalence rates are the same globally. Overall dementia prevalence is expected to rise dramatically across Asia due to maturing populations.

1.3- Etiology and pathogenesis

 The question of how and why dementia initiates or the overall underlying process is not yet fully comprehended, but available studies say that Certain portions of the intellectual ensemble are controlled by circumscribed regions of the cerebrum, Memory impairment, which is a central feature of most dementias, may occur with extensive disease in several different parts of the cerebrum, but the integrity of certain discrete parts of the diencephalon and inferomedial parts of the temporal lobes is fundamental to retentive memory.

 In a similar way, impairment of language function is associated specifically with disease of the dominant cerebral hemisphere, particularly the perisylvian parts of the frontal, temporal, and parietal lobes. Loss of capacity for reading and calculation is related to lesions in the posterior part of the left (dominant) cerebral hemisphere; loss of use of tools and imitation of gestures (apraxias) is related to loss of tissue in the dominant parietal region. Impairment in drawing or constructing simple and complex figures with blocks, sticks, picture arrangements, etc., is observed with parietal lobe lesions, more often with right-sided (non-dominant)than with left-sided ones.

 Moreover, problems with modulation of behavior and stability of personality are generally related to frontal lobe degeneration. Thus, the clinical picture resulting from cerebral disease depends in part on the extent of the lesion, i.e., the amount of cerebral tissue destroyed, and in part on the region of the brain that bears the brunt of the pathologic change.

 Degenerative dementia is often times related  to mainly the cerebral cortex structural disease,with also the possibility of  that of the diencephalon and possibly, as mentioned earlier under “Subcortical Dementia,” to the basal ganglia. In some pathologic cases, such as Alzheimer disease, the primary activity is a degeneration and loss of nerve cells in the cortical association areas and medial temporal lobes.

1.4- Clinical presentation of dementia and associated conditions

The earliest signs of dementia may be very subtle and may not even be noticed by the physician. Forgetfulness is the most prominent early symptom.

·         The purpose of an errand is forgotten.

·         Recent conversations and social events are overlooked.

·         The patient asks the same question repeatedly and cannot retain information.

·         Later every passing incidents easily distracts a patient.

·         It becomes close to impossible thinking or discussing a problem with clarity or to understand all aspects of complex situations.

·         There is deduction in judgment and ability to make inferences from given premises.

·         Unimportant events cause worry and concern

·         Tasks that require several steps cannot be fulfilled, and simple directions cannot be followed.

·          There is evidence in Perseveration in speech, action, and thought.

·         The patient tends to get lost, even along routes of travel that are known

·          Day- to-day events are not recalled.