'The Most Cruel Goodbye' Dementia, No Cure but Prevention Exists [Reading Science]

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[Asia Economy Reporter Kim Bong-su] 'The cruelest farewell' is another name for dementia. The brain's functions gradually deteriorate as one forgets even their loved ones. Precious memories are lost, and eventually, the person suffers from bedsores and other ailments before passing away. As the aging society progresses, dementia has become more common and, like the old saying "there is no filial son for a long illness," it poses the greatest welfare burden not only on individuals and families but also on society as a whole. Governments worldwide have selected the development of dementia treatments as a major national task and are striving to find solutions.

◇Is Dementia a Disease?

Dementia refers to symptoms of degenerative behavior caused by the death of brain cells due to various diseases and other causes. It occurs acquiredly and progresses gradually, eventually leading to the deterioration of brain functions to the extent that daily life becomes impossible. Dementia impairs all brain functions, including memory, spatial perception, language ability, calculation, judgment, and motor skills. It should be distinguished from simple forgetfulness due to aging, where hints can quickly trigger recall or overall memory remains but details are forgotten.

As dementia progresses, sufferers begin to experience depression, insomnia, and anxiety, followed by wandering, delusions, increased verbal and physical aggression, auditory and visual hallucinations, leading to psychiatric disorders. Ultimately, motor skills deteriorate, and many end up bedridden, dying from infections such as pneumonia or bedsores. Recently, dementia has been identified as a major underlying condition in COVID-19 infection fatalities.

Due to recent population aging and changes in dietary habits, dementia cases are rapidly increasing. Experts predict that the dementia population will double every 20 years, reaching 3 million by 2050. One in ten elderly people aged 65 and over suffers from dementia, and mild cognitive impairment, a precursor to dementia, affects 2 to 3 out of every 10 people. The social costs are also significant. The annual cost per dementia patient was 20.42 million KRW (as of 2019), placing a heavy burden on households. By around 2040, national dementia management costs are estimated to reach 63.1 trillion KRW.

◇Where Does Dementia Begin?

The fundamental causes, pathogenesis, and treatments are still uncertain. Currently, degenerative brain diseases such as Alzheimer's, vascular brain diseases like cerebral infarction and stroke, Lewy body and Parkinsonian dementia, and other diseases are considered causes. Alzheimer's disease accounts for more than 60% of all cases.

It has long been known that abnormal accumulation of "bad proteins" such as amyloid-beta and tau proteins kills brain cells. Recently, Korean researchers discovered that severe reactive astrocytes kill neurons and induce dementia pathology. Alzheimer's dementia incidence increases with age, doubling every five years after age 65.

If detected before age 70, progression can be slowed and symptoms alleviated, but no cure has yet been developed. Parkinsonian dementia involves the accumulation of a substance called Lewy bodies in the midbrain, disrupting the brain's dopamine system and causing motor and cognitive impairments; currently, no treatment exists. However, other types of dementia can improve or be treated if the underlying cause is addressed. Vascular dementia occurs when brain cells die or malfunction due to blocked or ruptured blood vessels in the brain, i.e., stroke. Treating stroke can improve or cure this type of dementia.

Additionally, about 90 diseases cause secondary dementia. Dementia can result from alcohol addiction, brain tumors, hydrocephalus, AIDS or viral encephalitis, neurosyphilis, and nutritional deficiencies such as vitamin B12. Currently, for cognitive decline due to Alzheimer's and other dementias, medications such as acetylcholinesterase inhibitors (Aricept, Reminyl, Exelon) and glutamate receptor antagonists are used to supplement neurotransmitters. These treatments show effects for about 6 months to a year, after which efficacy significantly decreases. Psychiatric medications are required for depression, delusions, or violent tendencies.

◇Prevention and Early Diagnosis Are Top Priorities

Experts advise that since dementia has deep roots, health management and prevention should begin in one's 40s and 50s. This is because the causative substances accumulate in the brain 15 to 20 years before symptoms appear. Regular exercise is foremost. Walking 30 minutes three times a week reduces the risk of cognitive impairment by 33% and dementia onset by 31%. Social activities, such as meeting many people, are essential. Making 1 to 2 new friends lowers the risk of cognitive decline by 30%, while those who live alone have a 1.5 times higher risk of dementia. Meeting relatives, friends, or neighbors at least once a month reduces dementia risk by 15%, and daily meetings reduce it by 43%. Conversations, information exchange, and emotional interactions stimulate brain neuron activity and improve connectivity.

Active brain activities such as reading, newspaper reading, and writing are also necessary. People who do not read or write have a fourfold higher risk of dementia. Passive brain activities like watching TV increase cognitive impairment risk by 10%, whereas creative activities such as gaming, entertainment, and writing help maintain brain function. Adequate nutrition is essential. Rather than consuming specific nutrients or health supplements, it is better to include fish, vegetables, and fruits regularly in the diet. Especially, daily milk consumption reduces the risk of Alzheimer's dementia by over 60%. People with so-called "three highs"?hypertension, hyperglycemia, and hyperlipidemia?are prone to brain dysfunction and require consistent medication or cause improvement.