Dementia. What does the prognosis depend on?

Prognosis of Various Dementias

The prognosis for the development and course of any dementia depends on the accurate diagnosis of the dementia. Specifically, it depends on which type of dementia is developing in the person.

For example, vascular dementia is a multifactorial disease, meaning it develops depending on numerous risk factors.

For example, due to high blood pressure, high cholesterol, the presence of diabetes in the patient, or after a stroke.

Therefore, it is not possible to clearly state what prognosis awaits a patient if they have vascular dementia.

However, in the case of an acute stroke, some recovery of cognitive functions is expected. After the initial recovery period, further improvement is less likely.

It is of great importance whether the patient experiences recurrent strokes in the future, whether the risk factors that led to the stroke persist, or whether the patient has taken all measures and changed their lifestyle to a more active one, adhering to all medication preventive measures.

Moreover, if the patient has concomitant neurodegenerative changes, such as temporal lobe atrophy (characteristic of Alzheimer’s disease), then the prognosis is more severe and suggests a more rapid decline in cognitive functions.

If we talk about neurodegenerative dementias, on average, patients with Alzheimer’s disease live about 7 years from the time of diagnosis. However, this period can vary significantly depending on adherence to all medical recommendations regarding the correction of cognitive and behavioral symptoms.

The prognosis also depends on patient care, which includes:

• proper, adequate nutrition
• rehabilitation and home safety
• prevention of falls and exacerbation of hallucinations
• prevention of pressure sores and aspiration pneumonia in swallowing disorders
• various therapeutic exercise methods (active and even passive, in bed, in case the patient is bedridden)

With proper, good care, a patient with Alzheimer’s disease can live much longer than 7 years. For example, the well-known Ronald Reagan lived 20 years from the time of his Alzheimer’s diagnosis, all because treatment began as soon as the first signs of the serious illness appeared, and, of course, he was immediately provided with good care and support.

The prognosis and survival estimates may be slightly more serious for a patient with other common neurodegenerative diseases—dementia with Lewy bodies and dementia developed in the context of Parkinson’s disease

In these diseases, which are often grouped together, there are many factors that influence a poorer prognosis. These include:

• early development of hallucinations and psychosis (which requires early prescription of antipsychotic drugs, which themselves are risk factors for earlier death)
• associated movement disorders such as parkinsonism and postural instability, which provoke falls and fractures with low survival rates thereafter
  orthostatic hypotension — a decrease in blood pressure upon standing, which can also lead to falls and fractures