The phase of life that is referred to as "old age" becomes longer and longer - due to medical progress and also for reasons of social change. Ageing involves, among other factors, reduction of muscular power, faster defatigation and elongated recovery periods after an infection. However, this is not a disease but a natural process.  

And in the same way as the rest of an ageing person's body, the brain is also subject to the natural ageing process that has special effects on the short-term memory and the ability to concentrate. It is absolutely normal that together with physical ageing, psychological aspects: such as a slight decline of the cognitive mobility, responsiveness, the ability to adapt to new situations, problem solving under pressure, and retention of new facts.
  

Dementia is not a variant from the normal age-related changes, but comprises a number of pathological processes that become apparent through a specific pattern of deficits and through accelerated regression of a person's cognitive abilities. The most important symptoms of a beginning disorder of cognitive functions are (these symptoms must not all emerge simultaneously): Disorientation, impairment of concentration and attentiveness, restlessness, depressive irritations, lack of motivation and drive, indifference and listlessness or impairment of social behaviour.   

It is fairly difficult obtaining a differential diagnosis for dementia and delimiting it from the normal ageing process. However, with the help of detailed interviews and questioning schemes, with medical examination and psychological test methods early signs of dementia can be detected.   

Differentiation is made between  irreversible   and   reversible   disorders of cognitive functions.  

The causes of the more rare   reversible   disorder of cognitive functions (approx. 10%) may be metabolic diseases, infectious diseases, poisoning or deficiency conditions. In these cases, therapy of the underlying cause must be initiated, i.e. the deficiency or adverse state must be eliminated or corrected.  

The cause of the more frequent   irreversible   disorder of cognitive functions (approx. 90% of the cases) is a pathological modification in the balance of glutamate, an important transfer agent in the brain. In these modification processes a very delicate equilibrium that is required for communication of the nervous cells in the brain is changed and as a consequence the flow of information is impaired and ultimately interrupted. In the long run, this morbid process inevitably leads to mortification of a growing number of nervous cells and thus causes a decline of the mental abilities. Therefore, the influence of glutamate as a transfer agent in the brain is a reasonable starting point of therapy and treatment.  

Currently, in Germany approximately 1,100,000 people are affected by this disease.  

For a successful treatment of disorders of cognitive functions the most important aspects are good early detection, a well-founded diagnosis and an appropriate therapy.  

Treatment should be a combination of drugs (anti-dementia drugs), exercise, cerebral training (brain jogging) and an appropriate diet; in Germany this type of treatment is referred to as ABCD-therapy (Arzneimittel, Bewegung, Cerebrales Training, Diät).  

The drugs that are currently administered for treatment of irreversible disorder of cognitive functions can effectively suspend and retard the development of the disease to some extent. There are various possibilities for medication therapy that must be administered consistently over a longer period in order to be successful.  

Physical exercise is a method to improve the blood flow in the brain and consequently increase mental abilities. Intellectually challenging activities, i.e. cerebral training, such as playing chess, doing puzzles or active participation in social and cultural live also stimulate continuous exercise of the brain. A balanced diet for the elderly patient should be rich in proteins and minerals (special diet) and include an appropriate quantity of liquids (minimum 2 litres per day).  

If not treated, the disease will continue constantly and lead to advanced mental decline of the memory and cognitive functions and will compromise the quality of life of the affected and their family and relatives.  

For the benefits of a harmonic and balanced relationship and in view of a fast and successful therapy, the family and relatives of a person affected should be actively included in the therapy as early as possible. The attending specialist(s) or organisations such as self-support groups give help and support. It is very important that the family and relatives realise that they decisively contribute to the success of the therapy.   

When was your grand-daughter’s birthday again?  Left the apartment without keys again? Looked for hours for the shirt you have hung up for drying? If you notice that you or one of your relatives have or has more and more gaps in your or their memory and problems of orientation, you should be attentive. A visit to your doctor can show whether these problems are normal “blackouts” or whether an incipient disorder of brain functions is manifesting itself.  

As a general rule it can be said that disorders of cognitive functions can be well treated if the diagnosis and therapy are defined at an early stage of the disease. In future, new insights and findings from medical research and development will contribute to an improvement of medication and therapy. For patients and their relatives a number of various possibilities for information and support are available today, e.g.: specialists, care assistants or self-support groups.