Dementia affecting subcortical regions: Classifications, indications, and management strategies
Subcortical dementia is a type of dementia that primarily affects regions beneath the brain's outer layer, known as the cortex. This condition is distinguished by its unique symptoms, causes, and treatment approaches compared to cortical dementia.
Brain Regions Involved
While cortical dementia results from damage to the cerebral cortex, the brain's outer layer responsible for memory, language, and higher cognitive functions, subcortical dementia arises from dysfunction in brain areas beneath the cortex, such as the basal ganglia, thalamus, and white matter tracts.
Symptoms
Subcortical dementia presents with slower cognitive processing, forgetfulness, impaired executive functions, mood changes, and motor symptoms such as slowed movements or gait disturbances. In contrast, cortical dementia typically manifests with problems in memory, language (aphasia), and praxis (ability to perform learned movements).
Causes
Subcortical dementias can be caused by vascular diseases affecting subcortical regions, Parkinson’s disease, Huntington’s disease, HIV-related brain disease, and other conditions targeting subcortical structures. Cortical dementias are often caused by Alzheimer’s disease, frontotemporal dementia, or other neurodegenerative disorders prominently affecting the cortex.
Diagnosis
Neuroimaging (e.g., fMRI) and molecular biomarkers are increasingly important for differentiating these types, detecting characteristic patterns of cortical or subcortical atrophy early in the disease process.
Treatment
Current treatment for both types of dementia focuses on symptom management with medications (e.g., cholinesterase inhibitors in cortical dementias like Alzheimer’s) and supportive therapies. Non-drug interventions such as cognitive therapy, music, and aromatherapy are used to improve quality of life across dementia types.
Risk Factors and Management
High blood pressure, advanced age, smoking, uncontrolled diabetes, consuming too much alcohol, and having a close family member with dementia are risk factors for developing dementia. A doctor may prescribe medications to treat these conditions and reduce the risk of blood clots.
A person may need to stop taking medications that can worsen cognitive decline, such as anticholinergics. Researchers are currently investigating the connection between brain changes and the development of dementia.
Prognosis
There is no cure for subcortical dementia, and it is a progressive condition that can result in a shortened life expectancy. However, treatments can help slow the progression of the disease. The walls of the blood vessels in subcortical dementia thicken, becoming stiff, which results in reduced blood flow.
In conclusion, understanding the differences between cortical and subcortical dementia is crucial for accurate diagnosis and targeted treatment. Both types have unique symptoms, causes, and treatment approaches, but they share some commonalities. Early and accurate identification via imaging and biomarkers may lead to more targeted future therapies.
Retargeting strategies could be employed in medical-health to focus on individuals diagnosed with neurological disorders, such as subcortical dementia, as targeted treatments are increasingly important for managing these conditions.
In the context of health-and-wellness, it is advisable for those at risk of developing dementia to manage their medical-conditions like high blood pressure, diabetes, and smoking, as these factors can increase the likelihood of developing dementia.
Paxlovid, a medication used in the treatment of COVID-19, may not have a direct impact on subcortical dementia, but understanding the connection between brain changes and the development of dementia could potentially involve investigations of such medications in relation to neurological disorders.
