Dementia – Definition
Dementia is a general loss of mental abilities. It can include a loss of ability to think, reason, learn, and understand. To be considered dementia, these mental losses must be severe enough to interfere with day to day activities. Dementia must also have:
- Memory problems
- Mental loss that is severe enough to cause problems with one or more of the following:
- Language
- Visuospatial function
- Executive function (foresight, planning, anticipation, insight)
- Praxis (learned motor skills)
Dementia – Causes
Causes of dementia include:
- Alzheimer’s disease — the most common cause of dementia
- Brain damage after multiple small strokes (also called vascular dementia)
- Lewy body disease
- Alcoholism
- AIDS
- Multiple sclerosis
- Huntington’s disease
- Parkinson’s disease
- Creutzfeldt-Jakob disease and other prion disorders
- Front-temporal dementia (including Pick’s disease)
- Normal pressure hydrocephalus
- Untreated syphilis
- Toxic levels of metals, such as aluminum (can sometimes occur in dialysis patients)
- Vitamin B12 deficiency
- Thiamine deficiency
- Thyroid dysfunction
Dementia – Risk Factors
Risk factors for dementia include:
- Advancing age
- Family members with dementia
- Down syndrome
- Apolipoprotein E status (a genetic risk)
- Elevated cholesterol
- Multiple strokes
- High blood pressure
- Diabetes
- High cholesterol
- Obesity
- Lack of physical activity
- Vitamin deficiency
- Chronic drug use
- Long-term use of hormone replacement therapy
- Repetitive head trauma (eg, may occur with contact sports)
- Overweight or obese
Dementia – Symptoms
Symptoms often begin mildly. They often get more severe over time. Symptoms vary according to the cause of the dementia, but often include:
- Increasing trouble remembering things, such as:
- How to get to familiar locations
- What the names of family and friends are
- Where common objects are usually kept
- How to do simple math
- How to do usual tasks, such as cooking, dressing, bathing, etc.
- How to drive
- How to pay bills
- Having difficulty concentrating on tasks
- Having difficulty completing sentences due to lost/forgotten words (may continue to a complete inability to speak)
- Forgetting the date, time of day, season
- Getting lost in familiar surroundings
- Having mood swings
- Being withdrawn, losing interest in usual activities
- Having personality changes
- Walking in a slow, shuffling way
- Having poor coordination
- Losing purposeful movement
Dementia – Diagnosis
Your doctor may diagnose dementia through:
- An extensive medical history from you and your family
- Observing your behavior
- A physical exam
- Tests for your nervous system
- Mental status and psychological tests
There are no blood tests or exams that can diagnose Alzheimer’s disease. Certain types of brain imaging such as a SPECT or a PET scan may aid in a diagnosis. Tests to rule out other causes of dementia and other medical conditions that may mimic dementia include:
Blood tests — to look for syphilis, vitamin B12, folate, thiamine (B1) thyroid, liver, and kidney function
- CT scan — a type of x-ray that uses a computer to make pictures of structures inside the head
- MRI scan — a test that uses magnetic waves to make pictures of structures inside the head
- PET or SPECT scans — tests that use dyes to measure the activity levels of various areas of the brain (used in some cases)
- Lumbar puncture — a test of the the fluid around the brain and spin to look for infection or bleeding, prion diseases, and potential markers of Alzheimer’s disease and other disorders
- Electroencephalogram (EEG) — a test that records the brain’s activity by measuring electrical signals from the brain
The doctor will also check to see if you have depression. It can often present like dementia.
Dementia – Treatment
Currently, there are no treatments to cure many types of dementia. Some medication may help to decrease the symptoms of dementia or slow its course.
Medications
Two types of medicines that may be used to reduce the symptoms of Alzheimer’s disease include:
- Cholinesterase inhibitors—approved and recommended for mild to moderate Alzheimer’s disease (eg, donepezil [Aricept], rivastigmine [Exelon], galantamine [Reminyl])
- N-methyl-D-aspartate (NMDA) receptor antagonist—approved for moderate to severe Alzheimer’s disease (eg, memantine)
Treatments that are being studied include:
- Gamma-secretase inhibitors
- Tau fiber aggregation inhibitors
- Herbs and supplements (eg, vitamin E, ginkgo biloba, huperzine A)—The evidence is mixed as to the effectiveness of these natural remedies.
Lifestyle Management
This type of support is critical for people with dementia. Behavioral and environmental support includes:
- Keeping you safe in your home
- Providing a calm, quiet, predictable environment
- Providing appropriate eyewear and hearing aids, easy-to-read clocks, and calendars
- Participating in music therapy and/or dance therapy
- Participating in physical and occupational therapy for daily activities
- Encouraging light exercise to reduce agitation and relieve depression
- Eating a healthy diet (eg, Mediterranean diet)
- Discussing healthcare wishes with family members and doctors and appointing a healthcare proxy and a legal power of attorney
Psychiatric Medications
People with dementia often develop psychiatric symptoms. You may need appropriate treatment, such as:
- Antidepressants
- Anxiolytics — to treat anxiety
- Antipsychotics — to treat severe confusion, paranoia, and/or hallucinations
- Must be used with caution. Generally not recommended in people with dementia.
- These medication may cause an increased risk for stroke or death in elderly patients with dementia.
- Mood stabilizers — to treat dangerous or disruptive behaviors
Caregiver Support
Caring for a person with dementia is very difficult. Those providing care will need support. The http://www.alz.org/index.asp is an excellent resource for families and caregivers.
Dementia – Prevention
While the exact cause of dementia is not known, these steps may help to reduce your risk:
- Eat a healthy diet. This will help you to maintain good levels of vitamin B12 and cholesterol.
- Exercise regularly. This can also enhance cardiovascular health, which may delay the onset of vascular dementia.
- Alcohol may have some benefits if you use it in moderation. This means no more than two drinks per day for a man, and one drink per day for a woman. Moderate amounts of alcohol may decrease your risk of dementia. But higher amounts of alcohol can increase your risk of dementia.
- Avoid drug abuse and practice safe sex. This can reduce the risk of AIDS -related dementia.
- Engage in mentally stimulating activity. This may also reduce the risk of Alzheimer’s disease.
