Definition  

Dementia is the name given to a group of disorders of the brain. They progressively damage the ability of the brain to function normally. In order to be diagnosed with dementia, there must be:

  • A disturbance in memory
  • A decline in one or more cognitive domains that cause functional impairment in:
    • Language
    • Visuospatial function
    • Executive function (foresight, planning, anticipation, insight, etc)
    • Praxis (learned motor skills)
Some Areas of the Brain Affected by Dementia  
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Causes  

Causes of dementia include:

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
  • Vitamin deficiency
  • Chronic drug use
  • Long-term use of hormone replacement therapy*¹
  • Repetitive head trauma (eg, may occur with contact sports)
Symptoms  

They often begin mildly and progress 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
    • The names of friends, family members
    • Where common objects are usually kept
    • Simple math
    • How to perform usual tasks, such as cooking, dressing, bathing, etc.
    • How to drive
    • Bill paying
  • Trouble concentrating on tasks
  • Trouble completing sentences, due to lost/forgotten words (may progress to complete inability to speak)
  • Inability to remember the date, time of day, season
  • Getting lost in familiar surroundings
  • Mood swings
  • Withdrawal, loss of interest in usual activities
  • Personality changes
  • Slow, shuffling walk
  • Poor coordination
  • Slowness and then loss of purposeful movement
Diagnosis  

Doctors diagnose dementia by:

  • Taking an extensive history from the patient and his family
  • Closely observing the patient
  • Performing a physical exam
  • Performing mental status and psychological tests

There are no blood tests or exams that can definitively diagnose Alzheimer's disease. Certain types of brain imaging such as a SPECT or a PET scan can aid in a diagnosis. Tests to rule out other causes of dementia and other medical conditions that may mimic dementia include:

  • Blood tests for syphilis , vitamin B12 , folate , 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 (used in certain instances)—a tests that use dyes to measure the activity levels of various areas of the brain
  • Lumbar puncture —collecting a sample of cerebrospinal fluid by inserting a needle between two vertebrae (rarely needed)
  • 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.

Treatment  

Currently there are no treatments to cure many types of dementia. Various drugs are being studied to see if they can decrease the symptoms of dementia or slow its course.

Medications  

Medications being used or studied for possible use include:

  • Cholinesterase inhibitors
  • NMDA receptor antagonists
  • Antioxidants (eg, vitamin E and others)
  • Estrogens—Long-term use of estrogen therapy may put you at a higher risk for stroke , fractures , and gallbladder disease *¹
  • Anti-inflammatory agents
  • Ginkgo biloba (herbal supplement)—There are mixed reports on the effectiveness of this herb. *²

Only two types of medications have been approved to reduce the symptoms of Alzheimer's disease:

  • Cholinesterase inhibitors—approved and recommended for mild-moderate Alzheimer's disease:
    • Donepezil (Aricept)
    • Rivastigmine (Exelon)
    • Galantamine (Reminyl)
  • NMDA receptor antagonist—approved for moderate to severe Alzheimer's disease:
    • Memantine (Namenda)

These medications only have a modest effect on the disease.

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
  • Music therapy and/or dance therapy
  • Encouraging light exercise to reduce agitation and relieve depression
  • 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 and may need appropriate treatment, such as:

  • Antidepressants
  • Anxiolytics—to treat anxiety
  • Antipsychotics—to treat severe confusion, paranoia, and/or hallucinations
    • These must be used with caution. There are reports of 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 Alzheimer’s Association is an excellent resource for families and caregivers.

Prevention  

There is no known way to prevent Alzheimer's disease. In general:

  • A healthy diet will help maintain good levels of vitamin B12 and cholesterol.
  • Exercise can also enhance cardiovascular health, which may delay the onset of vascular dementia.
  • Limiting alcohol intake can prevent dementia from alcoholism .
  • Avoiding drug abuse and practicing safe sex reduces the risk of AIDS -related dementia.
  • There is some evidence that engaging in mentally stimulating activity over a lifetime may also reduce the risk of Alzheimer’s disease