Dementia

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Introduction

What is dementia?

Dementia occurs when brain function is lost. Thought processes, judgment, behavior, language ability, and memory can be affected. Dementia can occur with a variety of different conditions. It is most common after the age of 60, although it can occur at earlier ages.

The progression of dementia can be halted or reversed in some cases, particularly when the dementia is due to medications, alcohol abuse, hormonal or chemical imbalances, vitamin deficiency, depression, infection, heart or lung disease, normal pressure hydrocephalus (fluid collection in the brain), or brain tumors. The most common types of dementia, however, are progressive.

Alzheimer’s disease, a degenerative condition, is the most common cause of dementia. Other degenerative causes of dementia include Lewy body dementia, Parkinson’s disease, and Huntington’s disease. Progressive dementia can also be caused by vascular disorders such as multi-infarct dementia and by infections such as HIV and Creutzfeldt-Jakob disease.

Treatment of dementia depends upon the underlying cause(s). For reversible causes, approaches such as changing medications, correcting chemical imbalances or deficiencies, or treating medical conditions may be helpful. Some medications are available to help slow the degenerative changes seen with Alzheimer’s disease, and others are available to help control the behavioral changes that may occur.

Dementia is usually a progressive disease, but in some circumstances it can be managed or even reversed. Seek prompt medical care if you notice difficulty with memory, thinking, talking, comprehension, writing or reading; increasing confusion; inability to care for yourself and your daily needs; changes in mood, personality or behavior; or other symptoms that concern you.

Symptoms

What are the symptoms of dementia?

Symptoms of dementia include progressive changes in thought processes, judgment, behavior, language ability, and memory. These symptoms interfere with work performance, social interactions, and personal relationships.

Common symptoms of dementia

Symptoms of dementia may be subtle at first and then slowly progress. Common symptoms include:

  • Changes in mood, personality or behavior

  • Changes in sleep pattern

  • Confusion

  • Difficulty performing complex tasks

  • Difficulty with memory, thinking, talking, comprehension, writing or reading

  • Impaired reasoning

  • Impaired spatial ability and orientation

  • Loss of judgment

  • Social withdrawal

Symptoms that might indicate a serious condition

Dementia tends to have a gradual onset with progressive worsening of symptoms. Rapid or abrupt onset of symptoms could indicate a medical emergency. It is important to seek care when these symptoms start to develop so that the process can be reversed or at least slowed if possible. Seek prompt medical care if you, or someone you are with, have any of these symptoms:

  • Altered judgment

  • Changes in mood, personality or behavior

  • Changes in sleep pattern

  • Confusion

  • Difficulty with complex tasks

  • Difficulty with memory, thinking, talking, comprehension, writing or reading

  • Inability to care for oneself

  • Loss of social skills

Causes

What causes dementia?

Many things are known to cause dementia, including progressive degenerative diseases, such as Alzheimer’s disease, Lewy body dementia, Parkinson’s disease, and Huntington’s disease, infections such as HIV and Creutzfeldt-Jakob disease, medications, alcohol abuse, hormonal or chemical imbalances, vitamin deficiency, depression, infection, heart or lung disease, normal pressure hydrocephalus (fluid collection on the brain), or brain tumors. Some conditions that cause dementia run in families and others have specific risk factors.

Disease causes of dementia

Many progressive diseases are known to cause dementia including:

  • Alzheimer’s disease
  • Huntington’s disease
  • Lewy body dementia
  • Multiple sclerosis
  • Parkinson’s disease
  • Pick’s disease

Other causes of dementia

A number of other conditions are also known to cause dementia. Examples include:

What are the risk factors for dementia?

A number of factors increase the risk of developing dementia. Not all people with risk factors will get dementia. Risk factors for dementia include:

Reducing your risk of dementia

Progressive diseases such as Alzheimer’s disease are not preventable, although some types of dementia, such as dementia associated with stroke or cardiovascular disease, may be preventable. You may be able to lower your risk of dementia by:

  • Controlling blood sugar and blood pressure
  • Eating a healthy diet that is low in fat
  • Exercising regularly
  • Limit alcohol consumption
  • Quitting smoking
Treatments

How is dementia treated?

Treatment of dementia begins with seeking regular medical care throughout your life. Regular medical care allows a health care professional to provide early screening tests. Regular medical care also provides an opportunity for your health care professional to promptly evaluate symptoms and your risks for developing dementia.

In general, treatment depends upon the cause of the dementia. For reversible causes, approaches such as changing medications, correcting chemical imbalances or deficiencies, or treating medical conditions may be helpful.

Medications to slow the progression of symptoms

Medications are available to help slow the degenerative changes seen with Alzheimer’s disease, and sometimes Parkinson’s disease including:

  • Cholinesterase inhibitors, such as donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon), which increase the availability of a chemical that is required for nerve signaling in the brain

  • NMDA receptor antagonists such as memantine (Namenda), which decrease the overexcitement of certain receptors in the brain that may contribute to the degenerative process

Medications to control behavioral changes

Medications are available to help control some of the behavioral changes that may occur with dementia including:

  • Antianxiety medications such as buspirone (Buspar)

  • Antidepressants, such as citalopram (Celexa), fluoxetine (Prozac), imipramine (Tofranil), and trazodone (Desyrel), to help stabilize moods

  • Antipsychotics, such as haloperidol (Haldol), olanzapine (Zyprexa), and risperidone (Risperdal), for severe behavioral issues

  • Stimulants such as methylphenidate (Methylin, Ritalin) to improve sleep disorders and flat moods

Complementary treatments

Some complementary treatments may help some people to better deal with dementia. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

What are the potential complications of dementia?

Most types of dementia are progressive, leading to significant memory loss, loss of ability to carry out activities of daily living, and loss of the ability to socialize.

Complications of dementia include:

    • Changes in mood, personality or behavior

    • Fecal incontinence (inability to control stools)

    • Increased risk of falling

    • Increased susceptibility to infections

    • Loss of communication abilities

    • Loss of self-care abilities, such as getting dressed and personal hygiene

    • Poor nutrition due to a decreased desire to eat

    • Progressive memory loss

    • Sleep disturbances

    • Social isolation

    • Sundowning, in which confusion and behavioral abnormalities tend to increase in the late afternoon or evening

    • Swallowing problems that can lead to aspiration pneumonia

    • Urinary incontinence (inability to control urination)

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2018 Nov 14
    1. NINDS dementia information page. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Dementia-Information-Page
    2. Dementia. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/dementia.html
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