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DementiaBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/dementia/DS01131
Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting thinking and social abilities severely enough to interfere with daily functioning.
Many causes of dementia symptoms exist. Alzheimer's disease is the most common cause of a progressive dementia.
Memory loss generally occurs in dementia. However, memory loss alone doesn't mean you have dementia. Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment or language, and the inability to perform some daily activities such as paying bills or becoming lost driving.
Dementia can make you confused and unable to remember people and names. You also may experience changes in personality and social behavior. However, some causes of dementia are treatable and even reversible.
Dementia symptoms vary depending on the cause, but common signs and symptoms include:
- Memory loss
- Difficulty communicating
- Difficulty with complex tasks
- Difficulty with planning and organizing
- Difficulty with coordination and motor functions
- Problems with disorientation, such as getting lost
- Personality changes
- Inability to reason
- Inappropriate behavior
When to see a doctor
See a doctor if you or a loved one experiences memory problems or other dementia symptoms. Some treatable medical conditions can cause dementia symptoms, so it's important that a doctor determine the underlying cause.
Alzheimer's disease and several other types of dementia worsen over time. Early diagnosis gives you time to plan for the future while you can participate in making decisions.
Dementia involves damage of nerve cells in the brain, which may occur in several areas of the brain. Dementia may affect people differently, depending on the area of the brain affected.
Dementias can be classified in a variety of ways and are often grouped by what they have in common, such as what part of the brain is affected, or whether they worsen over time (progressive dementias).
Some dementias, such as those caused by a reaction to medications or an infection, are reversible with treatment.
Types of dementias that worsen over time include:
Alzheimer's disease. In people age 65 and older, Alzheimer's disease is the most common cause of dementia. People generally may develop symptoms after age 60, but some people may have early-onset forms of the disease, often as the result of a defective gene.
Although in most cases the exact cause of Alzheimer's disease isn't known, plaques and tangles are often found in the brains of people with Alzheimer's. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein.
Certain genetic factors also may make it more likely that people will develop Alzheimer's.
Alzheimer's disease usually progresses slowly over seven to 10 years. Your cognitive abilities slowly decline. Eventually, the affected areas of your brain don't work properly, including parts of your brain that control memory, language, judgment and spatial abilities.
Lewy body dementia. Lewy body dementia affects approximately 10 to 22 percent of people with dementia, making it one of the most common types of dementia. Lewy body dementia becomes more common with age.
Lewy bodies are abnormal clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer's disease and Parkinson's disease.
Lewy body dementia symptoms are similar to symptoms of Alzheimer's disease. Its unique features include fluctuations between confusion and clear thinking (lucidity), visual hallucinations, and tremor and rigidity (parkinsonism).
People with Lewy body dementia often have a condition called rapid eye movement (REM) sleep behavior disorder that involves acting out dreams.
Vascular dementia. Vascular dementia, the second most common type of dementia, occurs as a result of brain damage due to reduced or blocked blood flow in blood vessels leading to your brain.
Blood vessel problems may be caused by stroke, infection of a heart valve (endocarditis) or other blood vessel (vascular) conditions.
Symptoms usually start suddenly and often occur in people with high blood pressure or people who have had strokes or heart attacks in the past.
Several different types of vascular dementia exist, and the types have different causes and symptoms. Alzheimer's disease and other dementias also may be present at the same time as this dementia.
Frontotemporal dementia. This less common cause of dementia tends to occur at a younger age than does Alzheimer's disease, generally between the ages of 40 and 65.
This is a group of diseases characterized by the breakdown (degeneration) of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language.
Signs and symptoms of frontotemporal dementia can include inappropriate behaviors, language problems, difficulty with thinking and concentration, and movement problems.
As with other dementias, the cause isn't known, although in some cases this dementia is related to certain genetic mutations.
Other disorders linked to dementia
Huntington's disease. This inherited disease causes certain nerve cells in your brain and spinal cord to waste away.
Signs and symptoms usually appear during your 30s or 40s. People may experience personality changes, such as irritability or anxiety. The condition causes a severe decline in thinking (cognitive) skills over time. Huntington's disease also causes weakness and difficulty with walking and movement.
Traumatic brain injury. This condition is caused by repetitive head trauma, such as experienced by boxers, football players or soldiers.
Depending on the part of the brain injured, this condition can cause dementia signs and symptoms such as uncoordinated movement and impaired speech, as well as slow movement, tremors and rigidity (parkinsonism). Symptoms may not appear until many years after the actual trauma.
A person who has experienced a single traumatic head injury could develop a similar condition called post-traumatic dementia, which may cause symptoms such as long-term memory problems.
- HIV-associated dementia. Infection with the human immunodeficiency virus (HIV), which causes AIDS, destroys brain matter and may cause memory problems, withdrawal from social situations, concentration problems or movement problems.
Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without risk factors. This condition may be due to an abnormal form of a protein. Creutzfeldt-Jakob disease sometimes may be inherited or caused by exposure to diseased brain or nervous system tissue.
Signs and symptoms of this fatal condition usually appear around age 60 and initially include problems with coordination, memory, thinking and vision. Symptoms worsen over time and may include the inability to move or talk, blindness, or infections.
- Secondary dementias. People with movement disorders and other conditions may develop dementia. For example, many people with Parkinson's disease eventually develop dementia symptoms (Parkinson's disease dementia).
The relationship between these disorders and dementia isn't completely understood.
Dementia causes that can be reversed
Some causes of dementia or dementia-like symptoms can be reversed. Your doctor may identify and treat these causes:
Infections and immune disorders. Dementia can result from fever or other side effects of your body's attempt to fight off an infection. People may develop dementia or thinking difficulties if they have brain infections like meningitis and encephalitis, untreated syphilis, Lyme disease, or conditions that cause a completely compromised immune system, such as leukemia.
Conditions such as multiple sclerosis that arise from the body's immune system attacking nerve cells also can cause dementia.
- Metabolic problems and endocrine abnormalities. People with thyroid problems, too little sugar in the bloodstream (hypoglycemia), too low or too high amounts of sodium or calcium, or an impaired ability to absorb vitamin B-12 may develop dementia or other personality changes.
- Nutritional deficiencies. Dementia symptoms can occur as a result of not drinking enough liquids (dehydration); not having enough thiamine (vitamin B-1), a condition common in people with chronic alcoholism; and not having enough vitamins B-6 and B-12 in your diet.
- Reactions to medications. Dementia may occur as a reaction to a single medication or because of an interaction of several medications.
- Subdural hematomas. Subdural hematomas are caused by bleeding between the surface of the brain and the covering over the brain. They can cause symptoms similar to dementia.
Poisoning. Dementia symptoms can occur as a result of exposure to heavy metals, such as lead, and other poisons, such as pesticides.
Dementia symptoms also may occur in some people who have abused alcohol or recreational drugs. Symptoms may disappear after treatment, but in some cases symptoms may still be present after treatment.
- Brain tumors. Dementia rarely can result from damage caused by a brain tumor.
Anoxia. This condition, also called hypoxia, occurs when organ tissues aren't getting enough oxygen. Anoxia may occur due to severe asthma, heart attack, carbon monoxide poisoning or other causes.
If you've experienced a severe lack of oxygen, recovery may take longer. Symptoms, such as memory problems or confusion, may occur during recovery.
- Heart and lung problems. Your brain can't survive without oxygen. Dementia symptoms may occur in people with chronic lung problems or a heart condition that deprives the brain of the oxygen it needs.
- Normal-pressure hydrocephalus. Sometimes people have normal-pressure hydrocephalus, a condition caused by enlarged ventricles in the brain. This condition can cause walking problems, urinary difficulty and memory loss. Shunt surgery, which delivers cerebrospinal fluid from the head to the abdomen or heart, may help these symptoms.
Many factors can eventually lead to dementia. Some factors, such as age, can't be changed. Others can be addressed to reduce your risk.
Risk factors that can't be changed
- Age. As you age, the risk of Alzheimer's disease, vascular dementia and several other dementias greatly increases, especially after age 65. However, dementia isn't a normal part of aging, and dementia can occur in younger people.
Family history. If you have a family history of dementia, you're at greater risk of developing the condition. However, many people with a family history never develop symptoms, and many people without a family history do.
If you have specific genetic mutations, you're at significantly greater risk of developing certain types of dementia.
Tests to determine whether you have certain genetic mutations are available, but doctors don't generally recommend testing because the tests aren't always accurate.
- Down syndrome. By middle age, many people with Down syndrome develop the plaques and tangles in the brain that are associated with Alzheimer's disease. Some may develop dementia.
Risk factors you can change
You may be able to take steps to control the following risk factors of dementia.
- Alcohol use. People who consume large amounts of alcohol may have a higher risk of dementia. Although studies have shown that moderate amounts of alcohol may have a protective effect, abuse of alcohol increases your risk of developing dementia.
- Atherosclerosis. This buildup of fats and other substances in and on your artery walls (plaques) can reduce the blood flow to your brain and lead to stroke. Reduced blood flow to your brain can also cause vascular dementia. Some research shows there may be an association between blood vessel (vascular) conditions and Alzheimer's disease.
- Blood pressure. Several studies show high or low blood pressure may increase your risk of developing dementia.
- Cholesterol. If you have high levels of low-density lipoprotein (LDL) cholesterol, you may have an increased risk of developing vascular dementia or Alzheimer's disease. Researchers continue to study how cholesterol may affect dementia.
- Depression. Although not yet well understood, late-life depression, especially in men, may be an indication for the development of Alzheimer's-related dementia.
- Diabetes. If you have diabetes, you may have an increased risk of developing Alzheimer's disease and vascular dementia.
- High estrogen levels. Women taking estrogen and progesterone years after menopause are at greater risk of developing dementia.
- Homocysteine blood levels. Elevated blood levels of homocysteine, a type of amino acid produced by your body, may increase your risk of developing vascular dementia. However, studies have had varying results in determining whether elevated homocysteine levels are a risk factor of dementia.
- Obesity. Being overweight or obese during the middle of your life may increase your risk of developing dementia when you're older.
- Smoking. Smoking may increase your risk of developing dementia and blood vessel (vascular) diseases.
Dementia can affect the functioning of many body systems and, therefore, the ability to carry out day-to-day tasks. Dementia may lead to several problems, including:
Inadequate nutrition. Many people with dementia will eventually reduce or stop eating and drinking. They may forget to eat or think they've already eaten. Changes in meal times or noise distractions in their environment may affect whether they eat.
Often, advanced dementia causes you to lose control of the muscles used to chew and swallow. This may put you at risk of choking or aspirating food in your lungs. If this happens, it can block breathing and cause pneumonia. You also lose the feeling of hunger and, with it, the desire to eat.
Depression, side effects of medications, constipation and other conditions also can decrease your interest in food.
- Reduced hygiene. In moderate to severe stages of dementia, you'll eventually lose the ability to independently complete daily living tasks. You may no longer be able to bathe, dress, brush your hair or teeth, or use the toilet on your own.
- Difficulty taking medications. Because your memory is affected, remembering to take the correct amount of medications at the right time can be challenging.
Deterioration of emotional health. Dementia changes behaviors and personality. Some of the changes may be caused by the actual deterioration happening in your brain, while other behavioral and personality changes may be emotional reactions to coping with the changes in your brain.
Dementia may lead to depression, aggression, confusion, frustration, anxiety, a lack of inhibition and disorientation.
- Difficulty communicating. As dementia progresses, you may lose the ability to remember the names of people and things. You may have trouble communicating with others or understanding others. Difficulty communicating can lead to feelings of agitation, isolation and depression.
Delusions and hallucinations. You may experience delusions in which you have false ideas about another person or situation.
Some people, especially those with Lewy body dementia, may have visual hallucinations.
- Sleep difficulties. You may experience sleep difficulties, such as waking up very early in the morning. Some people with dementia may have restless legs syndrome or rapid eye movement sleep behavior disorder, which also can interfere with sleep.
- Personal safety challenges. Because of a reduced capacity for decision making and problem-solving, some day-to-day situations can present safety issues for people with dementia. These include driving, cooking, falling, getting lost and negotiating obstacles.
Preparing for your appointment
Most likely, you'll first see your primary care provider if you have concerns about dementia. In some cases, you may be referred to a doctor trained in nervous system conditions (neurologist).
Because appointments can be brief, and because there's often a lot to talk about, it's a good idea to be well prepared. If you're a caregiver for someone with more advanced dementia, you'll likely be the one gathering information from the doctor. Here's some information to help you get ready.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
- Write down any symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements being taken.
- Take a family member, friend or caregiver along, if possible. Sometimes it can be difficult to soak up all the information provided during an appointment.
Preparing a list of questions will help make the most of your time with the doctor. List questions from most important to least important in case time runs out. For dementia, some basic questions to ask the doctor include:
- What is likely causing symptoms?
- Are there other possible causes for symptoms?
- What kinds of tests are necessary?
- Is the condition likely temporary or chronic?
- What's the best course of action?
- What are the alternatives to the primary approach being suggested?
- How can dementia and additional health issues best be managed together?
- Are there any restrictions?
- Is there a generic alternative to the medicine being prescribed?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
The doctor is likely to ask you and your caregiver a number of questions such as:
- What symptoms are you experiencing? For example, are you having trouble with finding words or remembering events, focusing attention, developing changes in personality, or getting lost?
- When did symptoms begin?
- Have symptoms been continuous or occasional?
- How severe are symptoms?
- What, if anything, seems to improve symptoms?
- What, if anything, appears to worsen symptoms?
- Is there a family history of dementia or related conditions such as Huntington's or Parkinson's disease?
- Are there any activities that you have had to stop because of difficulty thinking through them?
Tests and diagnosis
Memory loss and other dementia symptoms have many causes, so diagnosing dementia and other related conditions can be challenging and may require several appointments.
To diagnose your condition, your doctor will review your medical history and symptoms and conduct a physical examination. Doctors may order a number of tests to diagnose dementia and rule out other conditions.
Cognitive and neuropsychological tests
In these tests, doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention.
Doctors use these tests to determine whether you have dementia, how severe it is and what part of your brain is affected.
In a neurological evaluation, doctors will evaluate your movement, senses, balance, reflexes and other areas. Doctors may use the neurological evaluation to diagnose other conditions.
Doctors may order brain scans, such as a CT or MRI scan, to check for evidence of stroke or bleeding and to rule out the possibility of a tumor.
Simple blood tests can rule out physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland.
You may meet with a mental health specialist (psychologist or psychiatrist) who may evaluate whether depression or another psychological condition may be causing your symptoms.
Treatments and drugs
Most types of dementia can't be cured. However, doctors will help you manage your symptoms. Treatment of dementia symptoms may help slow or minimize the development of symptoms.
Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.
Side effects can include nausea, vomiting and diarrhea. Although primarily used to treat Alzheimer's disease, these medications may also treat vascular dementia, Parkinson's disease dementia and Lewy body dementia.
Memantine. Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions, such as learning and memory. A common side effect of memantine is dizziness.
Some research has shown that combining memantine with a cholinesterase inhibitor may have beneficial results.
- Other medications. Your doctor may prescribe other medications to treat other symptoms or conditions, such as a sleep disorder.
- Occupational therapy. Your doctor may suggest occupational therapy to help you adjust to living with dementia. Therapists may teach you coping behaviors and ways to adapt movements and daily living activities as your condition changes.
Several dementia symptoms and behavior problems may be treated initially using nondrug approaches, such as:
- Modifying the environment. Reducing clutter and distracting noise can make it easier for someone with dementia to focus and function. It also may reduce confusion and frustration.
- Modifying your responses. A caregiver's response to a behavior can make the behavior, such as agitation, worse. It's best to avoid correcting and quizzing a person with dementia. Reassuring the person and validating his or her concerns can defuse most situations.
- Modifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine during the day also help reduce confusion in people with dementia.
Lifestyle and home remedies
People with dementia will experience progression of their symptoms and behavior problems over time. Caregivers may need to adapt the following suggestions to individual situations:
- Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present only one idea or instruction at a time. Use gestures and cues, such as pointing to objects.
- Encourage exercise. Exercise benefits everyone, including people with dementia. The main benefits of exercise include improved strength and cardiovascular health. Some research also shows physical activity may slow the progression of impaired thinking (cognitive) function in people with dementia.
Exercise can also lessen symptoms of depression, help retain motor skills and create a calming effect.
- Encourage participation in games and thinking activities. Participating in games, crossword puzzles and other activities in which people are using thinking (cognitive) skills may help slow mental decline in people with dementia.
Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on to prevent disorientation.
Limiting caffeine during the day, discouraging daytime napping and offering opportunities for exercise during the day may help prevent nighttime restlessness.
- Encourage keeping a calendar. Keeping a reminder calendar may help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one.
- Plan for the future. Develop a plan with your loved one that identifies goals for care in the future. Several support groups, legal advisers, family members and others can help you. You'll need to consider financial and legal issues, safety and daily living concerns, and long-term care options.
Several dietary supplements, herbal remedies and therapies have been studied for people with dementia. Some may be beneficial.
Dietary supplements, vitamins and herbal remedies
Use caution when considering dietary supplements, vitamins or herbal remedies to slow the progress of dementia, especially if you're taking other medications.
Dietary supplements, vitamins and herbal remedies aren't regulated, and claims about their benefits aren't always based on scientific research. Some alternative medicine options for Alzheimer's disease and other forms of dementia that have been studied include:
- Vitamin E. Some studies have shown that vitamin E may slow the progression of Alzheimer's disease. Doctors warn against taking large doses of vitamin E because it may have a higher risk of mortality, especially in people with heart disease.
- Omega-3 fatty acids. Omega-3s, a type of polyunsaturated fatty acid found in fish and nuts, may reduce the risk of heart disease, stroke and mild cognitive impairment. However, in studies, omega-3 fatty acids haven't significantly slowed cognitive decline in mild to moderate Alzheimer's disease. More research is needed to understand whether omega-3 fatty acids benefit people with Alzheimer's and other types of dementia.
Coenzyme Q10. This antioxidant occurs naturally in your body. It's also necessary for normal cell reactions.
A synthetic version of this compound, called idebenone, showed some positive results in testing for Alzheimer's disease.
More studies are needed to determine safe dosages and potential benefits of coenzyme Q10.
Ginkgo. Extracts from the leaves of the Ginkgo biloba tree have antioxidant and anti-inflammatory properties that may protect cells in your brain from breaking down.
Some studies have shown that ginkgo may slow the progression of memory problems in people with Alzheimer's or other types of dementia. Other studies have found that ginkgo doesn't slow or delay the onset of dementia.
People with dementia often experience worse symptoms when they're frustrated or anxious. The following techniques may help reduce agitation and promote relaxation in people with dementia.
- Music therapy, which involves listening to soothing music
- Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia
- Aromatherapy, which uses fragrant plant oils
- Massage therapy
Coping and support
Receiving a diagnosis of dementia can be devastating to you and your loved ones. Many details need to be considered to ensure that you and those around you are as prepared as possible for dealing with a condition that's unpredictable and continually changing.
Care and support for the person with the disease
Throughout the disease, you may experience a wide range of feelings. Here are some suggestions you can try to help yourself cope:
- Learn as much as you can about memory loss, dementia and Alzheimer's disease.
- Write about your feelings about having dementia in a journal.
- Join a local support group.
- Get individual or family counseling.
- Talk to a member of your church or another person who can help you with your spiritual needs.
- Stay active and involved, volunteer, exercise, and participate in activities for people with memory loss.
- Maintain contact and spend time with friends and family.
- Participate in an online community of people who are having similar experiences.
- Find new ways to express yourself, such as through painting, singing or writing.
- Delegate help with decision making to someone you trust.
- Be patient with yourself.
Helping someone with dementia
You can help a person cope with the disease by listening, reassuring the person that he or she still can enjoy life, being supportive and positive, and doing your best to help the person retain dignity and self-respect.
Providing care for a person with dementia is physically and emotionally demanding. Often the primary caregiver is a spouse or other family member. Feelings of anger and guilt, frustration and discouragement, worry, grief, and social isolation are common. If you're a caregiver for someone with dementia:
- Ask friends or other family members for help when you need it
- Take care of your physical, emotional and spiritual health
- Learn as much about the disease as you can
- Ask questions of doctors, social workers and others involved in the care of your loved one
- Join a support group
- Find out about supportive services in your community, such as respite care or adult day care, which can provide you with a break from caregiving at scheduled times during the week
There's no sure way to prevent dementia, but there are steps you can take that might help. More research is needed, but it may be beneficial to do the following:
- Keep your mind active. Mentally stimulating activities, such as puzzles and word games, and memory training may delay the onset of dementia and help decrease its effects.
- Be physically and socially active. Physical activity and social interaction may delay the onset of dementia and reduce its symptoms.
- Quit smoking. Some studies have shown smoking in middle age and older may increase your risk of dementia and blood vessel (vascular) conditions. Quitting smoking may reduce your risk.
- Lower your blood pressure. High blood pressure may lead to a higher risk of some types of dementia. More research is needed to determine whether treating high blood pressure may reduce the risk of dementia.
- Pursue education. People who have spent more time in formal education appear to have a lower incidence of mental decline, even when they have brain abnormalities. Researchers believe that education may help your brain develop a strong nerve cell network that compensates for nerve cell damage caused by Alzheimer's disease.
- Maintain a healthy diet. Eating a healthy diet is important for many reasons, but a diet rich in fruits, vegetables and omega-3 fatty acids, commonly found in certain fish and nuts, may promote overall health and lower your risk of developing dementia.
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