Dementia (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: Jinhui Wu, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview
Dementia is not a specific disease. Instead, it is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior. Usual causes include Alzheimer's disease, stroke, brain tumors, Lewy body disease, Parkinson's disease, Multiple sclerosis, Huntington's disease, Pick's disease and progressive supranuclear palsy. Patients with dementia may show symptoms as progressively memory loss, difficulty communicating, difficulty reading or writing, difficulty with performing tasks that take some thought, difficulty with coordination and motor functions, withdrawing from social contact, personality changes or inappropriate behavior. A mental status examination can be used to assess patients' mental function, including language function, motor activity function, recognition function and executive function. Treatments of dementia include therapeutic schedule for the underlying causes and medications to improve symptoms and slow the progression. There is no preventable measurement for most cases of dementia. When dementia occurs, it usually developes progressively and often decreases patients' quality of life and lifespan.

What are the symptoms of Dementia?

 * Dementia symptoms include difficulty with many areas of mental function, including:
 * Language
 * Memory
 * Perception
 * Emotional behavior or personality
 * Cognitive skills (such as calculation, abstract thinking, or judgment)


 * Dementia usually first appears as forgetfulness.
 * Mild cognitive impairment is the stage between normal forgetfulness due to aging and the development of dementia.


 * The early symptoms of dementia can include:
 * Language problems, such as trouble finding the name of familiar objects
 * Misplacing items
 * Getting lost on familiar routes
 * Personality changes and loss of social skills
 * Losing interest in things you previously enjoyed, flat mood
 * Difficulty performing tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines


 * As the dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of yourself. The symptoms may include:
 * Forgetting details about current events
 * Forgetting events in your own life history, losing awareness of who you are
 * Change in sleep patterns, often waking up at night
 * More difficulty reading or writing
 * Poor judgment and loss of ability to recognize danger
 * Using the wrong word, not pronouncing words correctly, speaking in confusing sentences
 * Withdrawing from social contact
 * Having hallucinations, arguments, striking out, and violent behavior
 * Having delusions, depression, [Agitation (patient information)|agitation]]
 * Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving


 * People with severe dementia can no longer:
 * Understand language
 * Recognize family members
 * Perform basic activities of daily living, such as eating, dressing, and bathing


 * Other symptoms that may occur with dementia:
 * Incontinence
 * Swallowing problems

What causes Dementia?

 * Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer's disease is the most common type of dementia.


 * Lewy body disease is a leading cause of dementia in elderly adults. People with this condition have abnormal protein structures in certain areas of the brain.


 * Dementia also can be due to many small strokes. This is called vascular dementia.


 * The following medical conditions also can lead to dementia:
 * Parkinson's disease
 * Multiple sclerosis
 * Huntington's disease
 * Pick's disease
 * Progressive supranuclear palsy
 * Infections that can affect the brain, such as HIV/AIDS and Lyme disease


 * Some causes of dementia may be stopped or reversed if they are found soon enough, including:
 * Brain tumors
 * Changes in blood glucose, sodium, and calcium levels
 * Low vitamin B12 levels
 * Normal pressure hydrocephalus
 * Use of certain medications, including cimetadine and some cholesterol-lowering medications
 * Chronic alcohol abuse


 * Dementia usually occurs in older age. It is rare in people under age 60. The risk for dementia increases as a person gets older.

Who is at highest risk?

 * Degenerative: This is the most common cause of dementia, named Alzheimer's disease.
 * Stroke
 * Lewy body disease
 * Parkinson's disease
 * Multiple sclerosis
 * Huntington's disease
 * Pick's disease
 * Progressive supranuclear palsy
 * Brain tumors
 * Brain infection

When to seek urgent medical care?

 * Call your health care provider if symptoms of dementia gets worse.


 * If the patient experiences either of the following symptoms, seeking urgent medical care as soon as possible:
 * Stupor
 * Mania

Diagnosis

 * Dementia can often be diagnosed with a history and physical exam by a skilled doctor or nurse.
 * A health care provider will take a history, do a physical exam (including a neurological exam), and perform some tests of mental function called a mental status examination.
 * Motor activity function: Whether the patient is unable to perform motor activities even though physical ability remains intact or not
 * Recognition function: Whether the patient is unable to recognize objects, even though sensory function is intact or not
 * Executive function: Whether the patient is unable to plan, organize, think abstractly or not


 * The health care provider may order tests to help determine whether other problems could be causing dementia or making it worse. These conditions include:
 * Thyroid disease
 * Vitamin deficiency
 * Brain tumor
 * Intoxication from medications
 * Chronic infection
 * Anemia
 * Severe depression


 * The following tests and procedures may be done:
 * B12 level
 * Blood ammonia levels
 * Blood chemistry (chem-20)
 * Blood gas analysis
 * Cerebrospinal fluid (CSF) analysis
 * Drug or alcohol levels (toxicology screen)
 * Tests for exposure to metals such as lead or arsenic
 * Electroencephalograph (EEG)
 * Glucose test
 * Head CT or MRI
 * Liver function tests
 * Mental status test
 * Serum calcium


 * Serum electrolytes
 * Thyroid function tests
 * Thyroid stimulating hormone level
 * Urinalysis

Treatment options

 * The goal of treatment is to control the symptoms of dementia. Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time.


 * Stopping or changing medications that make confusion worse may improve brain function.


 * There is growing evidence that some kinds of mental exercises can help dementia.


 * Treating conditions that can lead to confusion often greatly improve mental functioning. Such conditions include:
 * Anemia
 * Decreased oxygen (hypoxia)
 * Depression
 * Heart failure
 * Infections
 * Nutritional disorders
 * Thyroid disorders


 * Medications may be needed to control behavior problems caused by a loss of judgement, increased impulsivity, and confusion. Possible medications include:
 * Antipsychotics (haloperidol, risperdal, olanzapine)
 * Mood stabilizers (fluoxetine, imipramine, citalopram)
 * Serotonin-affecting drugs (trazodone, buspirone)
 * Stimulants (methylphenidate)


 * Certain drugs may be used to slow the rate at which symptoms worsen. The benefit from these drugs is often small, and patients and their families may not always notice much of a change.
 * Donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne, formerly called Reminyl)
 * Memantine (Namenda)


 * A person's eyes and ears should be checked regularly. Hearing aids, glasses, or cataract surgery may be needed.


 * Psychotherapy or group therapy usually does not help because it may cause more confusion.

Diseases with similar symptoms

 * Delirium
 * Pseudodementia

Where to find medical care for Dementia?
Directions to Hospitals Treating Dementia

What to expect (Outlook/Prognosis)?
People with mild cognitive impairment do not always develop dementia. However, when dementia does occur, it usually gets worse and often decreases quality of life and lifespan.

Possible complications
Complications depend on the cause of the dementia, but may include the following:
 * Abuse by an overstressed caregiver
 * Increased infections anywhere in the body
 * Loss of ability to function or care for self
 * Loss of ability to interact
 * Reduced lifespan
 * Side effects of medications used to treat the disorder

Prevention

 * Most causes of dementia are not preventable.
 * For vascular dementia, keeping a healthy lifestyle, such as eating a low-fat diet, exercising regularly, quitting smoking, and controlling hypertension and diabetes, may reduce the risk.