What is Dementia?

Dementia is a decline in mental function that may interfere with the ability to perform daily activities. Dementia is not a disease. Instead it describes a collection of symptoms (most commonly memory loss, behavioral changes and problems with language) that generally occur together and can be caused by certain conditions. There are almost 7 million people with dementia in the United States, according to the National Institute of Neurological Disorders and Stroke (NINDS).

Dementia is classified in many different ways. Some physicians and scientists classify dementia as being either cortical or subcortical. Cortical dementia occurs as a result of impairment or damage to the cerebral cortex. This is the outer layer of the brain and is associated with memory and language, along with many other aspects of consciousness. Cortical dementias (e.g., Alzheimer's disease, Creutzfeldt-Jakob disease) often result in loss of memory and language skills.

Subcortical dementia results from impairment or damage to parts of the brain underneath the cerebral cortex. Because the cortex can be undamaged, people with subcortical dementia (such as those with Huntington's disease) rarely experience memory loss and problems with language. Instead, people with subcortical dementia can experience behavior and personality changes, resulting in socially inappropriate and unusual actions.

Some forms of dementia are progressive, which means that they get worse over time. Alzheimer's disease, Lewy body dementia and frontotemporal dementia are all forms of progressive dementia. Most progressive forms of dementia are poorly understood by physicians and scientists and can be difficult or impossible to treat. Other forms of dementia, especially those caused by factors such as medical reactions, alcohol abuse and malnutrition, are usually temporary and reversible.

How is it diagnosed?

People who are concerned about a decline in cognitive function, including memory loss or unusual changes in mood or behavior should consult their physician as soon as possible. Diagnosis will usually begin with a medical history and a physical examination. People are encouraged to keep a log of their symptoms to report to their physician. A physician may also ask family members or close friends about the nature of the patient's symptoms. During the medical history, the physician may ask questions related to the patient's dietary habits and use of alcohol in order to establish potential causes of dementia that can be reversible. During the physical examination, the physician will likely assess neurological function by testing the patient's reflexes, balance and coordination.

A physician may conduct a mental status examination to assess the patient's stage of dementia. During the exam, the physician may ask the patient a variety of questions aimed at testing the patient's awareness of surroundings, problem solving skills and memory skills. Examples of items on the test may include:

• Situational questions such as “What year is it?” or “What is the address of this office?”
• Remembering and recalling a short list of items (e.g. a ball, a pencil, a dog)
• Counting backwards or spelling a word backwards
• Naming familiar objects in the room as the physician points to them
• Following simple instructions or writing a simple sentence

This test can also be used after diagnosis to evaluate the progression of dementia in the patient.

Additionally, blood and urine tests may be performed to test for conditions that cause dementia. These may include tests for vitamin deficiencies, poisoning or infections. A sample of spinal fluid may also be taken using a spinal tap to test for infections of the brain or spine.

Imaging tests, such as magnetic resonance imaging (MRI) tests and computed axial tomography (CAT) scans may be used to identify signs of brain abnormalities that may be the result of injury, stroke or a tumor. This enables physicians to identify the underlying cause of the dementia or to take steps towards preventing potential causes of dementia (e.g. strokes). However, imaging tests have limitations and are unable to identify many of the brain abnormalities that are the hallmark of progressive dementias such as the plaques and tangles of Alzheimer's disease and the Lewy bodies of Lewy body dementia.

How is Dementia treated?

Treatment for dementia often relies on treating the underlying cause. If dementia is caused by medication interactions or drug or alcohol abuse, it may be possible to reverse the dementia by no longer taking the medication or substance. In some cases, dementia caused by a brain tumor or lesion may be treated and resolved by removing the tumor or lesion. However the damage the tumor or lesion caused to brain tissues and function can be permanent.

In the case of progressive dementias or dementias that are caused by brain injury, there is rarely a cure. However, there are treatment options available that can minimize or stabilize patients’ symptoms and in some cases delay the necessity of nursing home care.

There are certain medications that a physician may prescribe to try to reduce the symptoms of dementia. Some of these medications are designed to maintain the levels of a neurotransmitter in the brain called acetylcholine, which is important for brain function. Other medications work to regulate the function of the neurotransmitter glutamate, which is important for learning and memory.

Behavioral or psychiatric symptoms due to dementia may first be treated with non-drug methods. This usually includes identifying the trigger for the symptoms and attempting to resolve it. Many times this involves making adjustments to the environment that the patient lives in – for example, simplifying the environment or increasing the time between stimulating events (e.g. bath-time, getting dressed).

In addition to non-drug methods, a physician may recommend certain medications to control behavioral or psychiatric symptoms. It is important that these medications be used according to physician instructions. People with dementia are more likely to experience severe side effects from these medications than other people. Medications that may be prescribed for patients with behavioral or psychiatric symptoms include:

• Antidepressants to treat depression and low moods
• Anti-anxiety medications to treat anxiety or verbally disruptive behavior
• Anti-psychotic medication to treat hallucinations, delusions or aggression
• Sedatives to treat sleep problems

Some companies market herbal supplements as alternative treatment methods for dementia. However, in most cases, these treatments have not been thoroughly tested. In addition, unlike prescribed medication, they have not been approved and are not regulated by the Food and Drug Administration (FDA). It is important to discuss the use of alternative treatment methods with a physician before they are started. Some alternative remedies could interact with prescribed medication or lead to more serious health complaints.

Medications

• Medications used to treat other conditions may cause confusion or sedation; ask if they may be changed or discontinued.
• Medication appropriate to treat the underlying condition.

Aricept (Donepezil)

Activity

• Encourage as much activity as possible.
• Accident-proof the home.
• Take precautions against the patients wandering.

Diet

Provide a well-balanced diet.

What might complicate it?

The individual may become injured falling out of bed, may wander, and get lost. The person may be unable to take care of basic nutritional and hygienic needs. There is a susceptibility to infections. Severe depression and suicide can occur. The person may injure another individual.

Preventive measures

• Obtain early medical treatment for underlying causes.
• Protect yourself from head injury. Wear seat belts in vehicles. Wear protective head gear for riding bicycles, motorcycles and participating in contact sports.
• To prevent atherosclerosis, don't smoke, eat a diet low in fat, exercise regularly and reduce stress whenever possible.
• Ask your doctor about preventive steps to take.

Alternatives

Other possibilities are schizophrenia, dementia of the Alzheimer's type, major depression, manic episode, or malingering.

Appropriate specialists

Psychiatrist and psychologist.

Last updated 7 July 2015