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Dementia


Overview, Causes, & Risk Factors

Dementia is not a disease. It is a group of symptoms marked by gradual changes in brain function and the ability to think, reason, and remember. Serious changes in memory, personality, and behavior are the hallmarks of dementia.

What is going on in the body?

The ability of the brain to work correctly depends on a complex communication system among billions of neurons, or brain cells. Certain parts of the brain are in charge of creating a memory. Others catalog this memory. Still others retrieve it. The way that a brain functions could be compared to the workings of a computer.

If an area of the brain in charge of these special functions is damaged, dementia may occur. Damage may be caused by infection, loss of blood supply, chemicals, or a genetic tendency for losing neurons. People normally lose a certain number of brain cells as they age. However, major losses cause progressive and widespread loss of normal brain function.

In normal aging, memory loss is usually slow. It may result in forgetting names, phone numbers, or where an item was just placed. Intelligence and problem-solving skills are not affected. True dementia involves loss of intelligence and problem-solving skills. It often cannot be reversed and will become worse over time.

What are the causes and risks of the condition?

Dementia is always caused by an underlying disease or condition. Brain tissue is damaged, and the ability to function decreases. Some of these conditions can be reversed, while others cannot. The most common cause of dementia is Alzheimer disease. In this disease, changes in nerve cells in some parts of the brain result in the death of large numbers of cells. The result is a progressive, but slow, decline in memory and thought processes.

Another common form of dementia is multi-infarct dementia. With this condition, small strokes or changes in the blood supply to the brain from the narrowing or hardening of arteries causes the death of brain tissue. Symptoms will depend on what part of the brain tissue is destroyed. These symptoms usually come on suddenly.

Other common causes are as follows:

  • Creutzfeldt-Jakob disease, a degenerative disorder of the nervous system that progresses quickly and causes problems with walking, talking, and the senses. When dementia occurs in young or middle-aged people, it is often due to this disease.
  • Huntington disease, a progressive disease causing brain cells to waste away that affects both the body and the mind. It causes changes in thinking, memory, speech, judgment, and personality. Dementia often occurs in the later stages of the disease. Huntingdon Disease has been linked to a certain gene that a person can inherit.
  • Lewy body disease, a degenerative disease of the nervous system. Lewy bodies are deposits of protein in nerve cells, often deep within the brains of those who also have Parkinson Disease. When these protein deposits occur throughout the brain, dementia results. The course of illness is different from Alzheimer's disease, in that it results in changes in the speed of thought, memory, judgment, reasoning, and language. It can also cause a person to get lost easily. In addition, it may cause hallucinations.
  • Parkinson's disease, a degenerative disorder of part of the nervous system. Up to 30 to 40 percent of people with this disease may develop dementia in the later stages.
  • Pick disease, also known as frontotemporal dementia, or FTD. FTD is a rare disorder of the brain. It causes changes in personality, behavior, and memory over time. It gets steadily worse, but it hard to diagnose until after death.
  • Other less common disorders that can cause dementia, or dementia-like behaviors include:

  • brain tumor
  • chronic subdural hematoma, a bleeding between the brain lining and brain tissue
  • HIV, the immunodeficiency disorder that leads to AIDS
  • multiple sclerosis, a disorder of the sheath that lines the brain and spinal cord
  • neurosyphilis, an infection of the nervous system by the Treponema pallidum\ bacteria. Less often, syphilis is transmitted from a pregnant woman to her baby. This form of syphilis is known as \congenital syphilis.\ ',CAPTION,'Syphilis');" onmouseout="return nd();">syphilis bacterium, which causes weakness and mental deterioration
  • normal pressure hydrocephalus, which is a build up of cerebrospinal fluid in the brain. This condition can often be treated through surgery to put a shunt tube in the brain that allows the excess fluid to flow out of the brain.
  • progressive supranuclear palsy, also known as Steele-Richardson-Olszewski syndrome, a rare disorder of late middle age that causes widespread nervous system problems
  • stroke
  • viral or bacterial encephalitis, a swelling of the brain
  • Wilson disease, a rare disease causing an excess of copper in the liver, brain, kidneys, and corneas
  • Certain abnormal aspects of a person's metabolism or hormones may also be responsible for the development of dementia, including the following:

  • chronic alcohol abuse
  • chronic exposure to metals, such as lead or mercury, and to dyes, such as aniline
  • high-dose steroid abuse
  • hyperthyroidism, which means the thyroid gland is overactive
  • hypothyroidism, which means the thyroid gland is underactive
  • low body levels of B1\ \B2\ \B6\ \pantothenic acid\ \folic acid\ \niacin\ \biotin\ Cobalamin is the general name for vitamin B12. ',CAPTION,'Vitamin B12');" onmouseout="return nd();">vitamin B12
  • medicine side effects or drug interactions
  • vitamin B2\ \niacin\ \vitamin B6\ \vitamin B12\ \folate\ \biotin\ \pantothenic acid\',CAPTION,'Vitamin B1');" onmouseout="return nd();">thiamine deficiency
  • too little niacin, which is vitamin B3
  • In some of these cases, dementia can be reversed by removing the toxic agent or bringing vitamin levels back to a healthy range.

    In older adults, depression and dementia are often mistaken for each other. They do sometimes occur together, but depression is treatable, while dementia is not.


    Symptoms & Signs

    What are the signs and symptoms of the condition?

    Symptoms of dementia often aren't noticed right away. Or if they are, people sometimes assume that dementia is just a part of aging. However, as more brain cells die, more brain functions are lost, and symptoms become more severe. Common symptoms of dementia include the following:

  • being disoriented to time and place
  • changes in mood, including depression and anxiety
  • delusions, or believing things that are not true
  • hallucinations, which include hearing, seeing, feeling, and smelling things that do not exist
  • impaired ability to orient the body to the surrounding space
  • language breakdown, with slurred speech and trouble finding the right words
  • loss of bowel and bladder control
  • a loss of interest in activities that gave pleasure before
  • memory loss that affects the person's skills. Short-term memory, or memory of recent events, is particularly affected in people with dementia.
  • misplacing belongings
  • personality changes, including agitation, irritability, paranoia, and hostility
  • poor or decreased judgment
  • trouble doing familiar activities
  • Sometimes, family members may not want to face how serious their loved one's decline is. Doctors may misdiagnose the condition.


    Diagnosis & Tests

    How is the condition diagnosed?

    Dementia can be diagnosed only if a doctor is made aware of the problem. Diagnosis will start with a thorough physical and mental exam, as well as the gathering of a detailed medical history. The family should be prepared to tell the doctor the range of the person's symptoms over time. The doctor will want to know how the symptoms progressed and whether they have improved or become worse. Also, the family should report how suddenly or gradually symptoms appeared.

    A complete list of all medicines the person is taking will be needed. This includes over-the-counter products, herbal remedies, and prescription medicines. Combinations of drugs may impair thinking at times.

    To determine if other medical conditions may contribute to the symptoms, the doctor may order certain tests, such as:

  • blood tests, such as a complete blood count, called a CBC, thyroid function tests, tests for infectious diseases, and tests to determine vitamin levels in the blood
  • memory testing
  • electroencephalogram, called an EEG, which measures brain waves
  • electrocardiogram, called an EKG, which measures the electrical activity of the heart
  • cranial MRI or cranial CT scans, which can be used to view the structures of the brain
  • spinal tap, a procedure in which a small amount of fluid is withdrawn from the spinal column to check for infection or bleeding
  • Since there is no definitive test for dementia in a living person, the doctor will try to rule out other conditions or diseases that may cause the symptoms.


    Prevention & Expectations

    What can be done to prevent the condition?

    Most cases of dementia are caused by Alzheimer disease. Although there are no proven methods to prevent Alzheimer's disease, recent research findings provide some options that may slow the onset of the disease or how fast symptoms progress. These findings, which need further study, include the following:

  • low doses of aspirin and nonsteroidal anti-inflammatory drugs, called NSAIDs, which may work by making blood cells and vessels less sticky and by improving blood flow
  • actively engaging in cognitive activities such as reading, which may increase the nerve connections in the brain and delay the onset of the disease
  • taking antioxidants such as vitamin E and selignine. In the Alzheimer Disease Cooperative Study, a dose of 1,000 IU of vitamin E and 5 mg of selignine twice daily delayed nursing home placement, loss of the ability to perform self-care, and severe dementia.
  • hormone replacement therapy for menopausal women, which may delay the onset of symptoms of Alzheimer disease. The relationship between the hormone estrogen and Alzheimer disease needs further study.
  • avoiding head injuries. A person should wear a seat belt at all times when riding in a motor vehicle. Sports safety guidelines for children, adolescents, and adults can be helpful in avoiding other head injuries.
  • Strokes are another major cause of dementia. Preventing or treating high blood pressure, obesity, diabetes, high cholesterol, and alcohol abuse can lower the risk of stroke.

    What are the long-term effects of the condition?

    Long-term progressive dementia results in the continued loss of mental abilities. In the end, the person is unable to care for him or herself. A person suffering from the condition often requires nursing home care. Falls, trauma, infections, and depression may also result in a need for more intense medical care.

    What are the risks to others?

    Dementia poses no risk to others, except for the disruption to home life and family relationships.


    Treatment & Monitoring

    What are the treatments for the condition?

    Even when dementia is incurable, there are things that can be done to treat the patient and help his or her family to cope. Medical care is crucial, both for the patient and to answer questions family may have.

    In the early and middle stages of Alzheimer disease, medicine may help. The three medicines currently approved by the Food and Drug Administration for treatment of Alzheimer disease are donepezil, tacrine, and rivastigmine. These medicines are designed to improve memory by increasing the amount of acetylcholine in the body.

    Other medicines, such as risperidone or quetiapine, may also be used to help behavioral problems such as hallucinations, delusions, or agitation. Some people with dementia may also need medicines for depression, acute situational anxiety\ \generalized anxiety disorder\ \ panic disorder \ \ post-traumatic stress disorder \ \phobias\ \ obsessive compulsive disorders \ ',CAPTION,'Anxiety Disorders');" onmouseout="return nd();">anxiety, or insomnia.

    Eating a healthy diet and practicing healthy lifestyle habits can also help any person to maintain health status. In addition, the person's caregivers should work to maintain a daily routine, help the person to be as active as possible, and maintain social contacts. Memory aids such as posting big calendars, making lists of daily plans, and hanging up written directions for household tasks can help greatly.

    Other treatments include support and education for those caring for people with dementia. Individual and family counseling can help. Support groups have also been found to assist caregivers. As the disease progresses, many families are unable to provide home care for the person with dementia, and placement in a special facility is needed.

    What are the side effects of the treatments?

    Medicines used to treat dementia can damage the liver, so periodic liver function tests are needed. Other side effects may include:

  • nausea
  • diarrhea
  • insomnia
  • vomiting
  • fatigue
  • muscle cramps
  • What happens after treatment for the condition?

    In most cases, dementia is a progressive disease without a cure. Treatment is lifelong. Because the course of dementia is hard to predict, people with the condition should make plans for end-of-life care while they are still able to think clearly.

    Some of the challenges that family members may face include:

  • promoting independence while making sure the person is safe
  • stopping the person from driving
  • finding supportive care among family, in an assisted living facility, or in a nursing home
  • making business decisions
  • determining executors of written wills and making sure that advanced directives are in the person's patient file at his or her doctor's office
  • How is the condition monitored?

    A person with dementia needs to have regular visits to the doctor for evaluation and treatment. From time to time, liver function tests may be ordered if the person is taking one of the medicines that can cause liver damage. Any new or worsening symptoms should be reported to the doctor.


    Attribution

    Author:Ann Reyes, Ph.D.
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:04/04/02
    Reviewer:Kathleen A. MacNaughton, RN, BSN
    Date Reviewed:10/10/02


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