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.
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.
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:
Other less common disorders that can cause dementia, or dementia-like behaviors include:
Certain abnormal aspects of a person's metabolism or hormones may also be responsible for the development of dementia, including the following:
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 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:
Sometimes, family members may not want to face how serious their loved one's decline is. Doctors may misdiagnose the condition.
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:
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.
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:
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.
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.
Dementia poses no risk to others, except for the disruption to home life and family relationships.
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\ \
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.
Medicines used to treat dementia can damage the liver, so periodic liver function tests are needed. Other side effects may include:
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:
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.
Author:Ann Reyes, Ph.D.
Editor:Crist, Gayle P., MS, BA
Reviewer:Kathleen A. MacNaughton, RN, BSN