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Dementia

Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment and behavior. Most types of dementia are degenerative and irreversible. 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 caused by many small strokes is called vascular or multi-infarct dementia.

The following medical conditions also can lead to dementia:

  • Huntington’s disease
  • Multiple sclerosis
  • Infections that affect the brain, such as HIV/AIDS and Lyme disease
  • Parkinson’s disease
  • Pick’s disease
  • Progressive supranuclear palsy


Some causes of dementia may be stopped or reversed if they are found soon enough, including:

  • Brain injury
  • Brain tumors
  • Chronic alcohol abuse
  • Changes in blood sugar, sodium and calcium levels
  • Low vitamin B12 levels
  • Normal pressure hydrocephalus
  • Use of certain medications, including cimetadine and some cholesterol-lowering medications


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

Common Symptoms

Dementia symptoms include difficulty with many areas of mental function, including language, memory, perception, emotional behavior or personality and cognitive skills such as calculation, abstract thinking or judgment. Dementia usually first appears as forgetfulness.

Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. They are often aware of the forgetfulness. Not everyone with MCI develops dementia.

Symptoms of MCI include:

  • Difficulty performing more than one task at a time
  • Difficulty solving problems or making decisions
  • Forgetting recent events or conversations
  • Taking longer to perform more difficult mental activities


The early symptoms of dementia can include:

  • Difficulty performing tasks that take some thought and learning new information or routines
  • Getting lost on familiar routes
  • Language problems, such as trouble finding the name of familiar objects
  • Losing interest in things you previously enjoyed, flat mood
  • Misplacing items
  • Personality changes and loss of social skills, which can lead to inappropriate behaviors


As the dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of oneself. The symptoms may include:

  • Change in sleep patterns, often waking up at night
  • Difficulty doing basic tasks, such as preparing meals
  • Forgetting details about current events
  • Forgetting events in your own life history
  • Having hallucinations, arguments, striking out and violent behavior
  • Having delusions, depression, agitation
  • More difficulty reading or writing
  • Poor judgment and loss of ability to recognize danger
  • Using the wrong word or speaking in confusing sentences
  • Withdrawal from social contact


People with severe dementia can no longer:

  • Perform basic activities of daily living, such as eating, dressing and bathing
  • Recognize family members


Diagnosis

A skilled healthcare provider can often diagnose dementia by performing a physical exam and asking questions about the person's medical history. The physical exam will include a neurological exam, and a mental status examination will also be done.

Tests may be ordered to determine whether other problems could be causing dementia or making it worse. These conditions include:

  • Anemia
  • Brain tumor
  • Chronic infection
  • Intoxication from medications
  • Severe depression
  • Thyroid disease
  • Vitamin deficiency


The following tests and procedures may be done:

  • B12 level
  • Blood ammonia levels
  • Blood chemistry (chem-20)
  • Blood gas analysis
  • Cerebrospinal fluid (CSF) analysis
  • Toxicology screen
  • Electroencephalograph (EEG)
  • CT of the brain
  • MRI of the brain
  • Mental status test
  • Thyroid function tests
  • Thyroid stimulating hormone level
  • Urinalysis


Treatment

Treatment depends on the condition causing the dementia. Some people may need to be hospitalized for a short time. Stopping or changing medications that make confusion worse may improve brain function. There is growing evidence that certain types of mental exercises can help dementia.

Treating conditions that can lead to confusion often greatly improve mental functioning. Such conditions include anemia, congestive heart failure, decreased blood oxygen, depression, heart failure, infections, nutritional disorders and thyroid disorders.

Medications may be needed to control behavior problems caused by a loss of judgment, increased impulsivity and confusion. Possible medications include:

  • Antipsychotics
  • Mood stabilizers
  • Stimulants


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)
  • Memantine (Namenda)

Source: National Institutes of Health

For More Information

Dementia: Home Care

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