What Is It?
Dementia is a pattern of mental decline caused by different diseases or conditions.
A person with dementia loses mental abilities. Memory loss usually comes first. Gradually the person becomes unable to perform basic mental and physical tasks. Typically, dementia develops slowly over months or years. The first symptoms are often subtle. Eventually, people with dementia can have significant memory loss. They also may lose their ability to communicate effectively, recognize other people, perform complex tasks or think critically.
Most commonly, dementia occurs when nerve cells (neurons) in the brain break down (degenerate) and connections between neurons are interrupted. These disruptions have a variety of causes and usually cannot be reversed. Among the causes of dementia:
Other conditions that can cause dementia include:
In rare cases, dementia is caused by a treatable condition, and it may be partially or entirely reversed if the condition is diagnosed and treated early:
About 5 million people in the United States have dementia. Approximately 15% of people older than 65 are thought to have dementia. Alzheimer's disease, the most common cause of dementia, will affect more than 12 million Americans in the next 20 years.
Symptoms
Symptoms of dementia emerge slowly, get worse over time and limit the person's ability to function.
The first symptom of dementia is memory loss. Although everyone has memory lapses from time to time, the memory loss of dementia is greater and affects your ability to function. For example, forgetting where you put your car key is normal, but forgetting how to use the key is a possible symptom of dementia.
Often, someone with dementia recognizes that something is wrong, but fear may keep the person from seeking treatment. As the disease worsens, the person may become nervous, depressed or anxious about the symptoms.
Along with memory loss, a person with dementia may have trouble with complex mental tasks, such as balancing a checkbook, driving, knowing what day it is and learning new things. Attention, judgment, problem solving, mood and behavior also may change. As the disorder progresses, the person may have difficulty speaking in full sentences, recognizing his or her surroundings, recognizing other people, or handling personal care, such as bathing. In some cases, a person with dementia may experience hallucinations, delusions, agitation, social withdrawal and insomnia.
Diagnosis
The doctor's first step in diagnosing the cause of dementia is to look at the person's medical history and ask questions about when memory problems started and how quickly they got worse. This information, together with the person's age, can point toward a likely diagnosis. For example, if the person is elderly and has had consistently worsening memory and other problems for several years, a doctor may suspect Alzheimer's disease. If symptoms got worse rapidly, then Creutzfeldt-Jakob disease may be a likely cause. If the person has had a history of high blood pressure, diabetes and vascular disease, a doctor may suspect stroke.
To diagnose dementia, a doctor looks to see if a person's memory gets progressively worse, along with at least one of the following:
Doctors test people by asking them basic questions and requesting that they do various tasks involving memory and attention. A commonly used tool to screen for dementia is the Mini Mental State Exam. It consists of 11 short assessments, such as asking the person what day and year it is or have the person count backward from 100 by sevens (100, 93, 86, etc.). If the person answers correctly, dementia is less likely.
Laboratory tests can narrow down the possible causes. Some tests include:
Expected Duration
In most cases, dementia gets worse and cannot be cured. A person with dementia may live for months, years or decades, depending on the cause of the dementia and whether the person has other medical conditions.
In the rare cases in which dementia is caused by a treatable condition, such as infection, metabolic disorder or depression, the dementia usually is reversed after treatment.
Prevention
Most of the causes of dementia cannot be prevented. Good personal health habits and medical care, however, can prevent some types of dementia. Here are some things you can do:
Keeping your mind active and your body fit may help to prevent mental decline and reduce or postpone memory loss. If you get daily physical exercise and continue to challenge your brain throughout life, you can help to protect your brain against mental decline.
Treatment
Sometimes the cause of dementia can be reversed, such as vitamin B12 deficiency or an underactive thyroid. Treating these conditions may improve the dementia. Other reversible factors that can contribute to symptoms include overuse of alcohol, depression and insomnia.
People with vascular dementia may show less mental decline if their blood pressure is controlled, they stop smoking, lower LDL ("bad" cholesterol), exercise regularly and maintain a healthy weight.
In some people, medications for Alzheimer's may help with behavioral symptoms and perhaps slow down the mental decline. They may delay the need for placement into a nursing home. Acetylcholinesterase inhibitors, such as donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon), can be prescribed for mild to moderate Alzheimer's dementia. Memantine (Namenda) is approved for moderately severe Alzheimer's dementia.
These same medications are sometimes used to treat the dementia associated with Lewy body disease.
However, many people do not improve at all with medication or improve only a little.
People with dementia that cannot be reversed need care from doctors, nurses and social workers. This care can take place anywhere, including in a hospital, at home, in an assisted-living center or in other types of facilities. Depending on the cause of the dementia, several specialists may be involved in care, including neurologists, psychologists, psychiatrists or geriatric doctors. Important aspects of care include:
When To Call a Professional
Call your doctor if you have any concern about your memory or if you or a loved one is having more difficulty recently with any of the following:
A person with dementia may also exhibit the following types of behaviors:
Prognosis
The outlook for dementia depends on the cause and can vary by individual. For example, early treatment of dementia caused by a vitamin deficiency can lead to full recovery of memory. If stroke is the cause, the person's memory loss can remain stable for years. Drugs may slow the rate of decline for some people with Alzheimer's disease. In many cases, however, the disorder gradually gets worse. Depending on the cause, the person's age, general health and the availability of treatments, life expectancy can be as short as a few months or as long as 15 to 20 years.
Additional Info
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
Toll-Free: 1-800-352-9424
TTY: 301-468-5981
http://www.ninds.nih.gov/
American Geriatrics Society
The Empire State Building
350 Fifth Ave.
Suite 801
New York, NY 10118
Phone: 212-308-1414
E-Mail: info.amger@americangeriatrics.org
http://www.americangeriatrics.org/
Alzheimer's Association
225 North Michigan Ave.
Floor 17
Chicago, IL 60601-7633
Phone: 312-335-8700
Toll-Free: 1-800-272-3900
E-Mail: info@alz.orghttp://www.alz.org/
Alzheimer's Disease Education and Referral Center (ADEAR)
National Institute on Aging
P.O. Box 8250
Silver Spring, MD 20907-8250
Toll-Free: 1-800-438-4380
E-Mail: adear@alzheimers.org
http://www.alzheimers.org/
