• Dementia

    Definition

    Dementia is a general loss of mental abilities. It can include a loss of ability to think, reason, learn, and understand. To be considered dementia, these mental losses must be severe enough to interfere with day-to-day activities. Dementia must also have:
    • Memory problems
    • Mental loss that is severe enough to cause problems with one or more of the following:
      • Language
      • Visuospatial function
      • Executive function (foresight, planning, anticipation, insight)
      • Praxis (learned motor skills)
    Some Areas of the Brain Affected by Dementia
    Nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Causes of dementia include:

    Risk Factors

    Risk factors for dementia include:

    Symptoms

    Symptoms often begin mildly. They often get more severe over time. Symptoms vary according to the cause of the dementia, but often include:
      Increasing trouble remembering things, such as:
      • How to get to familiar locations
      • What the names of family and friends are
      • Where common objects are usually kept
      • How to do simple math
      • How to do usual tasks, such as cooking, dressing, bathing, etc.
      • How to drive
      • How to pay bills
    • Having difficulty concentrating on tasks
    • Having difficulty completing sentences due to lost/forgotten words (may continue to a complete inability to speak)
    • Forgetting the date, time of day, season
    • Getting lost in familiar surroundings
    • Having mood swings
    • Being withdrawn, losing interest in usual activities
    • Having personality changes
    • Walking in a slow, shuffling way
    • Having poor coordination
    • Losing purposeful movement

    Diagnosis

    Your doctor may diagnose dementia through:
    • An extensive medical history from you and your family
    • Observing your behavior
    • A physical exam
    • Tests for your nervous system
    • Mental status and psychological tests
    There are no blood tests or exams that can diagnose Alzheimer's disease. Certain types of brain imaging such as a SPECT or a PET scan may aid in a diagnosis. Tests to rule out other causes of dementia and other medical conditions that may mimic dementia include:
    • Blood tests—to look for syphilis, vitamin B12, folate, thiamine (B1) thyroid, liver, and kidney function
    • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the head
    • MRI scan—a test that uses magnetic waves to make pictures of structures inside the head
    • PET or SPECT scans—tests that use dyes to measure the activity levels of various areas of the brain (used in some cases)
    • Lumbar puncture—a test of the fluid around the brain and spine to look for infection or bleeding, prion diseases, and potential markers of Alzheimer’s disease and other disorders
    • Electroencephalogram (EEG)—a test that records the brain's activity by measuring electrical signals from the brain
    The doctor will also check to see if you have depression. It can often present like dementia.

    Treatment

    Currently, there are no treatments to cure many types of dementia. Some medication may help to decrease the symptoms of dementia or slow its course.

    Medications

    Two types of medicines that may be used to reduce the symptoms of Alzheimer's disease include:
    • Cholinesterase inhibitors—approved and recommended for mild to moderate Alzheimer's disease (such as donepezil [Aricept], rivastigmine [Exelon], galantamine [Reminyl])
    • N-methyl-D-aspartate (NMDA) receptor antagonist—approved for moderate to severe Alzheimer's disease (such as memantine)
    Treatments that are being studied include:
    • Gamma-secretase inhibitors
    • Tau fiber aggregation inhibitors
    • Herbs and supplements (such as vitamin E, ginkgo biloba, huperzine A)—The evidence is mixed as to the effectiveness of these natural remedies.

    Lifestyle Management

    This type of support is critical for people with dementia. Behavioral and environmental support includes:
    • Keeping you safe in your home
    • Providing a calm, quiet, predictable environment
    • Providing appropriate eyewear and hearing aids, easy-to-read clocks, and calendars
    • Participating in music therapy and/or dance therapy
    • Participating in physical and occupational therapy for daily activities
    • Encouraging light exercise to reduce agitation and relieve depression
    • Eating a healthy diet (such as Mediterranean diet)
    • Discussing healthcare wishes with family members and doctors and appointing a healthcare proxy and a legal power of attorney

    Psychiatric Medications

    People with dementia often develop psychiatric symptoms. You may need appropriate treatment, such as:
    • Antidepressants
    • Anxiolytics—to treat anxiety
    • Antipsychotics—to treat severe confusion, paranoia, and/or hallucinations
      • Must be used with caution. Generally not recommended in people with dementia.
      • These medications may cause an increased risk for stroke or death in elderly patients with dementia.
    • Mood stabilizers—to treat dangerous or disruptive behaviors

    Caregiver Support

    Caring for a person with dementia is very difficult. Those providing care will need support. The Alzheimer’s Association is an excellent resource for families and caregivers.

    Prevention

    While the exact cause of dementia is not known, these steps may help to reduce your risk:
    • Eat a healthy diet. This will help you to maintain good levels of vitamin B12 and cholesterol.
    • Exercise regularly. This can also enhance cardiovascular health, which may delay the onset of vascular dementia.
    • Alcohol may have some benefits if you use it in moderation. This means no more than two drinks per day for a man, and one drink per day for a woman. Moderate amounts of alcohol may decrease your risk of dementia. But higher amounts of alcohol can increase your risk of dementia.
    • Avoid drug abuse and practice safe sex. This can reduce the risk of AIDS-related dementia.
    • Engage in mentally stimulating activity. This may also reduce the risk of Alzheimer’s disease.

    RESOURCES

    Alzheimer's Association http://www.alz.org

    American Academy of Neurology http://www.aan.com

    CANADIAN RESOURCES

    Alzheimers Association of Canada http://www.alzheimer.ca

    Toronto Dementia Network http://www.dementiatoronto.org

    References

    Alzheimer's disease. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated July 11, 2012. Accessed August 22, 2012.

    Alzheimer's disease medications fact sheet. National Institute on Aging website. Available at: http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm. Updated July 2010. Accessed August 22, 2012.

    Alzheimer's disease and non-Alzheimer’s dementia. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary. Updated July 7, 2012. Accessed August 22, 2012.

    Beers MH, Berkow R, Bogin RM, et al. The Merck Manual of Geriatrics. 3rd ed. Whitehouse Station, NJ: Merck & Co. Inc.; 1995-2000.

    Cecil RL, Goldman L, Bennett JC. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

    DeKosky S, Jeff D, Williamson A, et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial JAMA. 2008;300:2253-2262.

    Dementia evaluation. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated July 19, 2012. Accessed August 22, 2012.

    American Academy of Neurology website. Available at: http://patients.aan.com/disorders/index.cfm?event=viewampdisorder%5Fid=844. Accessed August 22, 2012.

    Gidoni R, et al. Cerebrospinal fluid biomarkers for Alzheimer’s disease: the present and the future. Neurodegen Dis. 2011;8:413-20.

    Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt HP, van den Bussche H. Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomized clinical trials. BMJ. 2005;331:321-327.

    Ledger AJ & Baker FA. An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer’s Disease. Aging & Mental Health. 2007;11: 330-338.

    Mendez MF, Cummings JL. Dementia: A clinical Approach. 3rd ed. Boston, MA: Butterworth Heinemann; 2003.

    Middleton LE, Yaffe K. Promising strategies for the prevention of dementia. Arch Neurol. 2009;66(10):1210-1215.

    Obrien JT, et al. Dopamine transporter loss visualized with FP-CIT SPECT in the differential diagnosis of dementia with Lewy Bodies. Arch Neurol. 2004; 61: 919-925.

    Schneider L, Dagerman K, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005;294:1934-1943.

    Tierney L. Current Medical Diagnosis & Treatment. 44th ed. New York, NY: McGraw-Hill; 2005.

    12/16/2008 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Farquhar C, Marjoribanks J, Lethaby A, Suckling J, Lamberts Q. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2008;CD004143.

    2/24/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev. 2009;CD003120.

    9/18/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Anstey KJ, Mack HA, Cherbuin N. Alcohol consumption as a risk factor for dementia and cognitive decline: meta-analysis of prospective studies. Am J Geriatr Psychiatry. 2009;17:542-555.

    1/8/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Snitz BE, O'Meara ES, Carlson MC, et al. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA. 2009;302:2663-2670.

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