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Dementia

Alternate Names

  • senility

Definition

Dementia 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.

Risks

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, but not all, of these conditions can be reversed. The most common cause of dementia is Alzheimer's 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 begin suddenly.
Other less 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 should be considered.
  • Huntington's 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's Disease has been linked to a certain inerited gene.
  • 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 is difficult 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 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
  • vitamin B12 (cyanocobalamin) deficientcy
  • medicine side effects or drug interactions
  • vitamin B1 (thiamine) deficiency
  • vitamin B3 (niacin) deficiency
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.

Prevention

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 vitamins C and E
  • 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.

Diagnosed

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.

Long Term Effects

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.

Other Risks

What are the risks to others?

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

Treatments

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 5 medications currently approved by the Food and Drug Administration for treatment of Alzheimer's disease are donepezil (i.e., Aricept), tacrine (i.e., Cognex), galantamine (i.e., Razadyne), rivastigmine (i.e., Exelon), and memantine (i.e., Namenda). The first four medications are designed to improve memory by increasing the amount of acetylcholine in the body. Currently, tacrine is rarely prescribed. Memantine is a newer medication which works by reducing overexposure of the brain to a chemical called glutamate which harms brain cells.
Other medicines, such as risperidone (i.e, Risperdal) or quetiapine (i.e., Seroquel), may also be used to help behavioral problems such as hallucinations, delusions, or agitation if caused by psychotic symptoms.
Some people with dementia may also need medicines for depression, 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.

Side Effects

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

After Treatment

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

Monitor

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 tacrine (Cognex). Any new or worsening symptoms should be reported to the doctor.

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