What is dementia?
Dementia is a gradual loss of mental functions such as
the ability to think, remember, reason, and plan. Dementia
is not a disease, but a group of symptoms that can have
various causes. As dementia gets worse, the person loses the
ability to perform daily tasks. Behavior and personality
Symptoms of dementia often go unrecognized as such
because they may be regarded as the normal result of aging.
It is important to know that there are differences between
the signs of normal aging and dementia. In normal aging
memory loss is slow, not sudden. It may involve things like
forgetting names, phone numbers, or where objects are.
Chances are that such symptoms are signs of normal aging
rather than dementia if there has been no decline in
intelligence or problem-solving skills and if there is no
history of a physical, brain, or mental disorder that can
cause thinking problems,
Contact your health care provider if you are unsure
whether symptoms are due to normal aging or to another
How does it occur?
The most common cause of
dementia is Alzheimer's disease. Strokes, sometimes in the
form of many small strokes you may not be aware of having,
also can cause dementia. Other conditions that can cause
- Huntington's disease
- multiple sclerosis
- vascular disease
- Pick's Disease
- Creutzfeldt-Jakob disease
- Parkinson's disease
- Lewy body disease (a disorder similar to
- alcoholism or drug abuse
Medicines or untreated depression may cause symptoms that
look like dementia.
Damaged brain cells that can no longer store or work with
information in the normal way cause the symptoms of
dementia. As the disease causing the dementia progresses,
more brain functions are lost.
What are the symptoms?
Many symptoms are possible. At the beginning of dementia,
symptoms may be mild. However, as time passes, people may
have more of the following symptoms:
- memory problems (difficulty remembering recent
events; difficulty remembering people, places, times,
- impaired judgment and difficulty understanding the
results of their actions
- decline in intellectual ability (for example, not
being able to figure out the correct order to put
clothing on when getting dressed)
- inability to follow instructions or stay with a task
(problems paying bills, fixing meals, shopping, taking
- lack of emotions (lack of interest in what is going
on around them, less participation in activities
previously enjoyed, withdrawal from people)
- loss of interest in food and less concern about
looking neat and being clean
- irritability and a tendency to overreact (may strike
- tendency to wander away from home, getting lost,
rummaging about the house, not sleeping at night
- suspiciousness (for example, believing that someone
is taking money or belongings or that family members are
As the disease grows worse, more problems with control of
the body occur. The person may:
How is it diagnosed?
- be unable to control bowel or bladder
- be unsteady while walking, leading to falls and the
eventual inability to walk
- forget how to eat or have trouble chewing and
- have a hard time speaking and thinking of the right
words and eventually become unable to speak.
A health care provider may diagnose dementia when he or
she is told about the person's symptoms. Family members or
friends need to tell the provider how long the person has
had symptoms and whether they began suddenly or came on
The health care provider will first make sure that the
symptoms are not caused by a condition that can be treated,
a medicine that slows thinking, or an improper combination
of medicines. The provider will do a physical exam to find
out whether the person has had a stroke or has another
condition that could cause the symptoms. The provider may
also ask the person some questions to test memory and
thinking and to check for depression. To determine if there
is a treatable disease, the following tests also may be
- blood tests
- brain wave tracing (EEG, or electroencephalogram)
- heart wave tracing (EKG, or electrocardiogram)
- brain scan (CT scan, or computed tomography; or an
MRI, magnetic resonance imaging).
A sure diagnosis of the Alzheimer's disease form of
dementia can be made only after death by examining the brain
tissue. A likely diagnosis can be made, however, if other
conditions are ruled out and the person has the progressive
worsening of symptoms typical of the disease. This allows
the family time to learn more about the disease and how to
help the person who has it. It also permits the family to
make plans and consider treatment choices.
How is it treated?
Physical care and safety measures must be provided.
Symptoms that the person finds distressing, like frightening
thoughts, may require medicine. Sometimes behavior is so
disturbed and the person so agitated that medicine may be
given for these conditions also. Whenever possible, however,
it is better to distract the person or redirect his or her
attention to other activities than to use sedating drugs.
Although there is no cure for dementia, there are
medicines that slow the progress of early symptoms of
Alzheimer's in some people. Donepezil (Aricept), galantamine
(Reminyl), and rivastigmine (Exelon) are drugs that may slow
memory loss early in the disease. Memantine (Namenda) may
help slow memory loss in later stages of the disease.
Vitamin E and other medicines continue to be studied to see
whether they might be helpful. None of these medicines can
cure or reverse Alzheimer's disease. You should not expect
big improvements when these medicines are given. Not all
people with dementia should take these medicines. Those
whose disease is very severe will not benefit. It is
important to talk to your health care provider about these
What happens to people with dementia?
A few medical conditions, such as encephalitis (a viral
infection in the brain), cause symptoms of dementia that can
be reversed with treatment.
People with Alzheimer's dementia may live for many years,
gradually becoming unable to care for themselves. They may
lose weight, develop infections, fall and break bones, and
become bedridden and unable to speak. Other types of
dementia are different in the way they progress. Most
dementias do not get better and will get worse over time.
Your health care provider can explain more about the course
of these other conditions.
What can a family member or friend do?
The most important thing is to understand that a person
with dementia is not responsible for his or her behavior. It
occurs because of damage to brain cells. A person with
dementia may say or do hurtful things that family and
friends must overlook.
Providing care in a way that preserves dignity, allowing
choices where they can be safely made, and continuing to
stay closely involved are the most important things to do
for a loved one with dementia.
Family members may also need to plan ahead for the
business affairs of the person with dementia, keeping in
mind that someday the person may need 24-hour-a-day care.
Finally, decisions about what kinds of medical care should
and should not be offered are difficult but important
choices to make for a loved one with advanced dementia.