Dementia

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 also change.

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 cause.

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 dementia include:

• Huntington's disease
• multiple sclerosis
• vascular disease
• Pick's Disease
• Creutzfeldt-Jakob disease
• Parkinson's disease
• Lewy body disease (a disorder similar to Alzheimer's)
• alcoholism or drug abuse
• AIDS.

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.

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, and dates)
• 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 medicines)
• 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 out unpredictably)
• 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 impostors).

As the disease grows worse, more problems with control of the body occur. The person may:

• 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 swallowing
• 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 gradually.

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 done:

• 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.

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 issues.

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.

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.