Dementia Article

Dementia Article

Symptoms

Dementia symptoms vary depending on the cause, but common signs and symptoms include:

Cognitive changes

  • Memory loss
  • Difficulty communicating or finding words
  • Difficulty with complex tasks
  • Difficulty with planning and organizing
  • Difficulty with coordination and motor functions
  • Problems with disorientation, such as getting lost

Psychological changes

  • Personality changes
  • Inability to reason
  • Inappropriate behavior
  • Paranoia
  • Agitation
  • Hallucinations

Causes

Dementia involves damage of nerve cells in the brain, which may occur in several areas of the brain. Dementia may affect people differently, depending on the area of the brain affected.

Dementias can be classified in a variety of ways and are often grouped by what they have in common, such as what part of the brain is affected, or whether they worsen over time (progressive dementias).

Some dementias, such as those caused by a reaction to medications or an infection, are reversible with treatment.

Progressive dementias

Types of dementias that are not reversible and worsen over time include:

  • Alzheimer’s disease. In people age 65 and older, Alzheimer’s disease is the most common cause of dementia. People generally may develop symptoms after age 60, but some people may have early-onset forms of the disease, often as the result of a defective gene.

    Although in most cases the exact cause of Alzheimer’s disease isn’t known, plaques and tangles are often found in the brains of people with Alzheimer’s. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein.

    Certain genetic factors also may make it more likely that people will develop Alzheimer’s.

    Alzheimer’s disease usually progresses slowly over about eight to 10 years. Your cognitive abilities slowly decline. Eventually, the affected areas of your brain don’t work properly, including parts of your brain that control memory, language, judgment and spatial abilities

  • Vascular dementia. Vascular dementia, the second most common type of dementia, occurs as a result of brain damage due to reduced or blocked blood flow in blood vessels leading to your brain.

    Blood vessel problems may be caused by stroke, infection of a heart valve (endocarditis) or other blood vessel (vascular) conditions.

    Symptoms usually start suddenly and often occur in people with high blood pressure or people who have had strokes or heart attacks in the past.

    Several different types of vascular dementia exist, and the types have different causes and symptoms. Alzheimer’s disease and other dementias also may be present at the same time as this dementia.

  • Lewy body dementia. Lewy body dementia affects approximately 10 percent of people with dementia, making it one of the most common types of dementia. Lewy body dementia becomes more common with age.
    Lewy bodies are abnormal clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer’s disease and Parkinson’s disease.

    Lewy body dementia symptoms are similar to symptoms of Alzheimer’s disease. Its unique features include fluctuations between confusion and clear thinking (lucidity), visual hallucinations, and tremor and rigidity (parkinsonism).

    People with Lewy body dementia often have a condition called rapid eye movement (REM) sleep behavior disorder that involves acting out dreams.

  • •Frontotemporal dementia. This type of dementia tends to occur at a younger age than does Alzheimer’s disease, generally between the ages of 50 and 70.
    This is a group of diseases characterized by the breakdown (degeneration) of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language.

    Signs and symptoms of frontotemporal dementia can include inappropriate behaviors, language problems, difficulty with thinking and concentration, and movement problems.

    As with other dementias, the cause isn’t known, although in some cases this dementia is related to certain genetic mutations.

Other disorders linked to dementia

  • Huntington’s disease. This inherited disease causes certain nerve cells in your brain and spinal cord to waste away.

    Signs and symptoms usually appear during your 30s or 40s. People may experience personality changes, such as irritability or anxiety.

    The condition causes a severe decline in thinking (cognitive) skills over time. Huntington’s disease also causes weakness and difficulty with walking and movement.

  • Traumatic brain injury. This condition is caused by repetitive head trauma, such as experienced by boxers, football players or soldiers.

    Depending on the part of the brain that’s injured, this condition can cause dementia signs and symptoms such as uncoordinated movement and impaired speech, as well as slow movement, tremors and rigidity (parkinsonism). Symptoms may not appear until many years after the actual trauma.

    A person who has experienced a single traumatic head injury could develop a similar condition called posttraumatic dementia, which may cause symptoms such as long-term memory problems.

  • Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without risk factors. This condition may be due to an abnormal form of a protein. Creutzfeldt-Jakob disease sometimes may be inherited or caused by exposure to diseased brain or nervous system tissue.

    Signs and symptoms of this fatal condition usually appear around age 60 and initially include problems with coordination, memory, thinking and vision. Symptoms worsen over time and may include the inability to move or talk, blindness, or infections.

  • Parkinson’s disease. Many people with Parkinson’s disease eventually develop dementia symptoms (Parkinson’s disease dementia).

Dementia-like conditions that may be reversed

Some causes of dementia or dementia-like symptoms can be reversed. Your doctor may identify and treat these causes:

  • Infections and immune disorders. Dementia-like symptoms can result from fever or other side effects of your body’s attempt to fight off an infection.

    People may develop thinking difficulties if they have brain infections like meningitis and encephalitis, untreated syphilis, Lyme disease, or conditions that cause a completely compromised immune system, such as leukemia.

    Conditions such as multiple sclerosis that arise from the body’s immune system attacking nerve cells also can cause dementia.

  • Metabolic problems and endocrine abnormalities. People with thyroid problems, too little sugar in the bloodstream (hypoglycemia), too low or too high amounts of sodium or calcium, or an impaired ability to absorb vitamin B-12 may develop dementia-like symptoms or other personality changes.
  • Nutritional deficiencies. Dementia-like symptoms can occur as a result of not drinking enough liquids (dehydration); not having enough thiamin (vitamin B-1), a condition common in people with chronic alcoholism; and not having enough vitamins B-6 and B-12 in your diet.
  • Reactions to medications. Dementia-like symptoms may occur as a reaction to a single medication or because of an interaction of several medications.
  • Subdural hematomas. Subdural hematomas are caused by bleeding between the surface of the brain and the covering over the brain. They can cause symptoms similar to dementia.
  • Poisoning. Dementia-like symptoms can occur as a result of exposure to heavy metals, such as lead, and other poisons, such as pesticides.

    Dementia-like symptoms may also occur in some people who have abused alcohol or recreational drugs. Symptoms may disappear after treatment, but in some cases symptoms may still be present after treatment.

  • Brain tumors. Dementia rarely can result from damage caused by a brain tumor.
  • Anoxia. This condition, also called hypoxia, occurs when organ tissues aren’t getting enough oxygen. Anoxia may occur due to severe asthma, heart attack, carbon monoxide poisoning or other causes.

    If you’ve experienced a severe lack of oxygen, recovery may take longer. Symptoms, such as memory problems or confusion, may occur during recovery.

  • Normal-pressure hydrocephalus. Sometimes people have a condition caused by enlarged ventricles in the brain (normal-pressure hydrocephalus). This condition can cause walking problems, urinary difficulty and memory loss.

    Shunt surgery, which delivers cerebrospinal fluid from the head to the abdomen or heart, may help these symptoms.

Complications

Dementia can affect the functioning of many body systems and, therefore, the ability to carry out day-to-day tasks. Dementia may lead to several problems, including:

  • Inadequate nutrition.Many people with dementia will eventually reduce or stop eating and drinking. They may forget to eat or think they’ve already eaten. Changes in meal times or noise distractions in their environment may affect whether they eat.

    Often, advanced dementia causes you to lose control of the muscles used to chew and swallow. This may put you at risk of choking or aspirating food in your lungs. If this happens, it can block breathing and cause pneumonia.

    You also lose the feeling of hunger and, with it, the desire to eat. Depression, side effects of medications, constipation and other conditions also can decrease your interest in food.

  • Reduced hygiene. In moderate to severe stages of dementia, you’ll eventually lose the ability to independently complete daily living tasks. You may no longer be able to bathe, dress, brush your hair or teeth, or use the toilet on your own.
  • Difficulty taking medications. Because your memory is affected, remembering to take the correct amount of medications at the right time can be challenging.
  • Deterioration of emotional health. Dementia changes behaviors and personality. Some of the changes may be caused by the actual deterioration happening in your brain, while other behavioral and personality changes may be emotional reactions to coping with the changes in your brain.

    Dementia may lead to depression, aggression, confusion, frustration, anxiety, a lack of inhibition and disorientation.

  • Difficulty communicating. As dementia progresses, you may lose the ability to remember the names of people and things. You may have trouble communicating with others or understanding others.

    Difficulty communicating can lead to feelings of agitation, isolation and depression.

  • Delusions and hallucinations. You may experience delusions in which you have false ideas about another person or situation. Some people, especially those with Lewy body dementia, may have visual hallucinations.
  • Sleep difficulties. You may experience sleep difficulties, such as waking up very early in the morning. Some people with dementia may have restless legs syndrome or rapid eye movement (REM) sleep behavior disorder, which also can interfere with sleep.
  • Personal safety challenges. Because of a reduced capacity for decision-making and problem-solving, some day-to-day situations can present safety issues for people with dementia. These include driving, cooking, falling, getting lost and negotiating obstacles.

Treatment

There is no treatment for dementia. However, there are medications and techniques which

  • Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.

    Side effects can include nausea, vomiting and diarrhea. Although primarily used to treat Alzheimer’s disease, these medications may also treat vascular dementia, Parkinson’s disease dementia and Lewy body dementia.

  • Memantine. Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions, such as learning and memory. A common side effect of memantine is dizziness.

    Some research has shown that combining memantine with a cholinesterase inhibitor may have beneficial results.

  • Other medications. Your doctor may prescribe other medications to treat other symptoms or conditions, such as a sleep disorder.
  • Occupational therapy. Your doctor may suggest occupational therapy to help you adjust to living with dementia. Therapists may teach you coping behaviors and ways to adapt movements and daily living activities as your condition changes.
  • Therapies

    Several dementia symptoms and behavior problems may be treated initially using nondrug approaches, such as:

  • Modifying the environment. Reducing clutter and distracting noise can make it easier for someone with dementia to focus and function. It also may reduce confusion and frustration.
  • Modifying your responses. A caregiver’s response to a behavior can make the behavior, such as agitation, worse. It’s best to avoid correcting and quizzing a person with dementia. Reassuring the person and validating his or her concerns can defuse most situations.
  • Modifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine during the day also help reduce confusion in people with dementia.
  • People with dementia will experience progression of their symptoms and behavior problems over time. Caregivers may need to adapt the following suggestions to individual situations:

  • Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don’t rush the response. Present only one idea or instruction at a time. Use gestures and cues, such as pointing to objects.
  • Encourage exercise. Exercise benefits everyone, including people with dementia. The main benefits of exercise include improved strength and cardiovascular health.

    Some research also shows physical activity may slow the progression of impaired thinking (cognitive) function in people with dementia.

    Exercise can also lessen symptoms of depression, help retain motor skills and create a calming effect.

  • Encourage participation in games and thinking activities. Participating in games, crossword puzzles and other activities in which people are using thinking (cognitive) skills may help slow mental decline in people with dementia.
  • Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on to prevent disorientation.

    Limiting caffeine during the day, discouraging daytime napping and offering opportunities for exercise during the day may help prevent nighttime restlessness.

  • Encourage keeping a calendar. Keeping a reminder calendar may help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one.
  • Plan for the future. Develop a plan with your loved one that identifies goals for care in the future. Several support groups, legal advisers, family members and others can help you. You’ll need to consider financial and legal issues, safety and daily living concerns, and long-term care options.

    Several dietary supplements, herbal remedies and therapies have been studied for people with dementia. Some may be beneficial.

    Dietary supplements, vitamins and herbal remedies

    Use caution when considering dietary supplements, vitamins or herbal remedies to slow the progress of dementia, especially if you’re taking other medications.

    Dietary supplements, vitamins and herbal remedies aren’t regulated, and claims about their benefits aren’t always based on scientific research.

    Some alternative medicine options for Alzheimer’s disease and other forms of dementia that have been studied include:

  • Vitamin E. Some studies have shown that vitamin E may slow the progression of Alzheimer’s disease. Doctors warn against taking large doses of vitamin E because it may have a higher risk of mortality, especially in people with heart disease.
  • Omega-3 fatty acids. Omega-3s, a type of polyunsaturated fatty acid found in fish and nuts, may reduce the risk of heart disease, stroke and mild cognitive impairment.

    However, in studies, omega-3 fatty acids haven’t significantly slowed cognitive decline in mild to moderate Alzheimer’s disease. More research is needed to understand whether omega-3 fatty acids benefit people with Alzheimer’s and other types of dementia.

  • Coenzyme Q10. This antioxidant occurs naturally in your body. It’s also necessary for normal cell reactions.

    A synthetic version of this compound, called idebenone, showed some positive results in testing for Alzheimer’s disease.

    More studies are needed to determine safe dosages and potential benefits of coenzyme Q10.

  • •Ginkgo. Extracts from the leaves of the Ginkgo biloba tree have antioxidant and anti-inflammatory properties that may protect cells in your brain from breaking down.

    Some studies have shown that ginkgo may slow the progression of memory problems in people with Alzheimer’s or other types of dementia. Other studies have found that ginkgo doesn’t slow or delay the onset of dementia.