Dementia

Dementia

Chronic brain syndrome- Lewy body dementia- DLB- Vascular dementia- Mild cognitive impairment- MCI

Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.

See also: Alzheimer's disease

Causes, incidence, and risk factors

Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer's disease is the most common type of dementia.

Lewy body disease is a leading cause of dementia in elderly adults. People with this condition have abnormal protein structures in certain areas of the brain.

Dementia also can be due to many small strokes. This is called vascular dementia.

The following medical conditions also can lead to dementia:

Huntington's disease

Multiple sclerosis

Infections that can affect the brain, such as HIV /AIDS and Lyme disease

Parkinson's disease

Pick's disease

Progressive supranuclear palsy

Some causes of dementia may be stopped or reversed if they are found soon enough, including:

Brain injury

Brain tumors

Chronic alcohol abuse

Changes in blood sugar, sodium, and calcium levels (see: Dementia due to metabolic causes)

Low vitamin B12 levels

Normal pressure hydrocephalus

Use of certain medications, including cimetadine and some cholesterol-lowering medications

Dementia usually occurs in older age. It is rare in people under age 60. The risk for dementia increases as a person gets older.

Symptoms

Dementia symptoms include difficulty with many areas of mental function, including:

Language

Memory

Perception

Emotional behavior or personality

Cognitive skills (such as calculation, abstract thinking, or judgment)

Dementia usually first appears as forgetfulness.

Mild cognitive impairment is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. They are often aware of the forgetfulness. Not everyone with MCI develops dementia.

Symptoms of MCI include:

Difficulty performing more than one task at a time

Difficulty solving problems or making decisions

Forgetting recent events or conversations

Taking longer to perform more difficult mental activities

The early symptoms of dementia can include:

Difficulty performing tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines

Getting lost on familiar routes

Language problems, such as trouble finding the name of familiar objects

Losing interest in things you previously enjoyed, flat mood

Misplacing items

Personality changes and loss of social skills, which can lead to inappropriate behaviors

As the dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of yourself. The symptoms may include:

Change in sleep patterns, often waking up at night

Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving

Forgetting details about current events

Forgetting events in your own life history, losing awareness of who you are

Having hallucinations, arguments, striking out, and violent behavior

Having delusions, depression, agitation

More difficulty reading or writing

Poor judgment and loss of ability to recognize danger

Using the wrong word, not pronouncing words correctly, speaking in confusing sentences

Withdrawing from social contact

People with severe dementia can no longer:

Perform basic activities of daily living, such as eating, dressing, and bathing

Recognize family members

Understand language

Other symptoms that may occur with dementia:

Incontinence

Swallowing problems

Signs and tests

A skilled health care provider can often diagnose dementia by performing a physical exam and asking questions about the person's medical history.

The physical exam will include a neurological exam. Tests to check mental function will be done. This is called a mental status examination.

Other tests may be ordered to determine whether other problems could be causing dementia or making it worse. These conditions include:

Anemia

Brain tumor

Chronic infection

Intoxication from medications

Severe depression

Thyroid disease

Vitamin deficiency

The following tests and procedures may be done:

B12 level

Blood ammonia levels

Blood chemistry (chem-20)

Blood gas analysis

Cerebrospinal fluid (CSF) analysis

Drug or alcohol levels (toxicology screen)

Electroencephalograph (EEG)

Head CT

Mental status test

MRI of head

Thyroid function tests

Thyroid stimulating hormone level

Urinalysis

Treatment

Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time.

Stopping or changing medications that make confusion worse may improve brain function.

There is growing evidence that some kinds of mental exercises can help dementia.

Treating conditions that can lead to confusion often greatly improve mental functioning. Such conditions include:

Anemia

Congestive heart failure

Decreased blood oxygen (hypoxia)

Depression

Heart failure

Infections

Nutritional disorders

Thyroid disorders

Medications may be needed to control behavior problems caused by a loss of judgment, increased impulsivity, and confusion. Possible medications include:

Antipsychotics (haloperidol, risperidone, olanzapine)

Mood stabilizers (fluoxetine, imipramine, citalopram)

Stimulants (methylphenidate)

Certain drugs may be used to slow the rate at which symptoms worsen. The benefit from these drugs is often small, and patients and their families may not always notice much of a change.

Donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne, formerly called Reminyl)

Memantine (Namenda)

A person's eyes and ears should be checked regularly. Hearing aids, glasses, or cataract surgery may be needed.

Psychotherapy or group therapy usually does not help because it may cause more confusion.

For information on how to take care of a loved one with dementia, see: Dementia - home care

Expectations (prognosis)

People with mild cognitive impairment do not always develop dementia. However, when dementia does occur, it usually gets worse and often decreases quality of life and lifespan.

Complications

Complications depend on the cause of the dementia, but may include the following:

Abuse by an overstressed caregiver

Increased infections anywhere in the body

Loss of ability to function or care for self

Loss of ability to interact

Reduced lifespan

Side effects of medications used to treat the disorder

Calling your health care provider

Call your health care provider if:

Dementia develops or a sudden change in mental status occurs

The condition of a person with dementia gets worse

You are unable to care for a person with dementia at home

Prevention

Most causes of dementia are not preventable.

Quitting smoking and controlling high blood pressure and diabetes can help you reduce your risk of vascular dementia. This is dementia caused by a series of small strokes. Eating a low-fat diet and exercising regularly may also reduce the risk of vascular dementia.

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