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What is Dementia?

Dementia describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning.

Though dementia generally involves memory loss, memory loss alone doesn’t mean you have dementia.

What are some types of Dementia?

Alzheimer’s disease is the most common cause of a progressive dementia in older adults, but there are a number of causes of dementia. Depending on the cause, some dementia symptoms can be reversed.

What are the symptoms of dementia?

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

Cognitive changes

  • Memory loss, which is usually noticed by a spouse or someone else
  • Difficulty communicating or finding words
  • Difficulty reasoning or problem-solving
  • Difficulty handling complex tasks
  • Difficulty with planning and organizing
  • Difficulty with coordination and motor functions
  • Confusion and disorientation

Psychological changes

  • Personality changes
  • Depression
  • Anxiety
  • Inappropriate behavior
  • Paranoia
  • Agitation
  • Hallucinations

When to see a doctor?

See a doctor if you or a loved one has memory problems or other dementia symptoms. Some treatable medical conditions can cause dementia symptoms, so it’s important to determine the underlying cause.

What are the causes of Dementia?

Dementia involves damage of nerve cells in the brain, which can occur in several areas of the brain. Dementia affects people differently, depending on the area of the brain affected. Some dementias, such as those caused by a vitamin deficiencies, might improve with treatment.

Types of dementias that progress include:

1- Alzheimer’s disease : In people age 65 and older, Alzheimer’s disease is the most common cause of dementia. Certain genetic factors might make it more likely that people will develop Alzheimer’s.

2- Vascular dementia : This second most common type of dementia occurs as a result of damage to the vessels that supply blood to your brain. Blood vessel problems can be caused by stroke or other blood vessel conditions.

3- Lewy body dementia : 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. This is one of the more common types of progressive dementia.

4- Frontotemporal dementia : This is a group of diseases characterized by the degeneration of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language.

5- Mixed dementia : Many patients with dementia have a combination of Alzheimer’s disease, vascular dementia and Lewy body dementia.

6- Creutzfeldt-Jakob disease : This rare brain disorder usually occurs in people without known risk factors. Creutzfeldt-Jakob disease can be inherited or caused by exposure to diseased brain or nervous system tissue.

7- Parkinson’s disease : Many people with Parkinson’s disease eventually develop dementia symptoms (Parkinson’s disease dementia).

What are some Dementia-like conditions that can be reversed ?

Some causes of dementia or dementia-like symptoms can be reversed with treatment.

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

2- Metabolic problems and endocrine abnormalities : People with thyroid problems, low blood sugar (hypoglycemia), too little or too much sodium or calcium, or an impaired ability to absorb vitamin B-12 can develop dementia-like symptoms or other personality changes.

3- Nutritional deficiencies : Not drinking enough liquids (dehydration); not getting enough thiamin (vitamin B-1), which is common in people with chronic alcoholism; and not getting enough vitamins B-6 and B-12 in your diet can cause dementia-like symptoms.

4- Reactions to medications : A reaction to a medication or an interaction of several medications can cause dementia-like symptoms.

5- Brain tumors : Rarely, dementia can result from damage caused by a brain tumor.

This condition, also called hypoxia, occurs when organ tissues aren’t getting enough oxygen. Anoxia can occur due to severe asthma, heart attack, carbon monoxide poisoning or other causes.

6- Normal-pressure hydrocephalus : This condition, which is caused by enlarged ventricles in the brain, can cause walking problems, urinary difficulty and memory loss.

What are the risk factors for Dementia?

Many factors can eventually lead to dementia. Some factors, such as age, can’t be changed. Others can be addressed to reduce your risk.

Risk factors that can’t be changed

The risk rises as you age, especially after age 65. However, dementia isn’t a normal part of aging, and dementia can occur in younger people.

1- Family history : Having a family history of dementia puts you at greater risk of developing the condition.

2- Down syndrome : By middle age, many people with Down syndrome develop early-onset Alzheimer’s disease.

3- Mild cognitive impairment : This involves difficulties with memory but without loss of daily function. It puts people at higher risk of dementia.

 

Risk factors you can change

You might be able to control the following risk factors of dementia.

1- Heavy alcohol use : If you drink large amounts of alcohol, you might have a higher risk of dementia. Some studies, however, have shown that moderate amounts of alcohol might have a protective effect.

2- Cardiovascular risk factors : These include high blood pressure (hypertension), high cholesterol, buildup of fats in your artery walls (atherosclerosis) and obesity.
Although not yet well-understood, late-life depression might indicate the development of dementia.
If you have diabetes, you might have an increased risk of dementia, especially if it’s poorly controlled.
Smoking might increase your risk of developing dementia and blood vessel (vascular) diseases.

3- Sleep apnea : People who snore and have episodes where they frequently stop breathing while asleep may have reversible memory loss.

What are the complications of Dementia ?

Dementia can affect many body systems and can lead to:

1- Inadequate nutrition : Many people with dementia eventually reduce or stop their intake of nutrients. Ultimately, they may be unable to chew and swallow.
Difficulty swallowing increases the risk of choking or aspirating food into the lungs, which can block breathing and cause pneumonia.

2- Inability to perform self-care tasks : As dementia progresses, it can interfere with bathing, dressing, brushing hair or teeth, using the toilet independently and taking medications accurately.

3- Personal safety challenges : Some day-to-day situations can present safety issues for people with dementia, including driving, cooking and walking alone.

Late-stage dementia results in coma and death, often from infection.

How is Dementia diagnosed ?

We will review your medical history and symptoms and conduct a physical examination. We may to run a number of tests that may include:

Cognitive and neuropsychological tests : to measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention.

Neurological evaluation : to evaluate visual perception, movement, senses, balance, reflexes.

CT or MRI : scans can check for evidence of stroke or bleeding or tumor or hydrocephalus.

PET scans : can show patterns of brain activity and if the amyloid protein, a hallmark of Alzheimer’s disease, has been deposited in the brain.

Laboratory tests : Simple blood tests can detect problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. Sometimes the spinal fluid is examined for infection, inflammation or markers of some degenerative diseases.

Psychiatric evaluation : can determine whether depression or another mental health condition is contributing to your symptoms.

How is Dementia treated ? 

Most types of dementia can’t be cured, but there are ways to manage your symptoms.

Medications :

The following are used to temporarily improve dementia symptoms.

1- 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. Although primarily used to treat Alzheimer’s disease, these medications might also be prescribed for other dementias, including vascular dementia, Parkinson’s disease dementia and Lewy body dementia. Side effects can include nausea, vomiting and diarrhea.

2- Memantine (Namenda) works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory. In some cases, memantine is prescribed with a cholinesterase inhibitor. A common side effect of memantine is dizziness.

3- Other medications : Your doctor might prescribe medications to treat other symptoms or conditions, such as depression, sleep disturbances or agitation.

Are there any non-medication therapies available ?

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

1- Occupational therapy : An occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior; and prepare you for the dementia progression.

2- Modifying the environment : Reducing clutter and noise can make it easier for someone with dementia to focus and function.

3- You might need to hide objects that can threaten safety, such as knives and car keys.

4- Monitoring systems can alert you if the person with dementia wanders.

5- Modifying tasks : Break tasks into easier steps and focus on success, not failure. Structure and routine also help reduce confusion in people with dementia.

6- Music therapy, which involves listening to soothing music

7- Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia

8- Aromatherapy, which uses fragrant plant oils

9- Massage therapy

10- Art therapy, which involves creating art, focusing on the process rather than the outcome 

Are there any dietary supplement available ?

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

Use caution when considering taking dietary supplements, vitamins or herbal remedies, especially if you’re taking other medications. These remedies aren’t regulated, and claims about their benefits aren’t always based on scientific research.

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

1- Vitamin E : Doctors warn against taking large doses of vitamin E because it may have a higher risk of mortality, especially in people with heart disease.

2- Omega-3 fatty acids : There is some evidence that eating fish three times a week might lower your risk of dementia. However, in clinical studies, omega-3 fatty acids haven’t significantly slowed cognitive decline in mild to moderate Alzheimer’s disease.

3- Although ginkgo is considered safe, study results have been inconsistent in determining whether ginkgo helps people with dementia.

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