What Should I Know About Dementia?
What Is the Medical Definition of dementia?
- Dementia is a decline and/or loss of memory, reasoning, judgment, behavior, language and other mental abilities that are not a part of normal aging; it usually progressively worsens over time.
- Dementia, senility, and Alzheimer's disease are not the same things.
- In general, there are many causes of dementia, but all dementia diseases result from dysfunction of a person's cerebral cortex, directly or indirectly.
- There are irreversible, and potentially reversible causes of dementia.
- Early signs and symptoms of dementia may go unrecognized, but the first sign is usually loss of short-term memory.
What Are the Early Signs & Symptoms of Dementia?
- Some of the other early dementia symptoms and signs include:
- Personality changes
- Mood swings
- Poor judgment
- Paranoia or suspiciousness
- Some of the intermediate signs and symptoms of dementia include
- Worsening of early dementia symptoms
- Abnormal moods
- Inability to learn new information
- Some of the later signs and symptoms of dementia include
- Worsening of the intermediate signs and symptoms of dementia
- Inability to walk or move to place to place unassisted
- Complete loss of short and long-term memory
What Are the 7 Stages of Dementia?
- There are 7 stages of dementia based on the Global deterioration scale (Reisberg Scale). However, other dementia stages or scales exist that describe between 3 and 5 stages, but they all have similar symptoms and signs.
- Generalized treatment for dementia involves medical care and day-to-day care by family members.
- In many cases, family members can help loved ones handle dementia symptoms at home.
- Dementia treatment also can focus on correcting all reversible factors and slowing irreversible factors of dementia, for example, correcting drug doses, treating symptoms, treating depression, and treating specific medical disorders such as heart disease and diabetes.
- Certain medications such as cholinesterase inhibitors and others may help reduce symptoms. Surgery is reserved for specific conditions that may improve the individual's condition such as removal of a brain tumor.
- Occupational and physical therapy may improve some symptoms of dementia.
- Currently, there is no known way to prevent irreversible dementia. Some reversible dementia cases may be prevented or slowed by maintaining a healthy lifestyle (avoiding excessive use of alcohol, smoking and/or substance abuse, and avoiding infections that may affect the brain).
How Long Do People Live After Being Diagnosed with Dementia?
- Life expectancy for someone with dementia averages about eight years after initial diagnosis, and may range from about 3 to 20 years.
What Is Dementia?
Dementia is a decline or loss of reasoning, memory, and other mental abilities (the cognitive functions such as judgment, thinking, behavior, and language) and is not a normal part of aging. This decline is progressive and eventually impairs the ability to carry out everyday activities such as driving; household chores; and even personal care such as bathing, dressing, and feeding (often called activities of daily living).
According to World Health Organization (WHO) statistics, about 47.5 million people worldwide have dementia, with a projected increase to 75.6 million by 2030 with about 7.7 newly diagnosed each year.
Are Dementia, Senility, and Alzheimer's Disease the Same Things?
- Dementia occurs most commonly in elderly people; it used to be called senility and/or senile dementia, and was considered a normal part of aging. Affected people were labeled as demented. The term "senile dementia" is infrequently used in the current medical literature and has been replaced by the term "dementia."
- "Senile dementia," "senility," and "demented" are older outdated terms that incorrectly label people with memory loss, confusion and other symptoms as a normal part of aging.
- Dementia, as defined above, is a constellation of ongoing symptoms that are not part of normal aging (even though it occurs most often in older individuals) that have a large number of different causes, for example, Alzheimer's disease is the major cause of dementia in individuals (about 60%-70%) but it is only one of many problems that can cause dementia.
What Are the 7 Stages of Dementia?
Global Deterioration Scale for Assessment of Primary Degenerative Dementia (GDS) (also known as the Reisberg Scale)
Global Deterioration Scale for Assessment of Primary Degenerative Dementia (GDS)
|Stage||Diagnosis||Dementia Symptoms and Signs|
|Stage 1: No cognitive decline||No dementia||In stage 1, the person functions normally, has no memory loss, and is mentally healthy. People with no dementia would be considered to be in Stage 1.|
|Stage 2: Very mild cognitive decline||No dementia||Stage 2 is used to describe normal forgetfulness associated with aging; for example, forgetfulness of names and where familiar objects like keys were left. Symptoms are not evident to loved ones, family or the patient's physician.|
|Stage 3: Mild cognitive decline||no dementia||This stage includes increased forgetfulness, slight difficulty concentrating and some decreased work performance. People may get lost more often or have difficulty finding the right words. At this stage, a person's loved ones and family will begin to notice a decline in problem solving and traveling to new places. Note that other researchers may include this stage in either early stage or stage 1 of 3 stages (early, moderate or severe staging systems).|
|Stage 4: Moderate cognitive decline||Early-stage dementia||Stage 4 includes difficulty concentrating, decreased memory of recent events, and difficulties managing finances and/or traveling alone to new locations. People have trouble completing complex tasks and may be in denial about their mental abilities. They may also start withdrawing from family or friends because socialization becomes difficult. A physician can detect clear cognitive problems during a patient interview, physical exam and dementia testing.|
|Stage 6: Moderately severe cognitive decline||Mid-stage dementia||People in stage 5 have major memory deficiencies and need some assistance to complete their daily activities (for example, dressing, bathing, preparing meals). Memory loss is prominent and may include major relevant ongoing memory problems; for example, people may not remember their address or phone number and may not know the time or day or where they are currently.|
|Stage 6: Severe cognitive decline (middle dementia)||Mid-stage dementia||People in stage 6 require extensive assistance to carry out daily activities like dressing themselves. They start to forget names of close family members and have little memory of recent events. Many patients can remember only some details of earlier life. They also have difficulty counting down from 10 and finishing tasks. Incontinence (loss of bladder or bowel control) is a problem in this stage. Ability to speak declines. Personality changes, such as delusions (believing something to be true that is not), compulsions (repeating a simple behavior, such as cleaning), or anxiety and agitation may occur.|
|Stage 7: Very severe cognitive decline||Late-stage dementia||People in this stage have essentially no ability to speak or communicate. They require assistance with most common daily activities (e.g., using the toilet, eating). They often lose psychomotor skills, for example, the ability to walk or to sit in a chair.|
What Causes Dementia?
Dementia has many different causes, some of which are difficult to tell apart. Many medical conditions can cause dementia symptoms, especially in older people.
- The causes of dementia include various diseases and infections, strokes, head injuries, drugs, and nutritional deficiencies.
- All dementias reflect dysfunction in the cerebral cortex, the part of the brain that controls perception, memory, thoughts, language, and consciousness. Some disease processes damage the cortex directly; others disrupt subcortical areas of the brain that normally regulate the function of the cortex.
- When the underlying process does not permanently damage the cortical tissue, the dementia may sometimes be stopped or reversed.
- In classifying dementias, medical professionals may either separate the causes into cortical or subcortical dementias or into reversible and irreversible dementias.
What Are the Irreversible Causes of Dementia?
The main irreversible causes of dementia are described here. These damage brain cells in both cortical and subcortical areas. Treatment focuses on slowing progress of the underlying condition and relieving symptoms.
- Alzheimer's disease: This is the most common cause of dementia, accounting for about half of all cases. Alzheimer's disease is at least partly hereditary in that it tends to run in families. (Just because a relative has Alzheimer's disease, however, does not mean that another family member will have the disease.) In this disease, abnormal protein deposits in the brain destroy cells in the areas of the brain that control memory and mental functions. People with Alzheimer's disease also have lower-than-normal levels of brain chemicals called neurotransmitters that control important brain functions. Alzheimer's disease is not reversible, and no known cure exists. However, certain medications can slow its progress.
- Dementia with Lewy bodies: This is caused by abnormal microscopic deposits of protein, called Lewy bodies, which destroy nerve cells. These deposits can cause symptoms typical of Parkinson's disease, such as tremor and muscle rigidity, as well as dementia similar to that of Alzheimer's disease. Lewy body dementia affects thinking, attention, and concentration more than memory and language. Like Alzheimer's disease, Lewy body dementia is not reversible and has no known cure. The drugs used to treat Alzheimer's disease also benefit some people with Lewy body disease.
- Vascular dementia: This is the second most common cause of dementia, accounting for as many as 40% of cases. This dementia is caused by atherosclerosis, or "hardening of the arteries," in the brain. Deposits of fats, dead cells, and other debris form on the inside of arteries, partially (or completely) blocking blood flow. These blockages cause multiple strokes, or interruptions of blood flow, to the brain. Because this interruption of blood flow is also called "infarction," this type of dementia is sometimes called multi-infarct dementia. One subtype whose origin is not well understood is Binswanger disease. Vascular dementia is related to high blood pressure, high cholesterol, heart disease, diabetes, and related conditions. Treating those conditions can slow the progress of vascular dementia, but functions do not come back once they are lost.
- Parkinson's disease: People with this disease typically have limb stiffness (which causes them to shuffle when they walk), speech problems, and tremor (shaking at rest). Dementia may develop late in the disease, but not everyone with Parkinson's disease has dementia. Reasoning, memory, speech, and judgment are most likely to be affected.
- Huntington's disease: This inherited disease causes wasting of certain types of brain cells that control movement as well as thinking. Dementia is common and occurs in the late stages of the disease. Personality changes are typical. Reasoning, memory, speech, and judgment may also be affected.
- Creutzfeldt-Jakob disease: This rare disease occurs most often in young and middle-aged adults. Infectious agents called prions invade and kill brain cells, leading to behavior changes and memory loss. The disease progresses rapidly and is fatal.
- Pick disease (frontotemporal dementia): Frontotemporal dementia is another rare disorder that damages cells in the frontal and/or temporal part of the brain. Behavior and personality changes usually precede memory loss and language problems.
- Parkinson's disease and Huntington's disease begin in subcortical areas. They cause the subcortical type of dementia.
- Multiple sclerosis: In this condition, brain and spinal cord cells are damaged by an autoimmune process. Dementia can result in some people.
- Untreated brain infections (for example, HIV, Lyme disease) damage brain cells by forming lesions and trigger inflammatory responses that damage or kill brain cells.
- CTE dementia (chronic traumatic encephalopathy) is associated with repeated blows to the head that result over time (years) with behavioral, memory, personality and thinking problems.
- Mixed dementia is a combination of Alzheimer's and vascular dementia symptoms.
- Wernicke-Korsakoff syndrome is characterized by signs and symptoms of confusion, ataxia, vision changes, coma due to lack of vitamin B1, often associated with alcoholism.
What Are Potentially Treatable Causes of Dementia?
The dementia in treatable conditions may be reversible or partially reversible, even if the underlying disease or damage is not. However, readers should note that if underlying brain damage is extensive or severe, these causes may be classified as irreversible by the individual's physician(s).
- Head injury: This refers to brain damage from accidents, such as motor vehicle wrecks and falls; from assaults, such as gunshot wounds or beatings; or from activities such as boxing without protective gear. The resulting damage of brain cells can lead to dementia.
- Infections: Infections of brain structures, such as meningitis and encephalitis, can be primary causes of dementia. Other infections, such as HIV/AIDS and syphilis, can affect the brain permanently in later stages. In all infection cases, inflammation in the brain damages cells.
- Normal pressure hydrocephalus: The brain floats in a clear fluid called cerebrospinal fluid. This fluid also fills internal spaces in the brain called cerebral ventricles. If too much fluid collects outside the brain, it causes hydrocephalus. This condition raises the fluid pressure inside the skull and compresses brain tissue from outside. It may cause severe damage and death. If fluid builds up in the ventricles, the fluid pressure remains normal ("normal pressure hydrocephalus"), but brain tissue is compressed from within.
- Simple hydrocephalus: Simple hydrocephalus may cause typical dementia symptoms or lead to coma. In normal pressure hydrocephalus, people have trouble walking and become incontinent (unable to control urination) at the same time they start to lose mental functions, such as memory. If normal pressure hydrocephalus is diagnosed early, the internal fluid pressure may be decreased by putting in a shunt. This can stop the dementia, the gait problems, and the incontinence from getting worse.
- Brain tumors: Tumors can cause dementia symptoms in a number of ways. A tumor can press on structures within the brain such as the hypothalamus or pituitary gland, which control hormone secretion. They can also press directly on brain cells, damaging them. Treating the tumor, either medically or surgically, can reverse the symptoms in some cases.
- Toxic exposure: People who work around solvents or heavy metal dust and fumes (lead especially) without adequate protective equipment may develop dementia from the damage these substances can cause to brain cells. Some exposures can be treated, and avoiding further exposure can prevent further damage.
- Metabolic disorders: Diseases of the liver, pancreas, or kidneys can lead to dementia by disrupting the balances of salts (for example, sodium and calcium) and other chemicals (like low glucose levels) in the blood. Often, these changes occur rapidly and affect the person's level of consciousness. This is called delirium. Although the person with delirium, like the person with dementia, cannot think well or remember, treatment of the underlying disease may fully reverse the condition. If the underlying disease persists, however, brain cells may die, and the person will have dementia.
- Hormone disorders: Disorders of hormone-secreting and hormone-regulating organs such as the thyroid gland, the parathyroid glands, the pituitary gland, or the adrenal glands can lead to hormone imbalances, which can cause dementia if not corrected.
- Poor oxygenation (hypoxia): People who do not have enough oxygen in their blood may develop dementia because the blood brings oxygen to the brain cells, and brain cells need oxygen to live. The most common causes of hypoxia are lung diseases such as emphysema or pneumonia. These limit oxygen intake or transfer of oxygen from the airways of the lungs to the blood. Cigarette smoking is a frequent cause of emphysema. It can worsen hypoxic brain damage by damaging the lungs and also by increasing the levels of carbon monoxide in the blood. Heart disease leading to congestive heart failure may also lower the amount of oxygen in the blood. Sudden, severe hypoxia may also cause brain damage and symptoms of dementia. Sudden hypoxia may occur if someone is comatose or has to be resuscitated.
- Drug reactions, overuse, or abuse: Some drugs can cause temporary problems with memory and concentration as side effects in elderly people. Misuse of prescription drugs over time, whether intentional or accidental, can cause dementia. The most common culprits are sleeping pills and tranquilizers. Other drugs that cause dry mouth, constipation, and sedation ("anticholinergic side effects") may cause dementia or dementia symptoms. Illegal drugs, especially cocaine (which affects circulation and may cause small strokes) and heroin (which is very anticholinergic) may also cause dementia, especially in high doses, if taken for long periods, or in older people. The withdrawal of the drug usually reverses the symptoms.
- Nutritional deficiencies: Deficiencies of certain nutrients, especially B vitamins such as low levels of vitamin B12 or B1, can cause dementia if not corrected.
- Chronic alcoholism: Dementia in people with chronic alcoholism is believed to result from other complications such as liver disease and nutritional deficiencies.
What Are Early Signs and Symptoms of Dementia?
Symptoms of dementia vary considerably by the individual and the underlying cause of the dementia. Most people affected by dementia have some (but not all) of these symptoms. The symptoms may be very obvious, or they may be very subtle and go unrecognized for some time. The first sign of dementia is usually loss of short-term memory. The person repeats what he just said or forgets where she put an object just a few minutes ago. Other symptoms and signs are as follows:
Early dementia symptoms and signs
- Word-finding difficulty: May be able to compensate by using synonyms or defining the word
- Forgetting names, appointments, or whether or not the person has done something; losing things
- Difficulty performing familiar tasks: Driving, cooking a meal, household chores, managing personal finances
- Personality changes (for example, sociable person becomes withdrawn or a quiet person is coarse and silly)
- Uncharacteristic behavior
- Mood swings, often with brief periods of anger or rage
- Poor judgment
- Behavior disorders: Paranoia and suspiciousness
- Decline in level of functioning but able to follow established routines at home
- Confusion, disorientation in unfamiliar surroundings: May wander, trying to return to familiar surroundings
- Difficulty or inability to multitask
What Are Intermediate Signs and Symptoms of Dementia?
- Worsening of symptoms seen in early dementia, with less ability to compensate
- Unable to carry out activities of daily living (for example, bathing, dressing, grooming, feeding, using the toilet) without help
- Disrupted sleep (often napping in the daytime, up at night)
- Unable to learn new information
- Increasing disorientation and confusion even in familiar surroundings
- Greater risk of falls and accidents due to poor judgment and confusion
- Behavior disorders: Paranoid delusions, aggressiveness, agitation, inappropriate sexual behavior
- Confabulation (in conversation, filling in memory gaps with false information)
- Inattention, poor concentration, loss of interest in the outside world
- Abnormal moods (anxiety, depression)
What Are the Signs and Symptoms of Late or Severe Dementia?
- Worsening of symptoms seen in early and intermediate dementia
- Complete dependence on others for activities of daily living
- May be unable to walk or move from place to place unassisted
- Impairment of other movements such as swallowing: Increases risk of malnutrition, choking, and aspiration (inhaling foods and beverages, saliva, or mucus into lungs)
- Complete loss of short- and long-term memory: May be unable to recognize even close relatives and friends
- Complications: Dehydration, malnutrition, problems with bladder control, infections, aspiration, seizures, pressure sores, injuries from accidents or falls
The person may not be aware of these problems, especially the behavior problems. This is especially true in the later stages of dementia.
Depression in elderly people can cause dementia-like symptoms. About 40% of people with dementia are also depressed. Common symptoms of depression include depressed mood, loss of interest in activities once enjoyed, withdrawal from others, sleep disturbances, weight gain or loss, suicidal thoughts, feelings of worthlessness, and loss of ability to think clearly or concentrate.
People with irreversible or untreated dementia present a slow, gradual decline in mental functions and movements over several years. Total dependence and death, often from infection, are the last stages.
When to Seek Medical Care if You Think You or Someone You Know May Have Dementia?
A person affected with dementia may not be aware he or she has a problem. Most people with dementia are brought to medical attention by a caring relative or friend. Any of the following warrant a visit to the person's health care professional.
- Marked loss of short-term memory
- Behavior or personality changes
- Inappropriate or uncharacteristic behavior
- Depressed mood
- Marked mood swings
- Inability to carry out daily tasks such as bathing, dressing, feeding, using the toilet, or household chores
- Carelessness in personal hygiene
- Persistent word-finding difficulties
- Persistent or frequent poor judgment
- Persistent or frequent confusion or disorientation, especially in familiar situations
- Inability to manage personal finances
Which Specialties of Doctors Treat Dementia?
In addition to the patient's primary care doctor, neurologists, gerontologists, neuropsychologists and some psychiatrists may diagnose and treat patients with dementia. If the patient has a potentially treatable cause like an infection or tumor, various other specialists may be consulted.
Is There a Test for Dementia?
There is no specific test for dementia. However, dementia may be diagnosed if at least two of the following core mental functions are significantly impaired, according to some researchers:
- Attentiveness/focus on a problem or subject
- Visual perception
In some people, the signs and symptoms of dementia are easily recognized; in others, they can be very subtle. A careful and thorough evaluation is needed to identify their true cause.
- The individual's health-care professional will conduct a detailed medical interview to develop a picture of the symptoms. The interview will address the symptoms and when they began, the person's medical problems now and in the past, family medical problems, medications, work and travel history, and habits and lifestyle.
- Family members, especially those who live with the affected person, will also be asked about his or her symptoms.
- The review of medications is very important, especially for seniors, who are more likely to take several medications and to experience side effects.
- A thorough physical examination will look for evidence of illness and dysfunction that might shed light on what is causing the symptoms.
- This evaluation is designed to identify reversible, treatable causes of dementia symptoms.
- At any point in the evaluation or treatment, the person with dementia may be referred to specialists in conditions of older people (geriatricians), in brain disorders (neurologists), or in mental disorders (psychiatrists).
An assessment of dementia symptoms should include a mental status evaluation. This evaluation uses various "pencil and paper," "talking," and physical tests to identify brain dysfunction. A more thorough type of testing, performed by a psychologist, is called neuropsychologic testing.
- Mental status examination or neuropsychological testing pinpoints the nature and measures the severity of the person's mental problems. This can help give a more accurate diagnosis of the problems and, thus, can help in treatment planning.
- Testing includes noting the individual's appearance, mood, anxiety level, and experience of delusions or hallucinations.
- Dementia testing assesses cognitive abilities such as memory, attention, orientation to time and place, use of language, and abilities to carry out various tasks and follow instructions, but there is no definitive test for dementia.
- Reasoning, abstract thinking, and problem solving are also tested.
Lab tests may be used to identify or rule out possible causes of dementia.
- Routine blood tests include a complete blood cell (CBC) count, blood chemistry, liver function tests, thyroid function tests, and vitamin B levels (especially folic acid and vitamin B-12), ammonia level, and detection of drugs of abuse.
- Other blood tests (for example, syphilis and HIV testing, levels of intoxicating drugs, arterial blood gases [in hypoxia], specific hormone tests like thyroid function tests, or measurement of heavy metals) are used only when a person is at high risk for specific conditions.
- Urine tests may be needed to assess blood abnormalities further, to detect certain drugs, or to rule out certain kidney and metabolic disorders.
- Cerebrospinal fluid testing may be necessary to rule out brain infections, brain tumors, and hydrocephalus with elevated fluid pressure. A sample of the fluid is obtained by a procedure called a lumbar puncture (spinal tap), in which a long needle is inserted between two vertebrae of the spine at the lower back.
In some cases, imaging studies of the brain may be necessary to detect conditions such as normal pressure hydrocephalus, brain tumor, or infarction or bleeding in the brain.
- CT scan is usually adequate, although MRI may be used if greater detail is needed.
- Single-photon emission CT (SPECT) imaging detects blood flow in the brain and is used in some medical centers to distinguish Alzheimer's disease from vascular dementia.
- Electroencephalography (EEG) is not an imaging study but a recording of the electrical activity in different parts of the brain. It is used in people who are having seizures but may help diagnose other disorders as well.
What Is the Treatment for Dementia?
Although an individual with dementia should always be under medical care, family members handle much of the day-to-day care. Medical care should focus on optimizing the individual's health and quality of life while helping family members cope with the many challenges of caring for a loved one with dementia. Medical care depends on the underlying condition, but it most often consists of medications and nondrug treatments such as behavioral therapy.
However, early investigation into the cause of dementia symptoms is urged because, as mentioned previously in the causes of dementia section. There are some conditions that when adequately treated may either limit or reverse dementia.
While at Home, What Can I Do to Help my Loved One with Symptoms of Dementia?
Many people with dementia in the early and intermediate stages are able to live independently.
- With regular checks by a local relative or friend, they are able to live without constant supervision.
- Those who have difficulty with activities of daily living require at least part-time help from a family caregiver or home health aide.
- Visiting nurses can make sure that these individuals take their medications as directed.
- Housekeeping help is available for those who cannot keep up with household chores.
Other affected individuals require closer supervision or more constant assistance.
- Round-the-clock help in the home is available, but it is too expensive for many.
- Individuals who require this level of assistance may need to move from their home to the home of a family caregiver or to an assisted-living facility.
- Many families prefer these options because they give the individual the greatest possible independence and quality of life.
For individuals who are able to remain at home or to retain some degree of independent living, maintaining a familiar and safe environment is important.
- The individual must be comfortable and safe if he or she is to continue to function independently.
- Minor modifications of the home may be needed. Most important is to prevent falls and accidents. Getting rid of area rugs and putting grab bars in the shower and mats in the tub are easy important steps to make the environment safe. Sometimes, disabling the stove or using child proof knobs may be necessary to prevent cooking accidents.
- The balance between safety and independence must be assessed often. If necessary, changes must be made to keep the individual safe.
Individuals with dementia should remain physically, mentally, and socially active.
- Daily physical exercise helps the body and mind function and maintains a healthy weight. Exercise can be as simple as a daily walk.
- The individual should engage in as much mental activity as he or she can handle. Mental activity is believed to slow the progress of some types of dementia. Puzzles, games, reading, and safe hobbies and crafts are good choices.
- Social interaction is stimulating and enjoyable for most people with dementia. Most senior centers or community centers have scheduled activities, such as parties and clubs that are suitable for those with dementia.
A balanced diet that includes low-fat protein foods and plenty of fruits and vegetables helps maintain a healthy weight and prevents malnutrition and constipation. An individual with dementia should not smoke, both for health and for safety reasons. As a caregiver, make sure to take care of yourself.
What Medications Treat Dementia Symptoms?
Dementia treatment focuses on correcting all reversible factors and slowing irreversible factors. Some of the important drug treatment strategies in dementia are described. Except for the cholinesterase inhibitors, the U.S. Food and Drug Administration (FDA) has not approved any drug specifically for dementia. The drugs listed here are some of the most frequently prescribed from each class.
- Cholinesterase inhibitors: tacrine (Cognex), donepezil (Aricept), rivastigmine (Exelon), galantamine/galanthamine (Razadyne), memantine (Namenda)
- Antipsychotics: haloperidol (Haldol), risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), ziprasidone (Geodon)
- Antidepressants/anxiolytics: Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa)
- Anticonvulsants: Valproic acid (Depakote), carbamazepine (Tegretol) gabapentin (Neurontin), lamotrigine (Lamictal)
- Stimulants: Methylphenidate (Ritalin)
Slowing the progression of dementia
Dementia due to some conditions, such as Alzheimer's disease, can sometimes be slowed in the early-to-intermediate stages with medication. Many different types of medications have been or are being tried in dementia. The medications that have worked the best so far are the cholinesterase inhibitors.
- Cholinesterase is an enzyme that breaks down a chemical in the brain called acetylcholine. Acetylcholine acts as an important messaging system in the brain.
- Cholinesterase inhibitors, by stopping the breakdown of this neurotransmitter, increase the amount of acetylcholine in the brain of a person with dementia and improve brain function.
- These drugs not only improve or stabilize mental functions, but they may also have positive effects on behavior and activities of daily living.
- They are not a cure for dementia, and in many people the effect is fairly modest. In others, these drugs do not have much of a noticeable effect. Moreover, the effects are temporary, since these drugs do not change the underlying medical condition.
- Another drug, memantine (Namenda), which works in a different way, is showing promise in certain types of dementia.
Because depression is so common in people with dementia, treatment of depression can at least partially relieve symptoms.
- Depression is usually treated with any of a group of drugs known as antidepressants.
- The most important of these are the drugs known as selective serotonin reuptake inhibitors (SSRIs), for example, Fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil, Paxil CR, Pexeva), citalopram (Celexa).
- Stimulant drugs such as methylphenidate (used to treat attention deficit disorders in children) may sometimes be used to treat depression in people with dementia.
- Some of the medications that treat depression also help with anxiety.
Correcting drug doses and/or withdrawing misused drugs
Many seniors require ongoing medications for chronic conditions such as heart failure, high blood pressure, high cholesterol, diabetes, prostate enlargement, and many others.
- Reviewing these medications can reveal incorrect doses, drug interactions, side effects, or poor compliance (taking drugs inappropriately or not at all) that could be responsible for part or all of the person's dementia symptoms.
- Adjustment of doses, elimination of interactions, and development of a drug-taking regimen to ensure that the person takes his or her drugs as prescribed can help reverse symptoms.
All drugs cause side effects. In prescribing a drug, doctors weigh whether the benefits of the drug outweigh the side effects. Seniors are especially likely to experience drug side effects. People with dementia who are taking any of these drugs must be checked often to make sure that the side effects are tolerable.
What Diseases or Conditions May Worsen Dementia?
Treatable disorders revealed by the diagnostic evaluation should receive prompt attention.
- Common, treatable conditions that cause or worsen dementia include high blood pressure, high cholesterol, heart disease, diabetes, infections, head injuries, brain tumors, hydrocephalus, anemia, hypoxia, hormone imbalances, and nutritional deficiencies.
- Treatment varies by disorder, but some treatments (for example, stopping infections, correcting electrolyte or glucose levels) may rapidly reverse the dementia symptoms.
What Is the Treatment for Symptoms and Complications of Dementia?
Some symptoms and complications of dementia can be relieved by medical treatment, even if no treatment exists for the underlying cause of the dementia.
- Behavioral disorders may improve with individualized therapy aimed at identifying and changing specific problem behaviors.
- Mood swings and emotional outbursts may be treated with mood-stabilizing drugs.
- Agitation and psychosis (hallucinations and delusions) may be treated with antipsychotic medication or, in some cases, anticonvulsants.
- Seizures usually require anticonvulsant medication.
- Sleeplessness can be treated by changing certain habits and, in some cases, by taking medication.
- Bacterial infections require treatment with antibiotics.
- Dehydration and malnutrition may be treated with rehydration and supplements or with behavioral therapies.
- Aspiration, pressure sores, and injuries can be prevented with appropriate care.
Can Dementia Be Prevented?
No known way to prevent irreversible dementia or even many types of reversible dementia exists. The following may help prevent certain types of dementia:
- Maintaining a healthy lifestyle that includes a balanced diet, regular exercise, moderate use of alcohol, and no smoking or substance abuse
- Taking precautions to prevent infections (such as practicing safe sex)
- Using protective equipment such as a seat belt or motorcycle helmet to prevent head injury
The following may allow early treatment and at least partial reversal of dementia:
- Being alert for symptoms and signs that suggest dementia
- Early recognition of underlying medical conditions, such as hypoxia, HIV infection, low glucose levels, or low sodium levels
What Is the Life Expectancy for a Person with Dementia?
The outlook for most types of dementia is poor unless the cause is an early recognized reversible condition. Irreversible or untreated dementia usually continues to worsen over time. The condition usually progresses over years until the person's death. Life expectancy after diagnosis averages about 8-10 years with a range from about 3-20 years.
Making decisions about end-of-life care is important.
- The earlier in the disease these issues are discussed, the more likely the person with dementia will be able to express his or her wishes about medical care at the end of life.
- The issues may be presented by your health care professional. If not, ask about them.
- These issues include use of aggressive interventions and hospital care, artificial feeding, and medical treatment for medical illnesses.
- These issues should be discussed by family members and decisions made about how to deal with them when the time comes.
- The decisions should be documented in the person's medical records.
Support groups and counseling for caregivers
Caring for a person with dementia can be very difficult. It affects every aspect of your life, including family relationships, work, financial status, social life, and physical and mental health. You may feel unable to cope with the demands of caring for a dependent, difficult relative. Besides the sadness of seeing the effects of your loved one's disease, you may feel frustrated, overwhelmed, resentful, and angry. These feelings may, in turn, leave you feeling guilty, ashamed, and anxious. Depression in caregivers is not uncommon.
Different caregivers have different thresholds for tolerating these challenges. For many caregivers, just "venting" or talking about the frustrations of caregiving can be enormously helpful. Others need more but may feel uneasy about asking for the help they need. One thing is certain, though: If the caregiver is given no relief, he or she can burn out, develop his or her own mental and physical problems, and become unable to care for the person with dementia.
This is why support groups were invented. Support groups are groups of people who have lived through the same set of difficult experiences and want to help themselves and others by sharing coping strategies. Mental health professionals strongly recommend that family caregivers take part in support groups. Support groups serve a number of different purposes for a person living with the
of being a caregiver for a person with dementia.
- The group allows the person to express his or her true feelings in an accepting, nonjudgmental atmosphere.
- The group's shared experiences allow the caregiver to feel less alone and isolated.
- The group can offer fresh ideas for coping with specific problems.
- The group can introduce the caregiver to resources that may be able to provide some relief.
- The group can give the caregiver the strength he or she needs to ask for help.
Support groups meet in person, on the telephone, or on the Internet. To find a support group that works for you, contact the organizations listed below. You can also ask your health care professional or behavioral therapist or go on the Internet. If you do not have access to the Internet, go to a public library. For more information about support groups, contact these agencies:
- Family Caregiver Alliance, National Center on Caregiving: (800) 445-8106
- National Alliance for Caregiving
- Eldercare Locator Service: (800) 677-1116