Dementia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at October 27, 2016
StartDiseasesDementia

As we age, our brains process information more slowly. If moments of forgetfulness and cognitive impairment increase in frequency and become more serious, however, it could be a sign of dementia. Dementia is a chronic array of symptoms involving the decline of thinking skills and memory that interferes with daily functioning and results from injury or disease.

Contents

Definition & Facts

Dementia is an assortment of symptoms that limit a person’s ability to think, act and respond appropriately. In addition to significant memory loss, people with dementia may be unable to perform even the most mundane tasks, like tying a shoe or writing a check.

Some dementia can be reversed; a person may suffer temporary memory loss due to autoimmune diseases, infections or extreme responses to particular medications. Most cases of dementia are progressive, meaning that its onset is the beginning of a condition that will continue to worsen over time, and that other troubling symptoms might manifest themselves. 

Types of dementia include vascular dementia, Creutzfeldt-Jakob disease, Alzheimer's disease, Lewy body dementia, dementia associated with Parkinson's disease, frontotemporal dementia, Pick's disease (a type of frontotemporal dementia). The most common cause of dementia is Alzheimer's disease.

Symptoms & Complaints

A person with dementia will begin to forget things beyond the expected. He or she might suddenly be unable to find their way to a home they have lived in for decades after a simple walk around the neighborhood.

They might begin to call their closest loved ones by the wrong name. Often, people suffering from dementia have a hard time knowing what day of the week and year it is, and might have conversations about past events as if they were occurring in present day.

They also might experience personality changes. A person who once exercised extreme patience may begin to lash out in anger. This is because dementia can affect their judgement.

Additional symptoms of dementia can include apathy and depression. They may begin to lack interest in even common, everyday tasks such as getting dressed or basic hygiene. Loved ones may find it difficult to have a conversation with someone with dementia because they can be extremely repetitive, asking the same question over and over, and they have difficulty following story lines or finding the right words for thoughts they want to convey.

While everyone with dementia doesn’t necessarily exhibit all of these indicators of dementia, the primary, overriding symptom is their inability to remember things, and those memory lapses will become more frequent and more serious as the dementia progresses. 

Causes

In some people, it’s difficult to know what causes dementia, and there is a considerable amount of research and clinical trials ongoing, as scientists try to learn more about dementia including the role of genetic factors in patients with dementia. Most dementias are the result of progressive brain cell death that occurs over a period of time, also known as neurodegenerative disease. (Alzheimer’s is an example of a neurodegenerative disease.) 

Vascular dementia is another form of dementia that is the result of brain cell death where brain cells are deprived of oxygen. This can occur in a person who suffers a stroke, for example. When normal blood flow is interrupted for a period of time and the brain doesn’t receive oxygen, it can result in the onset of dementia from which a person likely cannot recover. 

In more recent years, scientists have been looking at the effect of repetitive, traumatic brain injury on a person’s long-term memory. Professional football players and other athletes who sustain repeated concussions are susceptible to developing a condition called chronic traumatic encephalopathy which causes dementia.

Diagnosis & Tests

People who suspect they – or their loved one – is suffering from dementia need to see a physician. There isn’t a single test to determine if a person has dementia; instead, doctors will perform a variety of tests to determine if a diagnosis of dementia is accurate and how to best to treat it going forward. 

They will probably begin with neuropsychological tests and evaluation to assess the patient's thinking skills, such as memory, attention, language and reasoning. Physicians will also want to evaluate a person’s reflexes, balance, problem-solving skills and visual perception.

Typical lab tests that are performed to diagnose dementia include a complete blood count (CBC) to look for any infections, as well as a toxicology screen to look for drugs or drug interactions that could be causing the problem. (Patients will need to provide the physician with a list of the medications they are taking, as well as a full medical history.) Liver function tests may also be conducted as well as lab tests that are designed to detect the presence of heavy metals in the blood.

Doctors also will order imaging tests, such as a magnetic resonance imaging (MRI) or computed tomography (CT) scan, which are used to rule out the presence or brain tumors or stroke activity that could be the culprit behind the symptoms of the dementia. 

Treatment & Therapy

Because dementia is a progressive disease, symptoms will continue to worsen over time. There is some evidence that certain medicines, if prescribed early enough, may slow the progression of dementia, but these are fairly new therapies and much more research is needed to authenticate their true efficacy. Cholinesterase inhibitors (which include donepezil, rivastigmine, and galantamine) and memantine are medications that are prescribed sometimes to improve symptoms among those with Alzheimer's disease.

Occupational therapy, speech therapy, psychotherapy, and reality orientation therapy may be utilized to mitigate symptoms and improve daily functioning. Regular physical exercise has also shown promise in reducing symptoms common among people with dementia. 

Prevention & Prophylaxis

There currently is no known single method for preventing all types of dementia. However, people can reduce their risk by adopting a healthy lifestyle, including regular physical exercise, maintaining a healthy body weight and eating a healthy diet.

People can also reduce their risk by limiting alcohol and avoiding tobacco products or quitting smoking. Wearing appropriate head gear when participating in contact sports as well as adopting proper safety protocols while driving or riding in motor vehicles may reduce the risk of head injury, an underlying cause of certain types of dementia.

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