Dementia

Dementia is a broad term that refers to a range of conditions affecting brain function, particularly memory, thinking, reasoning, mood, personality, and behavior. As mental function declines, it disrupts daily life and activities. Around half of people aged 85 and older are affected by dementia. While current medications may slow down cognitive decline, they cannot stop it entirely.

Overview of Dementia

Dementia is not a specific disease but a state of cognitive decline from a previously higher level, severe enough to impact daily living. It involves a decline in two or more areas, such as:

• Memory
• Reasoning
• Language
• Coordination
• Mood or behavior

This decline occurs when areas of the brain responsible for these functions are affected by diseases or infections. Alzheimer’s disease is the most common cause, but other causes include vascular dementia, dementia with Lewy bodies, and frontotemporal dementia.

Dementia vs. Alzheimer’s Disease

Dementia is an umbrella term for mental decline, while Alzheimer’s disease is a specific condition and the most common form of dementia. Other causes include Parkinson’s disease and vascular dementia.

Who is Affected by Dementia?

Dementia primarily affects older adults, with 5-8% of people over 65 experiencing some form of dementia. This number increases with age, doubling every five years after 65. By age 85, nearly half of the population may be affected.

Common Types of Dementia

• Alzheimer’s disease: The most common type, involving memory loss, confusion, and changes in personality or behavior.
• Vascular dementia: Caused by reduced blood flow to the brain, often following strokes.
• Lewy body dementia: Involves movement problems, hallucinations, and memory loss.
• Frontotemporal dementia (FTD): Affects personality and behavior, often occurring in younger people (ages 45-64).
• Mixed dementia: A combination of two or more types, often seen in people over 80.

Other Causes of Dementia

• Huntington’s disease
• Parkinson’s disease
• Traumatic brain injury
• Wernicke-Korsakoff syndrome

Misconceptions About Dementia

Memory loss alone doesn’t always indicate dementia, as normal aging can also involve memory changes. However, dementia interferes with a person’s ability to function in daily life, which goes beyond occasional forgetfulness.

Dementia Outlook

Dementia is a progressive condition, and while treatments may help manage symptoms, there is currently no cure. Early diagnosis and intervention can improve quality of life for both patients and caregivers.

Reversible Causes of Dementia-like Symptoms

Some conditions can lead to symptoms similar to dementia, but with treatment, these symptoms can be reversed. These include:

• Normal Pressure Hydrocephalus (NPH): This condition occurs when cerebrospinal fluid (CSF) accumulates in the brain’s ventricles, causing pressure that can damage the brain. NPH can result from brain infections, injuries, surgery, or bleeding. Symptoms include poor balance, forgetfulness, mood swings, and bladder control issues. Treatment involves draining the excess fluid with a surgically placed shunt (tube).

• Vitamin Deficiency: Lacking vitamins B1, B6, B12, copper, or vitamin E in your diet can mimic dementia symptoms.

• Infections: HIV, syphilis, Lyme disease, and even COVID-19 can lead to cognitive issues. COVID-19, in particular, has been associated with "brain fog" and acute delirium, with short- and long-term effects still under investigation. Urinary tract infections (UTIs) or lung infections in elderly people can also trigger dementia-like symptoms.

• Metabolic and Endocrine Disorders: Conditions like Addison's disease, Cushing’s disease, hypoglycemia, high calcium levels, heavy metal exposure, liver cirrhosis, and thyroid issues can all cause dementia-like effects.

• Medication Side Effects: Certain medications, such as sleeping pills, anti-anxiety meds, antidepressants, anti-seizure drugs, and narcotic pain relievers, can produce dementia-like symptoms. Speak with your doctor if you’re experiencing such side effects.

• Other Causes: Brain tumors and subdural hematomas (bleeding on the brain) can also result in cognitive symptoms similar to dementia.

Symptoms of Dementia

Dementia symptoms vary by person but commonly include:

• Forgetting recent events or information.
• Repeating questions or comments frequently.
• Misplacing items in unusual locations.
• Confusion about the time, season, or year.
• Difficulty finding the right words.
• Changes in mood, behavior, or interests.

As dementia progresses, symptoms may worsen, including:

• Increased memory problems and decision-making difficulties.
• Trouble with everyday tasks like brushing teeth or using a TV remote.
• Greater confusion and irritability.
• Sleep disturbances and heightened anxiety, frustration, or sadness.
• Needing assistance with daily activities such as eating, bathing, or dressing.
• Experiencing hallucinations.

Each person’s dementia symptoms are unique and can depend on the specific area of the brain that is affected.

Causes of Dementia

Dementia is caused by brain damage that disrupts communication between brain cells. It can also result from reduced blood flow to the brain, depriving it of oxygen and nutrients, which leads to tissue death.

Some dementias are irreversible and worsen over time, while others are linked to treatable conditions that can reverse symptoms. More information about the various types of dementia is available in the article discussing different forms of dementia.

Diagnosing Dementia

Diagnosing dementia can be complex due to the wide variety of conditions that cause similar symptoms. To make a diagnosis, your healthcare provider will:

• Review your symptom history and course.
• Assess your medical history and medications.
• Discuss any family history of dementia.

Your doctor may also order lab tests to rule out other conditions (e.g., infections, inflammation, vitamin deficiencies), as well as imaging tests like CT or MRI scans to check for stroke, bleeding, or fluid accumulation. In some cases, a special brain scan called an FDG-PET may be necessary to assess brain function.

Neurocognitive testing, which evaluates memory, problem-solving, language, and other mental abilities, may also be conducted, along with a psychiatric evaluation to check for mental health conditions like depression that could contribute to memory loss.

Management and Treatment

Is dementia treatable?

It's important to understand the difference between "treatable," "reversible," and "curable." Most types of dementia are treatable in that medication and other therapies can help manage symptoms. However, dementia is generally not curable or reversible, and treatments often only provide modest improvements.

That said, some types of dementia caused by treatable factors can be reversed. These dementia-like symptoms may be due to:

• Medication side effects or substance abuse (alcohol or illicit drugs)
• Removable tumors
• Subdural hematoma (a blood buildup from head trauma)
• Normal pressure hydrocephalus (fluid buildup in the brain)
• Metabolic disorders like vitamin B12 deficiency
• Hypothyroidism (low thyroid hormone levels)
• Low blood sugar
• Depression

For dementia types that can't be reversed, medications can still help with memory loss or behavior issues. These include:

• Alzheimer's disease
• Vascular dementia (multi-infarct dementia)
• Dementias associated with Parkinson's disease
• AIDS dementia complex
• Creutzfeldt-Jakob disease

What medications help manage dementia?

Medications approved for Alzheimer's disease, which is the most common form of dementia, include:

• Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
• Memantine (an NMDA receptor antagonist)
• Aducanumab (targets amyloid proteins)

Cholinesterase inhibitors help regulate brain chemicals that support communication between brain cells. Memantine works similarly but targets a different chemical. Both types of drugs may help improve or stabilize memory in some people.

Aducanumab focuses on amyloid proteins that form plaques in the brains of Alzheimer’s patients. Although these medications can’t stop the disease's progression, they might slow it down.

If dementia coexists with other conditions, healthcare providers may prescribe medications for those specific issues, such as sleep problems, depression, hallucinations, or agitation.

Prevention

Can dementia be prevented?

Dementia itself can't be fully prevented, but leading a healthy lifestyle may lower the risk of certain types. Keeping your blood vessels clear, maintaining healthy blood pressure, and controlling blood sugar can help your brain function at its best.

Steps you can take include:

• Stop smoking
• Follow a Mediterranean diet (rich in whole grains, vegetables, fruits, fish, and olive oil)
• Exercise regularly (at least 30 minutes most days)
• Keep your brain engaged with puzzles, word games, or similar activities
• Stay socially active and engage in conversations and events

What are the risk factors for dementia?

Key risk factors include:

• Age: The risk increases as you get older, particularly over 65.
• Family history: Having close relatives with dementia raises your risk.
• Down syndrome: This condition increases the risk of early-onset Alzheimer's.
• Heart health: High cholesterol, high blood pressure, smoking, and diabetes can damage blood vessels, increasing the risk of strokes and dementia.
• Race and ethnicity: Black and Hispanic individuals have a higher risk compared to white individuals.
• Brain injury: A history of severe brain injury also raises the risk.

Outlook/Prognosis

Is there a cure for dementia?

Unfortunately, there’s no cure for most forms of dementia. Current treatments can only slow the decline in some cases.

What complications can arise from dementia?

As the brain's functions decline, the entire body can be affected. Potential complications include:

• Dehydration and malnutrition
• Bedsores
• Falls leading to fractures
• Strokes and heart attacks
• Kidney failure
• Pneumonia
• Sepsis (infection)

What can I expect if I have dementia?

Receiving a dementia diagnosis can be tough. Some forms of dementia are irreversible, while others may result from treatable conditions. Your healthcare team will run tests to ensure the correct diagnosis and prescribe medications aimed at maintaining your quality of life. While Alzheimer’s patients can sometimes live up to 20 years post-diagnosis, the disease’s progression varies from person to person.

Living With

When should I see my doctor about dementia?

Make an appointment if you or those around you notice changes in your:

• Memory
• Mental functioning
• Ability to perform daily tasks
• Behavior or personality

What happens as dementia progresses?

As dementia worsens, the brain loses its ability to get the oxygen and nutrients it needs. The tissue starts to die, leading to memory loss, lapses in judgment, and eventually, impairment of vital functions like breathing, digestion, and heart rate. In late stages, people are unable to care for themselves, eat, communicate, or control basic functions. Many people in this stage develop infections or complications like pneumonia. At this point, many families opt for hospice care, which focuses on comfort rather than treatment.

What’s the life expectancy of someone with dementia?

Dementia covers a wide range of neurodegenerative diseases, and each has its own progression. On average, people with Alzheimer’s disease live about eight years after the onset of symptoms, though some have lived up to 20 years.

Common Questions

Are there stages of dementia?

Dementia doesn't have standardized stages, but Alzheimer’s disease, the most common form, is categorized into three stages:

• Early (mild): People can still function independently but may have trouble remembering names or losing items.
• Middle (moderate): Symptoms become more apparent, such as confusion, memory loss, mood changes, and difficulty managing daily tasks.
• Late (severe): People can no longer communicate or care for themselves and need 24-hour care.