DEMENTIA

DEFINITION :

Dementia is a loss of mental ability severe enough to interfere with normal activities of daily
living, not present since birth, and not associated with a loss or alteration of consciousness.

A chronic or persistent disorder of the mental processes caused by brain disease or injury and
marked by memory disorders, personality changes, and impaired reasoning.

TYPES OF DEMENTIAS :

ALZHEIMER'S DISEASE :

In people age 65 and older, Alzheimer's disease is the most common cause of dementia.

Although the cause of Alzheimer's disease is not known, plaques and tangles are often found
in the brains of people with Alzheimer's. Plaques are clumps of a protein called beta-amyloid,
and tangles are fibrous tangles made up of tau protein.

VASCULAR DEMENTIA :

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

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.
 FRONTO-TEMPORAL DEMENTIA :

This is a group of diseases characterized by the breakdown (degeneration) of nerve cells in

the frontal and temporal lobes of the brain, the areas generally associated with personality,
behavior and language.

RISK FACTORS :

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

RISK FACTORS THAT CAN'T BE CHANGED :

AGE :

The risk rises as age, especially after age 65. However, dementia is not a normal part of
aging, and dementia can occur in younger people.

FAMILY HISTORY :

Having a family history of dementia puts at greater risk of developing the condition.
However, many people with a family history never develop symptoms, and many people
without a family history do. Tests to determine whether to have certain genetic mutations
are available.

DOWN SYNDROME :

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

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.

HEAVY ALCOHOL USE :

Peoples who drink large amounts of alcohol, might have a higher risk of dementia. Some
studies, however, have shown that moderate amounts of alcohol might have a protective
effect.

CARDIOVASCULAR RISK FACTORS :

These include high blood pressure (hypertension), high cholesterol, buildup of fats in artery
walls (atherosclerosis) and obesity.

DEPRESSION :

Although not yet well-understood, late-life depression might indicate the development of
dementia.

DIABETES :

If having diabetes, might have an increased risk of dementia, especially if it is poorly

controlled.

SMOKING :

Smoking might increase risk of developing dementia and blood vessel (vascular) diseases.

SLEEP APNEA :

People who snore and have episodes where they frequently stop breathing while asleep may
have reversible memory loss.
CAUSES :

Several conditions can cause dementia, including diseases of the brain. The most common
such causes are Alzheimers disease and vascular 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.

Dementia may also be caused by other conditions, including:

structural brain disorders, such as normal-pressure hydrocephalus and subdural hematoma

metabolic disorders, such as hypothyroidism, vitamin B-12 deficiency, and kidney and
liver disorders.

SYMPTOMS :

Recent memory loss - a sign of this might be asking the same question repeatedly.
Difficulty completing familiar tasks - for example, making a drink or cooking a meal.
Problems communicating - difficulty with language; forgetting simple words or using
the wrong ones.
Disorientation - getting lost on a previously familiar street.
Problems with abstract thinking - for instance, dealing with money.
Misplacing things - forgetting the location of everyday items such as keys, or wallets.
Mood changes - sudden and unexplained changes in outlook or disposition.
Personality changes - perhaps becoming irritable, suspicious or fearful.
Loss of initiative - showing less interest in starting something or going somewhere.

DIAGNOSTIC STUDY :

Dementia is diagnosed after a series of assessments, including a physical evaluation

and determination of the history of any problems. Memory tests, imaging studies, and
blood work may exclude other problems which might mimic dementia. The diagnosis
of dementia can take a long time.
COGNITIVE AND NEUROPSYCHOLOGICAL TESTS :

Doctors will evaluate thinking (cognitive) function. A number of tests measure thinking skills
such as memory, orientation, reasoning and judgment, language skills, and attention.

NEUROLOGICAL EVALUATION :

Doctors evaluate memory, language, visual perception, attention, problem-solving,

movement, senses, balance, reflexes and other areas.

BRAIN SCAN :

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

PET scans : These 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 physical 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 :

A mental health professional can determine whether depression or another mental health
condition is contributing to symptoms.

STAGES OF DIAGNOSING DEMENTIA :

The stages of dementia are used when a progressive dementia has been diagnosed. The stages
include:

Stage 1: No impairment. The patient has no problems.

 Stage 2: Questionable impairment. The patient begins to have some difficulty but can
still function independently.
Stage 3: Mild impairment. The patient has obvious, but still mild difficulty with daily
activities.
Stage 4: Moderate impairment. The patient needs help with caring for him or herself
as well as with carrying out daily activities.
Stage 5: Severe Impairment; patients are unable to function independently.

COMPLICATIONS :

Dementia can affect many body systems and, therefore, the ability to function. Dementia can
lead to:

INADEQUATE NUTRITION :

Many people with dementia eventually reduce or stop their intake of nutrients.
Ultimately, they may be unable to chew and swallow.

PNEUMONIA :

Difficulty swallowing increases the risk of choking or aspirating food into the lungs,
which can block breathing and cause pneumonia.

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.

PERSONAL SAFETY CHALLENGES :

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

DEATH :

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

MEDICATIONS :

The following are used to temporarily improve dementia symptoms.

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.

MEMANTINE :

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.

OTHER MEDICATIONS :

Doctor might prescribe medications to treat other symptoms or conditions, such as

depression, sleep disturbances or agitation.

THERAPIES :

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

MODIFYING THE ENVIRONMENT :

Reducing clutter and noise can make it easier for someone with dementia to focus and
function. You might need to hide objects that can threaten safety, such as knives and car
keys. Monitoring systems can alert you if the person with dementia wanders.

MODIFYING TASKS :

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

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