Dementia isn't a specific disease. Instead, 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 has different causes. So memory loss alone doesn't mean you have 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.
Dementia symptoms vary depending on the cause, but common signs and symptoms include:
- 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
- Personality changes
- Inappropriate behavior
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.
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.
Dementias are often grouped by what they have in common, such as the part of the brain that's affected or whether they worsen over time (progressive dementias). Some dementias, such as those caused by a reaction to medications or vitamin deficiencies, might improve with treatment.
Types of dementias that progress and aren't reversible include:
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 isn't 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.
Certain genetic factors might make it more likely that people will develop Alzheimer's.
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.
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.
Frontotemporal 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.
As with other dementias, the cause isn't known.
Mixed dementia. Autopsy studies of the brains of people 80 and older who had dementia indicate that many had a combination of Alzheimer's disease, vascular dementia and Lewy body dementia. Studies are ongoing to determine how having mixed dementia affects symptoms and treatments.
Other disorders linked to dementia
Huntington's disease. Caused by a genetic mutation, this disease causes certain nerve cells in your brain and spinal cord to waste away. Signs and symptoms, including a severe decline in thinking (cognitive) skills usually appear around age 30 or 40.
Traumatic brain injury. This condition is caused by repetitive head trauma, such as experienced by boxers, football players, or soldiers.
Depending on the part of the brain that's injured, this condition can cause dementia signs and symptoms, such as depression, explosiveness, memory loss, uncoordinated movement, and impaired speech, as well as slow movement, tremors and rigidity (parkinsonism). Symptoms might not appear until years after the trauma.
Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without known risk factors. This condition might be due to an abnormal form of a protein. Creutzfeldt-Jakob disease can be inherited or caused by exposure to diseased brain or nervous system tissue.
Signs and symptoms of this fatal condition usually appear around age 60.
Parkinson's disease. Many people with Parkinson's disease eventually develop dementia symptoms (Parkinson's disease dementia).
Dementia-like conditions that can be reversed
Some causes of dementia or dementia-like symptoms can be reversed with treatment. They include:
- 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.
- 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.
- 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.
- Reactions to medications. A reaction to a medication or an interaction of several medications can cause dementia-like symptoms.
- Subdural hematomas. Bleeding between the surface of the brain and the covering over the brain, which is common in the elderly after a fall, can cause symptoms similar to dementia.
- Poisoning. Exposure to heavy metals, such as lead, and other poisons, such as pesticides, as well as alcohol abuse or recreational drug use can lead to symptoms of dementia. Symptoms might resolve with treatment.
- Brain tumors. Rarely, dementia can result from damage caused by a brain tumor.
- Anoxia. 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.
- Normal-pressure hydrocephalus. This condition, which is caused by enlarged ventricles in the brain, can cause walking problems, urinary difficulty, and memory loss.
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
- Age. 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.
- Family history. Having a family history of dementia puts you 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 you 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. 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.
- Cardiovascular risk factors. These include high blood pressure (hypertension), high cholesterol, buildup of fats in your artery walls (atherosclerosis), and obesity.
- Depression. Although not yet well-understood, late-life depression might indicate the development of dementia.
- Diabetes. If you have diabetes, you might have an increased risk of dementia, especially if it's poorly controlled.
- Smoking. Smoking might increase your 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.
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.
Diagnosing dementia and determining what type it is can be challenging. A diagnosis of dementia requires that at least two core mental functions be impaired enough to interfere with daily living. They are memory, language skills, ability to focus and pay attention, ability to reason and problem-solve, and visual perception.
Your doctor will review your medical history and symptoms and conduct a physical examination. He or she will likely ask someone close to you about your symptoms, as well.
No single test can diagnose dementia, so doctors are likely to run a number of tests that can help pinpoint the problem.
Cognitive and neuropsychological tests
Doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention.
Doctors evaluate your memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes, and other areas.
- 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.
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.
A mental health professional can determine whether depression or another mental health condition is contributing to your symptoms.
Most types of dementia can't be cured, but there are ways to manage your symptoms.
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. Your doctor might prescribe medications to treat other symptoms or conditions, such as depression, sleep disturbances or agitation.
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.
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:
Vitamin E. Evidence for taking vitamin E to slow Alzheimer disease is soft. Doctors warn against taking large doses of vitamin E because it may have a higher risk of mortality, especially in people with heart disease.
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. More research is needed.
Ginkgo. Although ginkgo is considered safe, study results have been inconsistent in determining whether ginkgo helps people with dementia.
The following techniques may help reduce agitation and promote relaxation in people with dementia.
- Music therapy, which involves listening to soothing music
- Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia
- Aromatherapy, which uses fragrant plant oils
- Massage therapy
- Art therapy, which involves creating art, focusing on the process rather than the outcome
Preparing for an appointment
Most likely, you'll first see your primary care provider if you have concerns about dementia. Or you might be referred to a doctor trained in nervous system conditions (neurologist).
Here's some information to help you get ready for your appointment.
What you can do
When you make the appointment, ask if there's anything that needs to be done in advance, such as fasting before certain tests. Make a list of:
- Symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment
- Key personal information, including any major stresses or recent life changes and family medical history
- All medications, vitamins, or supplements being taken, including the doses
- Questions to askthe doctor
Even in the early stages of dementia, it's good to take a family member, friend or caregiver along to help you remember the information you're given.
For dementia, basic questions to ask the doctor include:
- What is likely causing my symptoms?
- Are there other possible causes for my symptoms?
- What tests are necessary?
- Is the condition likely temporary or chronic?
- What's the best course of action?
- What alternatives are there to the primary approach being suggested?
- How can dementia and other health issues be managed together?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
The doctor is likely to ask questions, such as:
- When did your symptoms begin?
- Have symptoms been continuous or occasional?
- How severe are symptoms?
- What, if anything, seems to improve symptoms?
- What, if anything, appears to worsen symptoms?
- How have the symptoms interfered with your life?
Lifestyle and home remedies
Dementia symptoms and behavior problems will progress over time. Caregivers might try the following suggestions:
Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present one idea or instruction at a time. Use gestures and cues, such as pointing to objects.
Encourage exercise. Exercise benefits everyone, including people with dementia. The main benefits of exercise include improved strength and cardiovascular health. There is growing evidence that exercise also protects the brain from dementia, especially when combined with a healthy diet and treatment for risk factors for cardiovascular disease.
Some research also shows physical activity might slow the progression of impaired thinking in people with Alzheimer's disease. And it can lessen symptoms of depression.
Encourage activity. Plan activities the person with dementia enjoys and can do. Dancing, painting, gardening, cooking, singing, and others can be fun, can help you connect with your loved one, and can help your loved one focus on what he or she can still do.
Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup, and active family members. Leave nightlights on in the bedroom, hall, and bathroom to prevent disorientation.
Limiting caffeine, discouraging napping and offering opportunities for exercise during the day might ease nighttime restlessness.
Encourage keeping a calendar. A calendar might help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one.
Plan for the future. Develop a plan with your loved one while he or she is able to participate that identifies goals for future care. Support groups, legal advisers, family members and others might be able to help.
You'll need to consider financial and legal issues, safety and daily living concerns, and long-term care options.
Coping and support
Receiving a diagnosis of dementia can be devastating. Many details need to be considered to ensure that you and those around you are as prepared as possible for dealing with a condition that's unpredictable and progressive.
Care and support for the person with the disease
Here are some suggestions you can try to help yourself cope with the disease:
- Learn as much as you can about memory loss, dementia, and Alzheimer's disease.
- Write about your feelings in a journal.
- Join a local support group.
- Get individual or family counseling.
- Talk to a member of your spiritual community or another person who can help you with your spiritual needs.
- Stay active and involved, volunteer, exercise, and participate in activities for people with memory loss.
- Spend time with friends and family.
- Participate in an online community of people who are having similar experiences.
- Find new ways to express yourself, such as through painting, singing, or writing.
- Delegate help with decision-making to someone you trust.
Helping someone with dementia
You can help a person cope with the disease by listening, reassuring the person that he or she still can enjoy life, being supportive and positive, and doing your best to help the person retain dignity and self-respect.
Providing care for someone with dementia is physically and emotionally demanding. Feelings of anger and guilt, frustration and discouragement, worry, grief, and social isolation are common. If you're a caregiver for someone with dementia:
- Learn as much about the disease as you can and participate in caregiver education programs
- Find out about supportive services in your community, such as respite care or adult care, which can give you a break from caregiving at scheduled times during the week
- Ask friends or other family members for help
- Take care of your physical, emotional and spiritual health
- Ask questions of doctors, social workers and others involved in the care of your loved one
- Join a support group
There's no sure way to prevent dementia, but there are steps you can take that might help. More research is needed, but it might be beneficial to do the following:
Keep your mind active. Mentally stimulating activities, such as reading, solving puzzles and playing word games, and memory training might delay the onset of dementia and decrease its effects.
Be physically and socially active. Physical activity and social interaction might delay the onset of dementia and reduce its symptoms. Move more and aim for 150 minutes of exercise a week.
Quit smoking. Some studies have shown smoking in middle age and beyond may increase your risk of dementia and blood vessel (vascular) conditions. Quitting smoking might reduce your risk and will improve your health.
Get enough vitamin D. Research suggests that people with low levels of vitamin D in their blood are more likely to develop Alzheimer's disease and other forms of dementia. You can get vitamin D through certain foods, supplements and sun exposure.
More study is needed before an increase in vitamin D intake is recommended for preventing dementia, but it's a good idea to make sure you get adequate vitamin D.
Lower your blood pressure. High blood pressure might lead to a higher risk of some types of dementia. More research is needed to determine whether treating high blood pressure may reduce the risk of dementia.
Maintain a healthy diet. Eating a healthy diet is important for many reasons, but a diet such as the Mediterranean diet—rich in fruits, vegetables, whole grains, and omega-3 fatty acids, commonly found in certain fish and nuts—might promote health and lower your risk of developing dementia.
Publication Date: 2009-04-17