What is dementia?

Dementia is a general term for symptoms affecting memory, communication, and thinking. Although the likelihood of having dementia increases with age, it is not a normal part of aging.

Types and causes of dementia include:

Alzheimer’s disease

vascular dementia

Lewy body dementia, which may occur with Parkinson’s disease

frontotemporal dementia

mixed dementia

Experts may refer to these as Alzheimer’s disease and Alzheimer’s disease-related dementias.

Who gets dementia?

Dementia is a late-life disease because it tends to develop mostly in people who are older.

About 5% to 8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. It's estimated that as many as half of people 85 years of age and older have dementia.

This number of people 65 years old and older by race, the Alzheimer's disease and related dementias:

Blacks 14%

Hispanics 12%

Non-Hispanic whites 10%

American Indian and Alaska Natives 9%

Asian and Pacific Islanders 8%

What are dementia symptoms?

Depending on the kind of dementia an individual has, symptoms of the condition will be different. Still, some general symptoms of the condition include;

Memory loss.

Repetition of the same question.

Failure to find or comprehend words.

Inability to focus in a strange place.

Complications with finance and numbers

anxiety and withdrawal

difficulty planning and executing activities

mood changes

personality and behavioral changes

sleep disturbances

changes in social awareness, for example, inappropriate jokes

obsessive tendencies

The symptoms worsen over time. Some of the symptoms may be noticed by the individual, but some are noticed by family members or caregivers.

What causes dementia?

Dementia is caused by damage to your brain. Dementia affects your brain's nerve cells, which destroys your brain's ability to communicate with its various areas. Dementia can also result from blocked blood flow to your brain, depriving it of needed oxygen and nutrients. Without oxygen and nutrients, brain tissue dies.

Damage to your brain results in different symptoms, depending on the area of your brain affected. Some dementias aren’t reversible and will worsen over time. Other dementias are due to other medical conditions that also affect your brain. Another group of health issues can result in dementia-like symptoms. Many of these conditions are treatable, and the dementia symptoms are reversible.

All of the possible causes of dementia are discussed in the question, "Are there different types of dementia?"

How is dementia diagnosed?

To diagnose the cause of dementia, a health care professional must recognize the pattern of loss of skills and function. The care professional also determines what the person is still able to do. More recently, biomarkers have become available to make a more accurate diagnosis of Alzheimer's disease.

A medical care provider consults with you regarding your personal history and complaints and performs a physical examination. Someone close to you may be questioned about the symptoms you experience.

No specific test can accurately diagnose dementia. You are probably going to need several tests to narrow down what's going wrong.

Cognitive and neuropsychological tests

These tests assess your ability to think. There are various tests that check for thinking ability, including memory, orientation, reasoning and judgment, language abilities, and attention.

Neurological assessment

Your memory, language skills, visual perception, attention, problem-solving ability, movement, senses, balance, reflexes, and other skills are assessed.

Brain imaging tests

CT or MRI. This imaging can confirm whether there is any sign of stroke, hemorrhage, tumor, or accumulation of fluid inside the skull. Such a condition is called hydrocephalus.

PET scans. PET scans can outline patterns of activity in the brain. They may be able to determine whether the amyloid or tau protein characteristic of Alzheimer's disease has deposited in the brain.

Laboratory tests

Simple blood tests can detect physical problems that can affect brain function, such as too little vitamin B-12 in the body or an underactive thyroid gland. Sometimes the spinal fluid is examined for infection, for inflammation or for markers of some degenerative diseases.

Psychiatric evaluation

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

Is dementia treatable?

First, let's understand the terms "treatable," "reversible" and "curable." All or almost all forms of dementia are treatable, in that medication and other measures can help manage your symptoms. However, most types of dementia can't be cured or reversed, and treatments provide only modest benefits.

Fortunately, some types of dementia, like those brought on by treatable causes, may be successfully reversed. These dementia-like symptoms are caused by:

Medication or street drug/ alcohol side effect.

Tumors that may be resected.

Subdural hematoma (collections of blood from a head trauma beneath the cerebral dura, the outer-most meningeal layer covering the brain).

Hydrocephalus due to non-obstructed normal pressure.

Metabolic syndromes due to vitamin deficiency, such as B12, deficiency.

A hypothyroidism condition related to low activity of thyroid hormone.

Hypoglycaemia, hypoglycaemic state that results from deficient glucose in your blood.

Dysphoria or depression.

Dementias that are not reversible may still partially respond to drugs that treat memory loss or behavior problems. These dementias include:

Alzheimer's disease.

Multi-infarct (vascular) dementia.

Dementias associated with Parkinson's disease and similar disorders.

AIDS dementia complex.

Creutzfeldt-Jakob disease.

What drugs are available to treat dementia?

Drugs approved for the most common form of dementia, Alzheimer's disease, include:

Cholinesterase inhibitors, including donepezil (Aricept®), rivastigmine (Exelon®) and galantamine (Razadyne®).

NMDA receptor antagonist memantine (Namenda®).

Anti-amyloid antibody aducanumab (Aduhelm®).

These drugs are used by healthcare providers to treat people with some of the other forms of dementia.

Cholinesterase inhibitors and the NMDA receptor antagonist work on different chemical pathways in your brain. Both drug classes have been demonstrated to be of some benefit in improving or stabilizing memory function in some people with dementia.

Cholinesterase inhibitors adjust the chemicals within your brain so that messages sent between brain cells can occur - necessary for appropriate brain function. (Connections are lost as the brain cells die when dementia gets worse.) Memantine works similar to cholinesterase inhibitors except it has an effect on a different chemical messenger and protects the nerve cells longer.

This drug blocks amyloid proteins, which build up into the plaques seen in the brains of people with Alzheimer's disease.

Some drugs do not appear to do anything to the underlying disease progression. However, they probably slow it down.

When other medical conditions are causing dementia or co-exist with dementia, healthcare providers prescribe the appropriate drugs used to treat those specific conditions. Other conditions include sleeping problems, depression, hallucinations, and agitation.

Can dementia be prevented?

Dementia cannot be prevented, but a healthy lifestyle may reduce the risk factors for some types of dementia.

Keeping your blood vessels free of cholesterol buildup, maintaining normal blood pressure, keeping your blood sugar levels healthy, and maintaining a healthy weight — basically, staying as healthy as you can — can keep your brain fueled with the oxygen and nutrients it needs to function at its highest possible level. Specific healthful steps you can take include:

Quit smoking.

Stick to a Mediterranean diet: it is a diet that is rich in whole grains, vegetables, fruits, fish and shellfish, nuts, beans, olive oil, and just minimal red meat.

Exercising. Most days of the week should benefit from at least 30 minutes.

Keep your brain active. Engage yourself in solving jigsaw puzzles, word games, and similar activities. These activities have been shown to delay the onset of dementia.

You should stay socially active as you spend time with people, discuss what is happening around you, and keep your mind, heart, and soul intellectually engaged.

Risk factors of dementia

Risk factors of dementia include:

Age: This is the strongest risk factor because your likelihood of developing dementia increases as you grow old. Most cases affect individuals who are over 65 years of age.

Family history: If you have biological parents or siblings suffering from dementia, you risk developing dementia as well.

Down syndrome: If you have Down syndrome, you're at risk of developing early-onset Alzheimer's disease by middle age.

Poor heart health: If you have high cholesterol levels, high blood pressure, atherosclerosis or smoke, you increase your risk of dementia. These health problems, as well as diabetes, affect your blood vessels. Damaged blood vessels can lead to reduced blood flow and strokes.

Race and ethnicity: If you're a Black person, you have twice the risk as a white person for developing dementia. If you're a Hispanic person, you're 1.5 times more likely than a white person to develop dementia.

Brain injury: If you've had a severe brain injury, you're at a higher risk for dementia.

Is there a cure for dementia?

Sadly, there is no cure for most forms of dementia. Currently approved drugs can slow the decline as best.

What are the potential complications of dementia?

Your brain controls all body functions. So when your brain functions decline your overall health can be at stake. Many illness and conditions may occur due to having dementia.

Potential complications for dementia include

Dehydration and malnutrition

Bedsores (pressure ulcers).

Injuries and bone fractures from falls.

Strokes.

Heart attacks.

Kidney failure.

Pneumonia and aspiration pneumonia (food particles are inhaled into your lung and cause infection).

Sepsis (infection).

What can I expect if I have dementia?

Getting a diagnosis of dementia is certainly difficult to hear. Several types of dementia aren't reversible. Others are a side effect of other serious diseases. Some dementia-like symptoms are due to conditions that can be treated and reversed.

Your health care team will likely include a neurologist and/or a geriatric-psychiatrist or a geriatrician who will order the necessary tests to make the correct diagnosis. Medications available today focus on slowing the decline.

The goal is to maintain your or your loved one's quality of life. Some people with Alzheimer's dementia can live up to two decades, but each person has their own unique course. Researchers continue learning about the mechanisms that cause dementia and testing different methods to slow, and someday, hopefully, cure this disease.

When should I see my doctor about dementia?

Consult your doctor if you or your family and friends notice changes in the following areas:

Your memory

Your mental functions

Your capacity to carry out daily activities

Your behavior

Your personality.

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