Dementia
What
is it?
Dementia is the gradual deterioration of mental
functioning, such as concentration, memory, and
judgment, which affects a person’s ability to
perform normal daily activities.
Who
gets it?
Dementia occurs primarily in people who are over
the age of 65, or in those with an injury or
disease that affects brain function. While
dementia is most commonly seen in the elderly, it
is not a normal consequence of the aging process.
What
causes it?
Dementia is caused by the death of brain cells.
Brain cells can be destroyed by brain diseases,
such as Alzheimer’s disease, or strokes (called
vascular or multi-infarct dementia), which
decrease blood flow to the brain. Lewy body
dementia is another common cause attributed to
changes in brain tissue. Other causes can include
AIDS, high fever, dehydration, hydrocephalus,
systemic lupus erythematosus, Lyme disease,
long-term drug or alcohol abuse, vitamin
deficiencies/poor nutrition, hypothyroidism or
hypercalcemia, multiple sclerosis, brain tumor, or
diseases such as Pick’s, Parkinson's,
Creutzfeldt-Jakob, or Huntington's. Dementia can
also result from a head injury that causes
hemorrhaging in the brain or a reaction to a
medication.
What
are the symptoms?
In most
cases, the symptoms of dementia occur gradually,
over a period of years. Symptoms of dementia
caused by injury or stroke occur more abruptly.
Difficulties often begin with memory, progressing
from simple forgetfulness to the inability to
remember directions, recent events, and familiar
faces and names. Other symptoms include difficulty
with spoken communication, personality changes,
problems with abstract thinking, poor personal
hygiene, trouble sleeping, and poor judgment and
decision making. Dementia is extremely frustrating
for the patient, especially in the early stages
when he or she is aware of the deficiencies it
causes. People with dementia are likely to lash
out at those around them, either out of
frustration or because their difficulty with
understanding makes them misinterpret the actions
of others. They become extremely confused and
anxious when in unfamiliar surroundings or with
any change in routine. They may begin a task, such
as cooking, then wander away aimlessly and
completely forget what they had been doing.
Dementia is often accompanied by depression and
delirium, which is characterized by an inability
to pay attention, fluctuating consciousness,
hallucinations, paranoia, and delusions. People in
advanced stages of dementia lose all control of
bodily functions and are completely dependent upon
others.
How is
it diagnosed?
Dementia is diagnosed through a study of the
patient’s medical history and a complete physical
and neurological exam. The doctor will speak with
those close to the patient to document a pattern
of behavior. He or she will also evaluate the
patient’s mental functioning with tests of mental
status, such as those that require the patient to
recall words, lists of objects, names of objects,
and recent events. Diagnostic tests, such as blood
tests, x-rays, or magnetic resonance imaging (MRI),
positron emission tomography (PET), or computed
tomography (CT) scans, can help determine the
cause of the dementia.
What
is the treatment?
In some
instances, treating the cause of dementia may
successfully reverse some or all of the symptoms.
This is the case when the cause is related to a
vitamin/nutritional deficiency, tumor, alcohol or
drug abuse, reaction to a medication, or hormonal
disorder. When dementia is related to an
irreversible destruction of brain tissue, such as
with Alzheimer’s disease, Lewy body dementia, or
multiple strokes, treatment involves improving the
patient’s quality of life as much as possible.
This includes maintaining a stable, safe,
supportive environment and providing constant
supervision. While this may be done in the home,
people in the advanced stages of dementia may
require round-the-clock care in a long-term
healthcare facility. It is important to provide
the patient with structured activities and avoid
disruptions to his or her daily routine. Many
patients enjoy therapeutic activities, such as
crafts or games, designed specifically for people
with dementia. Some medications, such as donepezil
and tacrine, have been effective in improving the
mental functions of those in the beginning stages
of dementia. Patients with hallucinations and
delusions may also be treated with antipsychotic
drugs, while antidepressant medications are used
to treat depression.
Self-care tips
There
is currently no known way to prevent dementia
associated with Alzheimer's disease. You can
decrease your risk of dementia associated with
stroke by maintaining a healthy lifestyle,
following a heart-healthy diet, and controlling
high blood pressure and high cholesterol. Healthy
lifestyles, including not smoking and not abusing
drugs and alcohol, go a long way in keeping most
people in good health. Caring for a person with
dementia is stressful. It is important to learn
all you can about the disease, seek the help of
support groups, and find a responsible caregiver
who can give you a break when needed. There are
daycare programs specifically designed for
patients with dementia that are good for the
patient and the family.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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