CEN Dementia

CEN Dementia Overview

Dementia describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life. It isn’t a specific disease, but several different diseases may cause dementia.

Though dementia generally involves memory loss, memory loss has different causes. Having 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 may be reversible.

Signs and Symptoms

Cognitive changes

• Memory loss, which is usually noticed by a spouse or someone else
• Difficulty communicating or finding words
• Difficulty with visual and spatial abilities, such as getting lost while driving
• Difficulty reasoning or problem-solving
• Difficulty handling complex tasks
• Difficulty with planning and organizing
• Difficulty with coordination and motor functions
• Confusion and disorientation

Psychological changes

• Personality changes
• Depression
• Anxiety
• Inappropriate behavior
• Paranoia
• Agitation
• Hallucinations

Causes

Dementia is caused by damage to or loss of nerve cells and their connections in the brain. Depending on the area of the brain that’s affected by the damage, dementia can affect people differently and cause different symptoms.

Dementias are often grouped by what they have in common, such as the protein or proteins deposited in the brain or the part of the brain that’s affected. Some diseases look like dementias, such as those caused by a reaction to medications or vitamin deficiencies, and they might improve with treatment.

Risk Factors

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. There are tests to determine whether you have certain genetic mutations.
• Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer’s disease.

Risk factors you can change

You might be able to control the following risk factors for dementia.

• Diet and exercise. Research shows that lack of exercise increases the risk of dementia. And while no specific diet is known to reduce dementia risk, research indicates a greater incidence of dementia in people who eat an unhealthy diet compared with those who follow a Mediterranean-style diet rich in produce, whole grains, nuts and seeds.
• Heavy alcohol use. If you drink large amounts of alcohol, you might have a higher risk of dementia. While some studies have shown that moderate amounts of alcohol might have a protective effect, results are inconsistent. The relationship between moderate amounts of alcohol and dementia risk isn’t well-understood.
• 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. Having diabetes may increase your 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.
• Vitamin and nutritional deficiencies. Low levels of vitamin D, vitamin B-6, vitamin B-12 and folate may increase your risk of dementia.

Complications

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

• Poor nutrition. Many people with dementia eventually reduce or stop eating, affecting their nutrient intake. 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.

Treatment

Most types of dementia can’t be cured, but there are ways to manage your symptoms.

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. Other possible side effects include slowed heart rate, fainting and sleep disturbances.
• 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, hallucinations, parkinsonism 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.
• Simplifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine also help reduce confusion in people with dementia.