Alzheimer's disease is the
most common cause of dementia. This topic focuses on other conditions that
cause dementia. For more information on Alzheimer's, see the topic
Alzheimer's Disease.
What is dementia?
We all forget things as we get
older. Many older people have a slight loss of memory that does not affect
their daily lives. But memory loss that gets worse may mean that you have
dementia.
Dementia is a loss of mental skills that affects your
daily life. It can cause problems with your memory and how well you can think
and plan. Usually dementia gets worse over time. How long this takes is
different for each person. Some people stay the same for years. Others lose
skills quickly.
Your chances of having dementia rise as you get
older. But this doesn't mean that everyone will get it. By age 85, about 35 out of 100 people have some form of dementia. That means that 65 out of 100 don't have it. Dementia is rare before age 60.1
If you or a loved one has memory loss that is getting worse,
see your doctor. It may be nothing to worry about. If it is dementia, treatment
may help.
What causes dementia?
Dementia is caused by damage
to or changes in the brain. Things that can cause dementia include:
Strokes,
tumors, or head injuries. After
Alzheimer's disease, strokes are the most common cause
of dementia. This type of dementia is called
vascular dementia.
In a few cases, dementia is caused by a problem that can
be treated. Examples include having an underactive thyroid gland (hypothyroidism), not getting enough vitamin B12, and
fluid buildup in the brain (normal-pressure hydrocephalus). In
these cases, treating the problem may cure the dementia.
In some
people, depression can cause memory loss that seems like dementia. Depression
can be treated.
As you age, medicines may affect you more. Taking
some medicines together may cause symptoms that look like dementia. Be sure
your doctor knows about all of the medicines you take. This means all
prescription medicines and all
over-the-counter medicines, herbs, vitamins, and
supplements.
What are the symptoms?
Usually the first symptom
is memory loss. Often the person who has a memory problem doesn't notice it,
but family and friends do. As dementia gets worse:
You may have more trouble doing things that
take planning, like making a list and going shopping.
You may have
trouble using or understanding words.
You may get lost in places
you know well.
Over time, people with dementia may begin to act very
differently. They may become scared and strike out at others, or they may become
clingy and childlike. They may stop brushing their teeth or bathing.
Later, they cannot take care of themselves. They may not know where they
are. They may not know their loved ones when they see them.
How is dementia diagnosed?
There is no single test
for dementia. To diagnose it, your doctor will:
Do a physical exam.
Ask questions
about recent and past illnesses and life events. The doctor will want to talk
to a close family member to check details.
Ask you to do some
simple things that test your memory and other mental skills. Your doctor may
ask you to tell what day and year it is, repeat a series of words, or draw a
clock face.
The doctor may do tests to look for a cause that can be
treated. For example, you might have blood tests to check your thyroid or to
look for an infection. You might also have a test that shows a picture of your
brain, like an
MRI or a
CT scan. These tests can help your doctor find a tumor
or brain injury. They can also show if there has been shrinking in parts of the
brain. This can be a sign of dementia.
How is it treated?
There are medicines you can
take for dementia. They cannot cure it, but they can slow it down for a while
and make it easier to live with.
As dementia gets worse, a person
may get depressed or angry and upset. Treatment, such as medicines and
counseling, may help. So can getting out more and having an active social
life.
If a stroke caused the dementia, there are things you can
do to reduce the chance of another stroke. Stay at a healthy weight, exercise,
and keep your blood pressure and cholesterol at normal levels. If you have
diabetes, keep your blood sugar in your target range.
Keeping
both your mind and your body active is a good idea for anyone. So is not
smoking.
How can you help a loved one who has dementia?
There
are many things you can do to help your loved one be safe at home. For example,
get rid of throw rugs, and put handrails in bathrooms to help prevent falls.
Post reminder notes around the house. Put a list of important phone numbers by
the telephone. You also can help your loved one stay active. Play cards or
board games, and take walks.
Work with your loved one to make
decisions about the future before dementia gets worse. It is important to write
a
living will and a
durable power of attorney. A living will states the
types of medical care your loved one wants. A durable power of attorney lets
your loved one pick someone to be the
health care agent. This person makes care decisions
after your loved one cannot.
Watching a loved one slip away can
be sad and scary. Caring for someone with dementia can leave you feeling
drained. Be sure to take care of yourself and to give yourself breaks. Ask
family members to share the load, or get other help.
Your loved
one will need more and more care as dementia gets worse. In time, he or she may
need help to eat, get dressed, or use the bathroom. You may be able to give
this care at home, or you may want to think about using a nursing home. A
nursing home can give this kind of care 24 hours a day. The time may come when
a nursing home is the best choice.
You are not alone. Many
people have loved ones with dementia. Ask your doctor about local support
groups, or search the Internet for online support groups, such as the
Alzheimer's Association. Help is available.
Dementia is caused by damage to or changes in the
brain. After
Alzheimer's disease, stroke is the most common cause of
dementia. Dementia caused by stroke is called vascular dementia.
Some causes of dementia can be
reversed with treatment, but most cannot.
Causes that cannot
be reversed
Common causes of dementia that cannot
be reversed are:
Leukoencephalopathies, which are diseases that affect the
deeper, white-matter brain tissue.
Creutzfeldt-Jakob
disease, a rare and fatal condition that destroys brain
tissue.
Brain injuries from accidents or boxing.
Some
cases of
multiple sclerosis (MS) or
amyotrophic lateral sclerosis
(ALS).
Multiple-system atrophy (a group of degenerative brain
diseases affecting speech, movement, and
autonomic functions).
Infections such as late-stage
syphilis. Antibiotics can effectively treat syphilis
at any stage, but they cannot reverse the brain damage already done.
Causes that may be reversible
When dementia is caused by certain treatable problems, the treatment may also help the dementia. These treatable problems include:
Some disorders that cause dementia can run in families.
Doctors often suspect an inherited cause if someone younger than 50 has
symptoms of dementia. For more information, see the topic
Alzheimer's Disease.
Symptoms
Symptoms of
dementia vary depending on the cause and the
area of the brain that is affected. Symptoms include:
Memory loss. This is usually the earliest and most
noticeable symptom.
Trouble recalling recent
events or recognizing people and
places.
Trouble finding the right words.
Problems planning and carrying out tasks, such
as balancing a checkbook, following a recipe, or writing a
letter.
Trouble exercising judgment, such as knowing what to
do in an emergency.
Trouble controlling moods or
behaviors.
Depression is common, and agitation or aggression may
occur.
Not keeping up personal care such as grooming or
bathing.
Some types of dementia cause particular symptoms:
People who have
dementia with Lewy bodies often have highly detailed
visual hallucinations. And they may fall frequently.
The first symptoms
of
frontotemporal dementia may be personality changes or
unusual behavior. People with this condition may not express any caring for
others, or they may say rude things, expose themselves, or make sexually
explicit comments.
Symptoms of dementia that come on suddenly suggest
vascular dementia or possibly
delirium—short-term confusion caused by a new or
worsening illness.
It is important to
know that memory loss can be caused by conditions other than dementia, such as
depression, and that those conditions can be treated. Also, occasional trouble
with memory (such as briefly forgetting someone's name) can be a normal part of
aging. But if you are worried about memory loss or if a loved one has memory
loss that is getting worse, see your doctor.
What Happens
How quickly
dementia progresses depends on what is causing it and
the area of the brain that is affected. Some types of dementia progress slowly
over several years. Other types may progress more rapidly. If
vascular dementia is caused by a series of small
strokes, the loss of mental skills may be gradual. If
it is caused by a single stroke in a large blood vessel, loss of function may
occur suddenly.
The course of dementia varies greatly from one
person to another. Early diagnosis and treatment with medicines used for
Alzheimer's (cholinesterase inhibitors such as
donepezil [Aricept]) may help preserve mental functioning for a while in people
who have vascular dementia,
dementia with Lewy bodies, or
Parkinson's disease.2 Even
without these medicines, some people remain stable for months or years, while
others decline rapidly.
Many people with dementia are not aware
of their mental decline. They may deny their condition and blame others for their
problems. Those who are aware may mourn their loss of abilities
and become hopeless and depressed.
Depending on the type of
dementia, the person's behavior may eventually become out of control. The
person may become angry, agitated, and combative or clingy and childlike. He or
she may wander and become lost. These problems can make it difficult for family
members or others to continue providing care at home.
Even with the best care, people with dementia tend to
have a shorter life span than the average person their age. The progression
varies depending on the disease causing the dementia and whether the person has
other illnesses such as diabetes or heart disease. Death usually results from lung or kidney infections
caused by being bedridden.
For more information on
decisions you may face as your loved one's condition progresses, see the topic
Care at the End of Life.
What to think about
Many older people have a
slight loss of mental skills (usually recent memory) that doesn't affect their
daily functioning. This is called
mild cognitive impairment by some. People who have mild impairment may be in
the early stage of dementia, or they may stay at their present level of ability
for a long time.
What Increases Your Risk
Aging is the main risk factor
for all types of
dementia. Some diseases that cause dementia (such as
early-onset
Alzheimer's disease and some
frontotemporal dementias) may run in families.
Numbness, weakness, or inability to move the
face, arm, or leg, especially on one side of the body.
Vision
problems in one or both eyes, such as dimness, blurring, double vision, loss of
vision, or a sensation that a shade is being pulled down over your
eyes.
Confusion, or trouble speaking or understanding.
Trouble walking, dizziness, or loss of balance or coordination.
Severe headache with no known cause.
Call a doctor immediately if a
person suddenly becomes confused or emotionally upset or doesn't seem to know
who or where he or she is. These are signs of
delirium, which can be caused by a reaction to
medicines or a new or worsening medical condition.
Call a doctor
if you or a person you are close to has new and troubling memory loss that is
more than an occasional bout of forgetfulness. This may be an early sign of
dementia.
Watchful waiting
Occasional forgetfulness or memory loss can be a
normal part of aging. But any new or increasing memory loss or problems with
daily living should be reported to a doctor. Learn the
warning signs of dementia, and talk to a doctor if you
or a family member shows any of these signs. They include increased trouble
finding the right words when speaking, getting lost going to familiar places,
and acting more irritable or suspicious than usual.
Who to see
The following health professionals can evaluate
symptoms of memory loss or confusion:
Doctors diagnose the cause of
dementia by asking questions about the person's
medical history and doing a physical exam, a
mental status exam, and lab and imaging tests.
Tests can help the doctor learn whether dementia is caused by a treatable
condition. Even for those dementias that cannot be reversed, knowing the type
of dementia a person has can help the doctor prescribe medicines or other
treatments that may improve mood and behavior and help the family.
Medical history
During a
medical history and physical exam, the doctor will ask
the affected person and a close relative or partner about recent illnesses or
other life events that could cause memory loss or other symptoms such as
behavioral problems. The doctor may ask the person to bring in all medicines he
or she takes. This can help the doctor find out if the problem might be
caused by the person being overmedicated or having a drug interaction.
Although a person may have more than one illness causing dementia,
symptoms sometimes can distinguish one form from another. For example, early in
the course of
frontotemporal dementia, people may display a lack of
social awareness and develop obsessions with eating, neither of which occurs
early in other dementias.
Mental status exam
A doctor or other health
professional will conduct a
mental status exam. This test usually involves such
activities as having the person tell what day and year it is, repeat a series
of words, draw a clock face, and count back from 100 by 7s.
Other
tests have been developed to diagnose dementia. Doctors can use one such test,
Addenbrooke's Cognitive Examination, to distinguish
Alzheimer's disease from frontotemporal dementia.
Orientation, attention, and memory are worse in Alzheimer's, while language
skills and ability to name objects are worse in frontotemporal dementia.
Lab tests
Many medical conditions can cause
mental impairment. During a physical exam, the doctor will look for signs of
other medical conditions and have lab tests done to find any treatable
condition. Routine tests include:
Testing for heavy
metals in the blood, such as a
lead test.
A lumbar puncture to test for certain proteins in the spinal fluid. This test may also be done to rule out other causes of symptoms.
Imaging tests
Brain imaging tests such as
CT scans and
MRI may also be done to
make sure another problem isn't causing the symptoms. These tests may rule out
brain tumors,
strokes,
normal-pressure hydrocephalus, or other conditions
that could cause dementia symptoms.
MRI can show shrinkage in
parts of the brain that occurs in some types of dementia. MRI and CT scan also
can show evidence of strokes from
vascular dementia.
Two other forms of
imaging—single photon emission CT (SPECT) and
PET scan—are not used routinely to diagnose dementia.
But they may be useful if the symptoms are confusing or odd. These tests can
help identify several forms of dementia, including vascular dementia and
frontotemporal dementia.
In some cases, electrical activity in the brain may be
measured using an
electroencephalogram (EEG). Doctors seldom use this
test to diagnose dementia, but they may use it to distinguish dementia from
delirium and to look for unusual brain activity found
in Creutzfeldt-Jakob disease, a rare cause of dementia.
In rare
cases, a brain
biopsy may be done if a treatable cause of dementia is
suspected.
After death, an
autopsy may be done to find out for sure what caused
dementia. This information may be helpful to family members concerned about
genetic causes.
Treatment Overview
Some cases of
dementia are caused by medical conditions that can be
treated, and treatment can restore some or all mental function. But most of the time, dementia cannot be
reversed.
Treatment when dementia can be reversed
Sometimes treating the cause of dementia helps the dementia. For example, the person might:
Take vitamins for a deficiency of vitamin B12.
Take
thyroid hormones for
hypothyroidism.
Have surgery to remove a
brain tumor or to reduce pressure on the brain.
Stop or change
medicines that are causing memory loss or confusion.
Take medicines
to treat an infection, such as
encephalitis.
Take medicine to treat
depression.
Get treatment for reversible
conditions caused by
AIDS.
Treatment when dementia can't be reversed
If the cause of dementia cannot be
treated, the doctor will work with the person and caregivers to develop a plan
to make life easier and more comfortable. Care plans may include:
Tips to help
the person be independent and manage daily life as long as possible. For more
information, see Home Treatment.
Medicine. While
medicines cannot cure dementia, they may help improve mental function, mood, or
behavior.
Support and counseling. A diagnosis of dementia can
create feelings of anger, fear, and anxiety. A person in the early stage of the
illness should seek emotional support from family, friends, and perhaps a
counselor experienced in working with people who have dementia.
Planning for the future
If possible, make decisions while
your loved one is able to take part in the decision making. These are difficult
but important conversations. Questions include:
What kind of care does he or she need right
now?
Who will take care of him or her in the future?
What can the family expect as the disease progresses?
Education of the family and other caregivers is critical to successfully caring for someone who has dementia. If you are or will be a caregiver, start learning what
you can expect and what you can do to manage problems as they arise. For more
information, see Home Treatment.
Treatment as dementia gets worse
The goal of ongoing treatment
for
dementia is to keep the person safely at home for as
long as possible and to provide support and guidance to the caregivers.
Routine follow-up visits to a health professional (every 3 to 6 months) are necessary to monitor medicines and the person's level of functioning.
Eventually, the family may have to consider whether to place the
person in a care facility that has a dementia unit.
Taking
care of a person with dementia is stressful. If you are a caregiver,
seek support from family members or friends. Take care
of your own health by getting breaks from caregiving. Counseling, a support
group, and adult day care or respite care can help you through stressful times
and bouts of burnout.
Prevention
Dementia is
hard to prevent, because what causes it often is not known. But people who have dementia caused by stroke may be able to prevent future declines by lowering their risk of heart disease and stroke. Even if you don't have these known risks, your overall health can benefit from these strategies:
Treat or prevent high blood pressure.
Don't
smoke.
Stay at a healthy weight. This also reduces your risk of
diabetes, another risk factor for
dementia.
Keep your
cholesterol in the normal range.
Get plenty of exercise.
Stay mentally alert by learning new hobbies,
reading, or solving crossword puzzles.
Stay involved socially.
Attend community activities, church, or support groups.
If your doctor recommends it, take aspirin.
Home Treatment
Home treatment for
dementia involves teamwork among health professionals
and caregivers to create a safe and comfortable environment and to make tasks
of daily living as easy as possible. People who have mild dementia can be involved in planning for the future and organizing the home and daily tasks.
The team can also help you learn how to manage behavior problems. For example, you can learn ways to:
Make the most of remaining abilities. Reinforce and support the person's efforts to
remain independent, even if tasks take more time or aren't done
perfectly.
Caregivers should remember to
seek support from other family and friends. For more
information, see the topic
Caregiver Tips.
Nursing home placement
Even with the best care,
a person with progressive dementia will decline, perhaps to the point where the caregiver is no longer physically, emotionally, or financially able to provide
care.
Making the decision about
nursing home placement is often very difficult. Every family needs to consider
its own financial situation, emotional capacity, and other issues.
Doctors use medicines to treat
dementia in the following ways:
To correct a condition that's causing dementia, such as
thyroid replacement for
hypothyroidism, vitamins for lack of vitamin B12, or
antibiotics for infections
To maintain mental functioning for as
long as possible when dementia cannot be reversed
To prevent further strokes in people who have dementia caused by stroke (vascular dementia)
To manage
mood or behavior problems, such as depression, insomnia,
hallucinations, and agitation
Medication choices
Medicines to help
maintain mental function
Cholinesterase inhibitors such as donepezil (Aricept),
galantamine (Reminyl), and rivastigmine (Exelon).
These drugs were developed to treat Alzheimer's disease, but they may be tried in other dementias, especially vascular dementia.2
It is not clear
how long these medicines will work.
Side effects include nausea, vomiting, diarrhea, and weight loss.3
Memantine (Namenda). This medicine is used to treat symptoms of Alzheimer's disease, but may also help with mild to moderate vascular dementia.3
Medicines to help control mood or behavior problems
Antipsychotic drugs, such as risperidone (Risperdal) and
olanzapine (Zyprexa).
The doctor may prescribe medicines for high blood
pressure and high cholesterol, since these conditions are risk factors for
vascular dementia.4 These drugs can't reverse
existing dementia, but they may prevent future strokes and heart disease that
can lead to further brain damage.
Ginkgo biloba. Many people take ginkgo biloba to improve or preserve memory. But studies have not shown that ginkgo biloba helps improve memory or prevent dementia.5
Reality orientation. People who have dementia may
benefit from a structured group program that encourages them to focus on a
variety of topics and to think creatively within their limits. This type of
program, sometimes called reality orientation or cognitive stimulation therapy,
is offered in some day care and residential settings.6
Occupational therapy. Studies have shown
occupational therapy can improve the daily functioning of people with
dementia.7Occupational therapists focus on a person's ability to
perform daily tasks and take part in social activities.
Other Places To Get Help
Organizations
National Institute of Neurological Disorders and
Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424
Phone:
(301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
Alzheimer's Association
225 North Michigan Avenue, Floor 17
Chicago, IL 60601-7633
Phone:
1-800-272-3900
Fax:
1-866-699-1246 toll-free
TDD:
1-866-403-3073 toll-free
Email:
info@alz.org
Web Address:
www.alz.org
The Alzheimer's Association is a national organization that
provides educational materials, support groups, and community services for
people dealing with Alzheimer's disease. It has more than 200 local chapters
throughout the United States. The organization publishes a newsletter as well
as a wide range of brochures and videos. The Web site includes a lot of useful
information for people with Alzheimer's and other dementias, as well as for
their caregivers.
American Geriatrics Society: The AGS Foundation for
Health and Aging
The Empire State Building
350 Fifth Avenue
Suite 801
New York, NY 10118
Phone:
(212) 755-6810
Fax:
(212) 832-8646
Email:
info@americangeriatrics.org
Web Address:
www.healthinaging.org
The AGS Foundation for Health and Aging was started by
the American Geriatrics Society (AGS). The foundation works on behalf of older
adults in the areas of wellness and preventive care, self-responsibility and
independence, and connections to family and community.
This Web
site has stories about healthy aging, information on caring for elders at home,
and tips on winter safety, preparing for emergencies, and overcoming the
challenges to healthy aging. The site also has links to many other Internet
resources on aging.
Family Caregiver Alliance
180 Montgomery Street
Suite 1100
San Francisco, CA 94104
Phone:
1-800-445-8106 (415) 434-3388
Email:
info@caregiver.org
Web Address:
www.caregiver.org
This organization supports and assists people who are
providing long-term care at home. It also provides education, research,
services, and advocacy.
National Institute on Aging
Building 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD 20892
Phone:
1-800-222-2225
Phone:
(301) 496-1752
TDD:
1-800-222-4225 (TTY)
Email:
niaic@nia.nih.gov
Web Address:
www.nia.nih.gov
The National Institute on Aging (NIA), one of the
centers of the U.S. National Institutes of Health, leads a broad scientific
effort to understand the nature of aging and to extend the healthy, active
years of life. The NIA funds research and provides information about health and
research advances to the public and interested groups.
Beers MH, et al., eds. (2004). Merck Manual of Health and Aging. Whitehouse Station, NJ: Merck Research
Laboratories.
Drugs for cognitive loss and dementia (2010). Medical Letter on Drugs and Therapeutics: Drugs of Choice, 8(91): 19–24.
Warner J, et al. (2010). Dementia, search date
April 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Tzourio C, et al. (2003). Effects of blood pressure
lowering with perindopril and indapamide therapy on dementia and cognitive
decline in patients with cerebrovascular disease. Archives of Internal Medicine, 163(9): 1069–1075.
Birks J, Grimley Evans J (2009). Ginkgo biloba for
cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).
Spector A, et al. (2003). Efficacy of an
evidence-based cognitive stimulation therapy programme for people with
dementia. British Journal of Psychiatry, 183:
248–254.
Graff MJ, et al. (2006). Community-based occupational
therapy for patients with dementia and their caregivers: Randomised controlled
trial. BMJ, 333(1196). Also available online:
http://www.bmj.com/cgi/content/full/333/7580/1196.
Other Works Consulted
Bourgeois JA, et al. (2008). Dementia section of
Delirium, dementia, and amnestic and other cognitive disorders. In RE Hales et
al., eds., American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 304–363. Washington DC: American Psychiatric
Publishing.
Knopman DS (2009). Alzheimer disease and other dementing illnesses. In EG Nabel, ed., ACP Medicine, section 11, chap. 11. Hamilton, ON: BC Decker.
Knopman DS, et al. (2001, reaffirmed 2004). Practice
parameter: Diagnosis of dementia (an evidence-based review). Report of the
Quality Standards Subcommittee of the American Academy of Neurology.
Neurology, 56: 1143–1153.
Langa KM, et al. (2004). Mixed dementia: Emerging
concepts and therapeutic implications. JAMA, 292(23):
2901–2908.
U.S. Preventive Services Task Force (2003). Screening
for dementia: Recommendation and rationale. Annals of Internal Medicine, 139(11): 925–926.
Beers MH, et al., eds. (2004). Merck Manual of Health and Aging. Whitehouse Station, NJ: Merck Research
Laboratories.
Drugs for cognitive loss and dementia (2010). Medical Letter on Drugs and Therapeutics: Drugs of Choice, 8(91): 19–24.
Warner J, et al. (2010). Dementia, search date
April 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Tzourio C, et al. (2003). Effects of blood pressure
lowering with perindopril and indapamide therapy on dementia and cognitive
decline in patients with cerebrovascular disease. Archives of Internal Medicine, 163(9): 1069–1075.
Birks J, Grimley Evans J (2009). Ginkgo biloba for
cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).
Spector A, et al. (2003). Efficacy of an
evidence-based cognitive stimulation therapy programme for people with
dementia. British Journal of Psychiatry, 183:
248–254.
Graff MJ, et al. (2006). Community-based occupational
therapy for patients with dementia and their caregivers: Randomised controlled
trial. BMJ, 333(1196). Also available online:
http://www.bmj.com/cgi/content/full/333/7580/1196.
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