Diseases & Conditions

Dementia

Dementia isn't a specific disease. Instead, it describes a group of symptoms affecting intellectual and social abilities severely enough to interfere with daily functioning. It's caused by conditions or changes in the brain. Different types of dementia exist, depending on the cause. Alzheimer's disease is the most common type.

Memory loss generally occurs in dementia, but memory loss alone doesn't mean you have dementia. Dementia indicates problems with at least two brain functions, such as memory loss along with impaired judgment or language. Dementia can make you confused and unable to remember people and names. You may also experience changes in personality and social behavior. However, some causes of dementia are treatable and even reversible.

Dementia symptoms vary depending on the cause, but common signs and symptoms include:

• Memory loss
• Difficulty communicating
• Inability to learn or remember new information
• Difficulty with planning and organizing
• Difficulty with coordination and motor functions
• Personality changes
• Inability to reason
• Inappropriate behavior
• Paranoia
• Agitation
• Hallucinations

When to see a doctor
See a doctor if you or a loved one experiences memory problems or other dementia symptoms. Some medical conditions can cause symptoms of dementia and are treatable, so it's important that a doctor determine the underlying cause. Early diagnosis is also important so that treatment can begin before symptoms get worse.

If the diagnosis is a dementia that will progressively worsen over time, such as Alzheimer's disease, early diagnosis also gives a person time to plan for the future while he or she can still participate in making decisions.

If a cause of dementia has already been diagnosed, talk with a doctor if symptoms seem to be getting worse.

Memory loss and other dementia symptoms have many causes, so diagnosis can be challenging and may require several doctor visits. Diagnosis involves a number of tests.

Medical history and physical exam

• Medical history. The doctor will ask about how and when symptoms began and about any health issues that may help identify the cause of the problem, for example diabetes, high blood pressure or a family history of dementia.

  In addition, the doctor may request information from your caregiver or family member to find out whether your concerns represent a change from your earlier level of functioning.

• Physical examination. A physical exam helps your doctor rule out treatable causes of dementia and identify signs of stroke or other disorders that may cause similar symptoms. It also helps your doctor determine the best course of treatment. As part of an exam, your doctor may collect urine or blood samples, check blood pressure and review what medications you're using.

  This examination can also help identify signs of other illnesses, such as heart disease, diabetes or thyroid abnormalities and any medication side effects, which can overlap with dementia.

Cognitive and neuropsychological tests
Anyone screened for dementia needs his or her cognitive function evaluated. A number of tests measure orientation, general intellectual skills, academic skills, language skills, spatial skills, attention, memory, reasoning and judgment. The goal is to determine whether dementia is present, how severe it is and what part of the brain is affected.

Neurological evaluation
This part of the examination evaluates balance, sensory function and reflexes to identify conditions that may affect the diagnosis or are treatable with medication.

Brain scans
A look at your brain can help your doctor identify strokes, tumors or other problems that can cause dementia. Alzheimer's disease changes brain structure over time and can also be seen with a brain scan. Several types of scans are used.

• CT and MRI scans. The most common imaging techniques for identifying dementia are computerized tomography (CT) and magnetic resonance imaging (MRI). A CT scan is an X-ray technique that produces images of your body that show internal structures in cross section. MRI is a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues in your body. These scans help identify brain-size changes, strokes and other problems such as excess fluid in the brain (hydrocephalus) or bleeding on the surface of the brain (subdural hematoma).
• Electroencephalogram (EEG). Using electrodes placed on your scalp, your doctor can detect and record patterns of electrical activity and check for abnormalities. If found, these abnormalities can indicate cognitive dysfunction, a condition common in people with moderate to severe Alzheimer's disease. An EEG may also detect seizures, Creutzfeldt-Jakob disease and other disorders associated with dementia.

Laboratory tests
A variety of lab tests can help rule out other conditions, such as kidney failure, that can contribute to symptoms. Treatable medical conditions are often associated with dementia. Medication and other treatments can improve many symptoms and quality of life.

Tests that help identify treatable medical conditions include:

• A complete blood count (CBC) to rule out anemia
• A blood glucose test to rule out diabetes
• Blood tests to estimate kidney function, to estimate liver function and to measure vitamin B-12 levels
• A blood or urine screen to identify drugs or alcohol
• Cerebrospinal fluid analysis (spinal tap) to rule out brain infections
• Analysis of thyroid and thyroid-stimulating hormone levels to rule out hypothyroidism

Psychiatric evaluation
This examination may be performed to determine whether depression or another psychiatric disorder is contributing to symptoms.

You can take steps to improve quality of life as the disease progresses.

Carry a reminder calendar
Record not just upcoming events, but things that happen and activities you need to complete on a daily basis. And check off those activities when done. If you can make this process a habit before your memory problems worsen, you'll be more likely to retain this skill as the disease progresses. If you can't remember if you took your pills or who called that morning, you can check your calendar.

Maintain a calm and stable home environment
A calm and stable home environment reduces behavior problems. New situations, noise, large groups of people, being rushed or pressed to remember, or being asked to do complicated tasks can cause anxiety. When you have Alzheimer's disease or dementia, becoming upset reduces the ability to think clearly even more.

Establish a nighttime ritual
Dementia behaviors may be worse at night when you're more tired, strained by the demands of the day, or perhaps confused because of the decrease in daylight. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on to prevent disorientation. Limiting caffeine during the day, avoiding daytime napping and exercising during the day may help prevent nighttime restlessness.

Create a plan
Develop a comprehensive plan that identifies goals for care as well as the various support agencies, care centers, primary and specialty doctors, legal advisors and other family members that can help achieve these goals.

This process may or may not be something that a person with dementia can participate in. Some things for you and your caregiver to consider are:

• What is the long-term prognosis and what is the plan for treatment?
• Is independent living possible? If not, will care be provided in a family home or a nursing home?
• Does support need to be provided for things such as meal preparation, daily hygiene and taking medications?
• If independent or semi-independent living isn't possible, who will be the primary caregiver?
• What about driving? Should it continue?
• Are there safety issues, such as installing bed and bathroom safety rails and removing or securing knives and other dangerous substances or objects, that need to be addressed?
• What assistance is available through adult care centers, in-home nursing care or other agencies?
• What about legal issues such as a living will and power of attorney for health care issues? What are your wishes?

Keep in mind that the disease will evolve over time, and care needs to be adjusted as symptoms change and progress. People with dementia should be encouraged to continue their normal activities as long as they're safe and the activities don't cause frustration or confusion. Mental, social and physical activities help maintain a person's health and well-being.