Dementia

Overview

Dementia is a term used to describe a group of symptoms affecting memory, thinking and social abilities. In people who have dementia, the symptoms interfere with their daily lives. Dementia isn't one specific disease. Several diseases can cause dementia.

Dementia generally involves memory loss. It's often one of the early symptoms of the condition. But having memory loss alone doesn't mean you have dementia. Memory loss can have different causes.

Alzheimer's disease is the most common cause of dementia in older adults, but there are other causes of dementia. Depending on the cause, some dementia symptoms might be reversible.

Symptoms

Dementia symptoms vary depending on the cause. Common symptoms include:

Cognitive changes

• Memory loss, which is usually noticed by someone else.
• Problems communicating or finding words.
• Trouble with visual and spatial abilities, such as getting lost while driving.
• Problems with reasoning or problem-solving.
• Trouble performing complex tasks.
• Trouble with planning and organizing.
• Poor coordination and control of movements.
• Confusion and disorientation.

Psychological changes

• Personality changes.
• Depression.
• Anxiety.
• Agitation.
• Inappropriate behavior.
• Being suspicious, known as paranoia.
• Seeing things that aren't there, known as hallucinations.

When to see a doctor

See a health care professional if you or a loved one has memory problems or other dementia symptoms. It's important to determine the cause. Some medical conditions that cause dementia symptoms can be treated.

Causes

Dementia is caused by damage to or loss of nerve cells and their connections in the brain. The symptoms depend on the area of the brain that's damaged. Dementia can affect people differently.

Dementias are often grouped by what they have in common. They may be grouped by the protein or proteins deposited in the brain or by the part of the brain that's affected. Also, some diseases have symptoms like those of dementia. And some medicines can cause a reaction that includes dementia symptoms. Not getting enough of certain vitamins or minerals also can cause dementia symptoms. When this occurs, dementia symptoms may improve with treatment.

Progressive dementias

Dementias that are progressive get worse over time. Types of dementias that worsen and aren't reversible include:

• Alzheimer's disease. This is the most common cause of dementia.

  Although not all causes of Alzheimer's disease are known, experts do know that a small percentage are related to changes in three genes. These gene changes can be passed down from parent to child. While several genes are probably involved in Alzheimer's disease, one important gene that increases risk is apolipoprotein E4 (APOE).

  People with Alzheimer's disease have plaques and tangles in their brains. Plaques are clumps of a protein called beta-amyloid. Tangles are fibrous masses made up of tau protein. It's thought that these clumps damage healthy brain cells and the fibers connecting them.

• Vascular dementia. This type of dementia is caused by damage to the vessels that supply blood to the brain. Blood vessel problems can cause stroke or affect the brain in other ways, such as by damaging the fibers in the white matter of the brain.

  The most common symptoms of vascular dementia include problems with problem-solving, slowed thinking, and loss of focus and organization. These tend to be more noticeable than memory loss.

• Lewy body dementia. Lewy bodies are balloonlike clumps of protein. They have been found in the brains of people with Lewy body dementia, Alzheimer's disease and Parkinson's disease. Lewy body dementia is one of the more common types of dementia.

  Common symptoms include acting out dreams in sleep and seeing things that aren't there, known as visual hallucinations. Symptoms also include problems with focus and attention. Other signs include uncoordinated or slow movement, tremors, and stiffness, known as parkinsonism.

• Frontotemporal dementia. This is a group of diseases characterized by the breakdown of nerve cells and their connections in the frontal and temporal lobes of the brain. These areas are associated with personality, behavior and language. Common symptoms affect behavior, personality, thinking, judgment, language and movement.
• Mixed dementia. Autopsy studies of the brains of people age 80 and older who had dementia indicate that many had a combination of several causes. People with mixed dementia can have Alzheimer's disease, vascular dementia and Lewy body dementia. Studies are ongoing to determine how having mixed dementia affects symptoms and treatments.

Other disorders linked to dementia

• Huntington's disease. Huntington's disease is caused by a genetic change. The disease causes certain nerve cells in the brain and spinal cord to waste away. Symptoms include a decline in thinking skills, known as cognitive skills. Symptoms usually appear around age 30 or 40.

• Traumatic brain injury (TBI). This condition is most often caused by repetitive head trauma. Boxers, football players or soldiers might develop TBI.

  Dementia symptoms depend on the part of the brain that's injured. TBI can cause depression, explosiveness, memory loss and impaired speech. TBI also may cause slow movement, tremors and stiffness. Symptoms might not appear until years after the trauma.

• Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without known risk factors. This condition might be due to deposits of infectious proteins called prions. Symptoms of this fatal condition usually appear after age 60.

  Creutzfeldt-Jakob disease usually has no known cause but it can be passed down from a parent. It also may be caused by exposure to diseased brain or nervous system tissue, such as from a cornea transplant.

• Parkinson's disease. Many people with Parkinson's disease eventually develop dementia symptoms. When this happens, it's known as Parkinson's disease dementia.

Dementia-like conditions that can be reversed

Some causes of dementia-like symptoms can be reversed with treatment. They include:

• Infections and immune disorders. Dementia-like symptoms can result from a fever or other side effects of the body's attempt to fight off an infection. Multiple sclerosis and other conditions caused by the body's immune system attacking nerve cells also can cause dementia.
• Metabolic or endocrine problems. People with thyroid problems and low blood sugar can develop dementia-like symptoms or other personality changes. This also is true for people who have too little or too much sodium or calcium, or problems absorbing vitamin B-12.
• Low levels of certain nutrients. Not getting enough of certain vitamins or minerals in your diet can cause dementia symptoms. This includes not getting enough thiamin, also known as vitamin B-1, which is common in people with alcohol use disorder. It also includes not getting enough vitamin B-6, vitamin B-12, copper or vitamin E. Not drinking enough liquids, leading to dehydration, also can cause dementia symptoms.
• Medicine side effects. Side effects of medicines, a reaction to a medicine or an interaction of several medicines can cause dementia-like symptoms.
• Subdural bleeding. Bleeding between the surface of the brain and the covering over the brain can be common in older adults after a fall. Subdural bleeding can cause symptoms similar to those of dementia.
• Brain tumors. Rarely, dementia can result from damage caused by a brain tumor.
• Normal-pressure hydrocephalus. This condition is a buildup of fluid in the cavities in the brain known as ventricles. It can result in walking problems, loss of bladder control and memory loss.

Risk factors

Many factors can eventually contribute to dementia. Some factors, such as age, can't be changed. You can address other factors to reduce your risk.

Risk factors that can't be changed

• Age. The risk of dementia rises as you age, especially after age 65. However, dementia isn't a typical part of aging. Dementia also 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 changes that may increase your risk.
• 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 has found that people at higher risk of dementia who followed a healthy lifestyle lowered their risk of cognitive decline. They ate a diet that included fish, fruits, vegetables and oils. They also exercised, had cognitive training and participated in social activities. While no specific diet is known to reduce dementia risk, research indicates that those who follow a Mediterranean style diet rich in produce, whole grains, nuts and seeds have better cognitive function.
• Drinking too much alcohol. Drinking large amounts of alcohol has long been known to cause brain changes. Several large studies and reviews found that alcohol use disorders were linked to an increased risk of dementia, particularly early-onset dementia.
• Cardiovascular risk factors. These include obesity, high blood pressure, high cholesterol and the buildup of fats in the artery walls, known as atherosclerosis. Having high levels of low-density lipoprotein (LDL), in particular, is a risk factor for cognitive decline and dementia. Diabetes and smoking also are cardiovascular risk factors. Having diabetes can increase the risk of dementia, especially if it's poorly controlled. Smoking might increase the risk of developing dementia and blood vessel disease.
• Hearing loss or vision loss that is not treated. Having hearing loss is associated with a higher risk of dementia. The worse the hearing loss, the higher the risk. Research also suggests that vision loss can raise the risk of dementia, while treating vision loss can lower the risk.
• Depression. Although not yet well understood, late-life depression might indicate the development of dementia.
• Air pollution. Studies in animals have indicated that air pollution particulates can speed degeneration of the nervous system. And human studies have found that air pollution exposure — particularly from traffic exhaust and burning wood — is associated with greater dementia risk.
• Head trauma. People who've had a severe head trauma have a greater risk of Alzheimer's disease. Several large studies found that in people age 50 years or older who had a traumatic brain injury (TBI), the risk of dementia and Alzheimer's disease increased. The risk increases in people with more-severe and multiple TBIs. Some studies indicate that the risk may be greatest within the first six months to two years after the TBI.
• Sleep symptoms. People who have sleep apnea and other sleep disturbances might be at higher risk of developing dementia.
• Low levels of certain vitamins and nutrients. Low levels of vitamin D, vitamin B-6, vitamin B-12 and folate can increase the risk of dementia.

• Medicines that can worsen memory. These include sleep aids that contain diphenhydramine (Benadryl) and medicines to treat urinary urgency such as oxybutynin (Ditropan XL).

  Also limit sedatives and sleeping tablets. Talk to a health care professional about whether any of the medicines you take might make your memory worse.

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. Trouble swallowing increases the risk of choking. And food or liquids can enter the lungs, known as aspiration. This can block breathing and cause pneumonia.
• Inability to perform self-care tasks. As dementia gets worse, people have a hard time bathing, dressing, and brushing their hair or teeth. They need help using the toilet and taking medicines as directed.
• Personal safety challenges. Some day-to-day situations can present safety issues for people with dementia. These include driving, cooking, and walking and living alone.
• Death. Coma and death can occur in late-stage dementia. This often happens because of an infection.

Prevention

There's no sure way to prevent dementia, but there are steps you can take that might help. More research is needed, but it might help to do the following:

• Keep your mind active. Mentally stimulating activities might delay the onset of dementia and decrease its effects. Spend time reading, solving puzzles and playing word games.
• Be physically and socially active. Physical activity and social interaction might delay the onset of dementia and reduce its symptoms. Aim for 150 minutes of exercise a week.
• Quit smoking. Some studies have shown that smoking in middle age and beyond might increase the risk of dementia and blood vessel conditions. Quitting smoking might reduce the risk and improve health.

• Get enough vitamins. Some research suggests that people with low levels of vitamin D in their blood are more likely to develop Alzheimer's disease and other forms of dementia. You can increase your vitamin D levels with certain foods, supplements and sun exposure.

  More study is needed before an increase in vitamin D intake is recommended for preventing dementia. But it's a good idea to make sure you get adequate vitamin D. Taking a daily B-complex vitamin and vitamin C also might help.

• Manage cardiovascular risk factors. Treat high blood pressure, high cholesterol and diabetes. Pay attention to your levels of LDL cholesterol and get treatment if the levels are too high. High levels of LDL in middle age raises the risk of dementia. Lose weight if you're overweight.

  High blood pressure might lead to a higher risk of some types of dementia. More research is needed to determine whether treating high blood pressure may reduce the risk of dementia.

• Treat health conditions. See your doctor for treatment of depression or anxiety.
• Maintain a healthy diet. A diet such as the Mediterranean diet might promote health and lower the risk of developing dementia. A Mediterranean diet is rich in fruits, vegetables, whole grains and omega-3 fatty acids, which are commonly found in certain fish and nuts. This type of diet also improves cardiovascular health, which also may help lower dementia risk.
• Get good-quality sleep. Practice good sleep hygiene. Talk to a health care professional if you snore loudly or have periods where you stop breathing or gasp during sleep.
• Treat hearing loss. People with hearing loss have a greater chance of developing problems with thinking, known as cognitive decline. Early treatment of hearing loss, such as use of hearing aids, might help decrease the risk.
• Get regular eye exams and treat vision loss. Research suggests that not treating vision loss may be associated with a raised risk of dementia.

Diagnosis

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 health care professional reviews your medical history and symptoms and conducts a physical exam. Someone who is close to you may be asked about your symptoms as well.

No single test can diagnose dementia. You'll likely need a number of tests that can help pinpoint the problem.

Cognitive and neuropsychological tests

These tests evaluate your thinking ability. A number of tests measure thinking skills, such as memory, orientation, reasoning and judgment, language skills, and attention.

Neurological evaluation

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

Brain scans

• CT or MRI. These scans can check for evidence of stroke, bleeding, tumor or fluid buildup, known as hydrocephalus.
• PET scans. These scans can show patterns of brain activity. They can determine whether amyloid or tau protein, hallmarks of Alzheimer's disease, have been 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.

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 medicines work by boosting levels of a chemical messenger involved in memory and judgment. They include donepezil (Aricept, Adlarity), rivastigmine (Exelon) and galantamine (Razadyne ER).

  Although primarily used to treat Alzheimer's disease, these medicines also might be prescribed for other dementias. They might be prescribed for people with 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 problems.

• Memantine. Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions such as learning and memory. Memantine is sometimes prescribed with a cholinesterase inhibitor.

  A common side effect of memantine is dizziness.

• Other medicines. You might take other medicines to treat symptoms or other conditions. You may need treatment for depression, sleep problems, hallucinations, parkinsonism or agitation.

The U.S. Food and Drug Administration (FDA) has approved lecanemab (Leqembi) and donanemab (Kisunla) for people with mild Alzheimer's disease and mild cognitive impairment due to Alzheimer's disease.

Clinical trials found that the medicines slowed declines in thinking and functioning in people with early Alzheimer's disease. The medicines prevent amyloid plaques in the brain from clumping.

Lecanemab is given as an IV infusion every two weeks. Side effects of lecanemab include infusion-related reactions such as fever, flu-like symptoms, nausea, vomiting, dizziness, changes in heart rate and shortness of breath.

Donanemab is given as an IV infusion every four weeks. Side effects of the medicine may include flu-like symptoms, nausea, vomiting, headache and changes in blood pressure. Rarely, donanemab can cause a life-threatening allergic reaction and swelling.

Also, people taking lecanemab or donanemab may have swelling in the brain or may get small bleeds in the brain. Rarely, brain swelling can be serious enough to cause seizures and other symptoms. Also in rare instances, bleeding in the brain can cause death. The FDA recommends getting a brain MRI before starting treatment. The FDA also recommends periodic brain MRIs during treatment for symptoms of brain swelling or bleeding.

People who carry a certain form of a gene known as APOE e4 appear to have a higher risk of these serious complications. The FDA recommends testing for this gene before starting treatment.

If you take a blood thinner or have other risk factors for brain bleeding, talk to your healthcare professional before taking lecanemab or donanemab. Blood-thinning medicines may increase the risk of bleeds in the brain.

More research is being done on the potential risks of taking lecanemab and donanemab. Other research is looking at how effective the medicines may be for people at risk of Alzheimer's disease, including people who have a first-degree relative, such as a parent or sibling, with the disease.

Therapies

Several dementia symptoms and behavior problems might be treated initially with therapies other than medicine. These may include:

• 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. The therapy also helps you manage behavior and prepare you for when the dementia progresses.
• Changes to 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.
• Simpler tasks. Breaking tasks into easier steps and focusing on success, not failure, can be helpful. Structure and routine help reduce confusion in people with dementia.

Lifestyle and home remedies

Dementia symptoms and behavior problems get worse over time. Caregivers and care partners might try the following suggestions:

• Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present one idea or instruction at a time. Use gestures and cues, such as pointing to objects.

• Encourage exercise. The main benefits of exercise in people with dementia include improved strength, balance and cardiovascular health. Exercise also might help with symptoms such as restlessness. There is growing evidence that exercise also protects the brain from dementia, especially when combined with a healthy diet and treatment of risk factors for cardiovascular disease.

  Some research also shows that physical activity might slow the progression of impaired thinking in people with Alzheimer's disease. It also can lessen symptoms of depression.

• Engage in activity. Plan activities the person with dementia enjoys and can do. Dancing, painting, gardening, cooking, singing and other activities can help you connect with your loved one. The activities also can help people with dementia focus on what they can still do.

• Establish a nighttime routine. Behavior is often worse at night. Try to establish going-to-bed routines. Aim for a calming routine away from the noise of television, meal cleanup and active family members. Leave night lights on in the bedroom, hall and bathroom to prevent disorientation.

  Limiting caffeine, discouraging napping and offering opportunities for exercise during the day might ease nighttime restlessness.

• Keep a calendar. A calendar might help your loved one remember upcoming events, daily activities and medicine schedules. Consider sharing a calendar with your loved one.

• Plan for the future. Develop a plan while your loved one is still able to participate. The plan can state goals for future care. Support groups, legal advisers, family members and others might be able to help.

  You'll also need to consider financial and legal issues, safety and daily living concerns, and long-term care options.

Alternative medicine

Several dietary supplements, herbal remedies and therapies have been studied for people with dementia. But there's no convincing evidence that these treatments are effective.

Use caution when considering taking dietary supplements, vitamins or herbal remedies, especially if you're taking other medicines. Supplements, vitamins and herbs aren't regulated. Claims about their benefits aren't always based on scientific research.

While some studies suggest that vitamin E supplements may be helpful for Alzheimer's disease, study results have been mixed. Also, high doses of vitamin E can pose risks. Taking vitamin E supplements is generally not recommended. However, including foods high in vitamin E, such as nuts, in your diet is recommended.

Other therapies

The following techniques may help reduce agitation and promote relaxation in people with dementia.

• Music therapy, which involves listening to soothing music.
• Light exercise.
• Watching videos of family members.
• Pet therapy, which can include visits from dogs or other animals to promote improved mood and behavior.
• Aromatherapy, which uses fragrant plant oils.
• Massage therapy.
• Art therapy, which involves creating art, focusing on the process rather than the outcome.

Coping and support

After being diagnosed with dementia, you'll need to consider many details to prepare you and your family members to deal with the condition.

Care and support for the person with the disease

Here are some suggestions you can try to help yourself cope with the disease:

• Learn about memory loss, dementia and Alzheimer's disease.
• Write about your feelings in a journal.
• Join a local support group.
• Get individual or family counseling.
• Talk to a member of your spiritual community or another person who can help you with your spiritual needs.
• Stay active and involved. Volunteer, exercise and participate in activities for people with memory loss.
• Spend time with friends and family.
• Participate in an online community of people who are having similar experiences.
• Find new ways to express yourself, such as through painting, singing or writing.
• Delegate help with decision-making to someone you trust.

Helping someone with dementia

You can help a person cope with the disease by listening. Offer reassurance that the person can enjoy life. Be supportive and positive, and do your best to help the person retain dignity and self-respect.

Support for caregivers and care partners

Providing care for someone with dementia is physically and emotionally demanding. You might feel angry, guilty, frustrated or worried. Grief and social isolation are common. If you're a caregiver or care partner for someone with dementia:

• Learn about the disease and participate in caregiver education programs.
• Find out about supportive services in your community, such as respite care or adult care. These services can give you a break from caregiving at scheduled times during the week.
• Ask friends or other family members for help.
• Take care of your physical, emotional and spiritual health.
• Ask questions of health care professionals, social workers and others involved in the care of your loved one.
• Join a support group.

Preparing for an appointment

Most likely, you'll first see a health care professional if you have concerns about dementia. Or you might be referred to a doctor trained in nervous system conditions, known as a neurologist.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything that needs to be done in advance, such as fasting before certain tests. Make a list of:

• Symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
• Key personal information, including any major stresses or recent life changes and family medical history.
• All medicines, vitamins or supplements you take, including the doses.
• Questions to ask the health professional.

Even in the early stages of dementia, it's good to take a family member, friend or caregiver along to help you remember the information you're given.

For dementia, basic questions to ask a health care professional include:

• What is likely causing my symptoms?
• Are there other possible causes for my symptoms?
• What tests are necessary?
• Is the condition likely temporary or chronic?
• What's the best course of action?
• What alternatives are there to the primary approach being suggested?
• How can dementia and other health issues be managed together?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

You're likely to be asked questions such as:

• When did your symptoms begin?
• Have symptoms been continuous or occasional?
• How severe are symptoms?
• What, if anything, seems to improve symptoms?
• What, if anything, appears to worsen symptoms?
• How have the symptoms interfered with your life?