Dementia is not a disease in and of itself, but rather a byproduct of other mentally degenerative conditions such as multiple strokes, Alzheimer's or Parkinson's disease. In general, dementia is a nearly irreversible disintegration of all the higher thinking skills that keep us sane and sociable. A patient suffering from dementia can still see and hear, for example, but can no longer put all of the sensory information they receive together coherently. The patient may form nonsensical sentences or experience complete memory loss.
Dementia is often associated with the natural aging process, although its development among the elderly is not inevitable. Alzheimer's disease can destroy brain cells over time, which in turn leads to cognitive failures and eventually full-blown dementia. Some elderly people can also develop senior dementia without also contracting Alzheimer's. The forgetfulness of Alzheimer's sufferers is often replaced with the personality breakdown of a senior dementia patient. An Alzheimer's patient may still be able to perform essential functions, but a dementia sufferer often loses all ability to remain social.
Diagnosing dementia can involve a series of psychological tests measuring cognitive functions. Quite often, true dementia affects memory and executive decision skills first, followed by changes in personality and language difficulties. Only in advanced stages of dementia do patients display the complete loss of time and space comprehension commonly associated with the disorder. Other diagnostic tests may look for signs of previous strokes or adverse drug interactions.
There is a precursor to dementia that mimics many of its symptoms. People who have been subjected to sleep deprivation, invasive surgeries, extended hospital stays or social isolation may develop delirium. Delirium can cause a loss of language comprehension, short-term memory loss and alteration of the sufferer's personality. Delirium can also devolve into the more serious first stages of dementia. Unlike dementia, however, many cases of delirium are reversible through drug regimens, counseling and stimulation of the brain.
Dementia is not considered curable at this point in time, but scientists are working to find a way to slow down the progression. Currently, most senior dementia sufferers are treated in nursing homes and other extended care facilities.
Sometimes, people with dementia are unaware they have any symptoms, especially symptoms that affect behaviour.
The symptoms of vascular dementia can develop suddenly and quickly worsen, or they can develop gradually over many months.
Symptoms include:
increasing difficulties with tasks and activities that require concentration and planning
memory loss
depression
changes in personality and mood
periods of mental confusion
low attention span
urinary incontinence
stroke-like symptoms, such as muscle weakness or paralysis on one side of the body
visual hallucinations
wandering during the night
slow and unsteady gait (the way that you walk)
The symptoms of dementia with Lewy bodies usually develop gradually but get more severe over the course of many years.
The symptoms of dementia with Lewy bodies include:
memory loss
low attention span
visual hallucinations
periods of mental confusion
delusions
difficulty planning ahead
muscle stiffness
slower movement
shaking and trembling of arms and legs
shuffling while walking
problems sleeping
loss of facial expression.
Fronto-temporal dementia is caused by damage to the parts of the brain that help control emotional responses and behaviour. Therefore, many of the initial symptoms of fronto-temporal dementia involve changes in emotion, personality and behaviour.
Someone with fronto-temporal dementia may become less sensitive to other people’s emotions. This can make them seem cold and unfeeling.
They may also lose some of their inhibitions. This could lead to strange behaviour, such as making sexually suggestive gestures in a public place, being rude to others or making tactless comments.
Other symptoms of fronto-temporal dementia include:
aggression
compulsive behaviour
being easily distracted
an increasing lack of interest in washing themselves
personality changes: person who was previously withdrawn may become very outgoing or vice versa.
Some people with fronto-temporal dementia also have problems with language. This can include speaking far less than usual or not speaking at all, or having problems finding the right words to express themselves or describe something.
Some cases of dementia are caused by medical conditions that can be treated, fully or partly restoring mental function. When dementia cannot be reversed, the goal of treatment is to make life as easy as possible for the person and the caregivers.
If the cause of dementia can be reversed, the doctor will prescribe treatment. 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, that is causing changes in mental state.
Take medicine to treat depression.
Get treatment for reversible conditions caused by AIDS.
After treatment for reversible conditions, the person will continue to see his or her doctor to make sure the symptoms do not return.
For people with vascular dementia, doctors may prescribe medicines to lower high blood pressure and medicines for high cholesterol (statins). These drugs cannot reverse existing dementia, but they may prevent future strokes and heart disease that can lead to further brain damage.
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. Education of the family and other caregivers is critical to successfully caring for a person with 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.
While medicines cannot cure dementia, they may help improve mental function, mood, or behavior. Medicines that your doctor may prescribe include:
Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), or rivastigmine (Exelon), to improve or maintain mental function. These drugs were developed to treat Alzheimer's disease, but they may be tried in other dementias. Studies indicate that they hold promise for the treatment of people with vascular dementia. Both donepezil and galantamine have been shown to improve mental function with few side effects. Rivastigmine may help people with dementia with Lewy bodies and Parkinson's disease, but side effects such as nausea, vomiting, and weight loss are common. Exelon patches cause fewer side effects. At present, medicines can slow but not stop the progress of dementia.
Memantine (Namenda). This type of medicine can slow the late stages of Alzheimer's disease. It may also benefit those with mild to moderate vascular dementia. More studies are under way.
Antidepressants to treat depression. They must be used carefully because they can cause delirium in people with dementia. Antidepressants that have the fewest side effects in people with dementia are SSRIs, such as fluoxetine (Prozac, for example) and citalopram (Celexa).
Medicines to ease anxiety, agitation, aggression, and hallucinations. Some of these medicines, called antipsychotic drugs, are not approved by the FDA for the treatment of dementia. Studies of people with psychosis due to dementia who were treated with these medicines, including Zyprexa and Risperdal, found an increased risk of death. Discuss this risk with your doctor before using these medicines.