Dementia: A Slow, Silent Thief

What Are the Symptoms of Dementia? People with dementia may have a variety of symptoms, such as: Gradually worsening memory loss (to previously known people, places, tasks)Difficulty concentratingIncreasingly poor judgmentConfusionDisorientationSleep problemsDifficulty performing activities of daily living, including problems washing and dressing oneself, loss of bladder and bowel controlLoss of language skills, eventually leading to the complete inability to speakPersonality changes, including mood swings, depression, irritability, combativeness, agitation, or hallucinationsLoss of executive function, the ability to perform calculations, pay bills, spell, and balance a check book How Is Dementia Diagnosed? Dementia is diagnosed by testing various mental functions, including memory, thinking, concentration, orientation, and judgment. When these tests are repeated over time, the results will become progressively more abnormal. Can Dementia Be Cured? Sometimes, medical testing reveals other problems that might be responsible for the symptoms of dementia (such as infections or chemical imbalances). In these cases, correcting the underlying problem might lead to improvement in the dementia. When dementia is due to Alzheimers disease or another progressive illness (such as Parkinsons disease), there are no treatments to halt its progression.

How Is Dementia Treated? If testing doesnt uncover a curable cause for dementia, the only treatments are those that attempt to improve its symptoms. Rivastigmine (Exelon), donepezil (Aricept), memantine (Namenda, Axura), and galantamine (Razadyne (formerly available as Reminyl, Razadyne ER) are medications used in the treatment of Alzheimers Disease that try to slow the loss of function and improve thinking. Other medications that are under investigation include. beta- and gamma-secretase inhibitors, which interfere with the formation of abnormal plaques in the brain, and vaccines. Dementia patients who are agitated, suspicious, combative, or who have unwanted thoughts or hallucinations may be treated with anti-psychotic medications. Other important treatments for dementia involve making sure that the individual is in a safe environment as his or her judgment becomes increasingly impaired. Trying to keep the dementia patient as well-oriented as possible (by the presence of clocks and calendars) can be helpful. Although activity should be encouraged, its important to make sure that the activities are not frustrating to the patient. Support for the Caregiver Finally, if you are a caregiver for someone with dementia, make sure that you have some kind of respite care available. Its an exhausting, emotionally-wrenching job to take care of someone you love who is undergoing changes and progressively becoming severely debilitated. You also need care, and should have regular breaks from your duties, so that you stay fresh and energized. Dont be afraid to seek support from family, friends, your religious community, support groups, doctor, or social service organizations.

RESOURCES: Alzheimers Association http://www.alz.org/ Alzheimers Disease Education and Referral Service (ADEAR) at the National Institute on Aging http://www.alzheimers.org CANADIAN RESOURCES: Alzheimer Society Canadahttp://www.alzheimer.ca/ Public Health Agency of Canadahttp://www.phac-aspc.gc.ca References: Alzheimers Disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed March 17, 2008. Beer, MH. Behavior disorders in dementia. Merck Manual of Geriatrics. 2000-2003. Defilippi, JL, Crismon ML. Antipsychotic agents in patients with dementia. Pharmacotherapy. 2000;20(1)23-33. Fago, J. Dementia: causes, evaluation, and management. Hospital Practice. 2001;36(1):59-66,69. Farlow MR. Alzheimers disease. Continuum Lifelong Learning. Neurol. 2007;13(2):39-68. Mace, N, Rabins PV. The Thirty-Six Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life. 4th Ed. Baltimore, MD: The Johns Hopkins University Press;2006. Petersen RC, Thomas RG, Grundman M, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment (published electronically April 13, 2005). N Engl J Med. 2005;352(23):2379-2388.

Raskind MA, Peskind ER. Advances in the pathophysiology and treatment of psychiatric disorders: implications for internal medicine. Medical Clinics of North America. 2001;85(3). Rosack, J. Antipsychotics effective for elderly patients with dementia. Psychiatric News. 2003;38(8)32. Sano M, Ernesto C, Thomas RG, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. N Engl J Med. 1997;336:1216-1222. Last reviewed March 2008 by J. L. Chang, MD, FAASM, D, ABSM Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.