Dementia is the name given to a group of neurological disorders that progressively deteriorate the ability of the brain to function normally. In order to be diagnosed with dementia, there must be:
A disturbance in memory
A decline in two or more cognitive domains that is sufficient in severity to cause functional impairment. These cognitive domains include language, visuospatial function, executive function (foresight, planning, anticipation, insight, etc.), and praxis (learned motor skills) .
Symptoms of dementia generally come on gradually. They often begin mildly and progress over time. Symptoms vary according to the cause of the dementia, but often include:
Increasing trouble remembering things, such as:
How to get to familiar locations
The names of friends, family members
Where common objects are usually kept
Simple math
How to perform usual tasks, such as cooking, dressing, bathing, etc.
How to drive
Bill paying
Trouble concentrating on tasks
Trouble completing sentences, due to lost/forgotten words (This may progress to complete inability to speak.)
Inability to remember the date, time of day, season
Getting lost in familiar surroundings
Mood swings
Withdrawal, loss of interest in usual activities
Personality changes
Slow, shuffling walk
Poor coordination
Slowness and then loss of purposeful movement
Diagnosis
Doctors diagnose dementia by:
Taking an extensive history from the patient and his or her family
Closely observing the patient
Performing a physical exam
Performing mental status and psychological tests
There are no blood tests or imaging studies to definitively diagnose Alzheimer's disease, although certain types of brain imaging such as a SPECT or a PET scan can aid clinicians in making a diagnosis. Tests to rule out other causes of dementia and other medical conditions that may mimic dementia include:
Blood tests for syphilis, vitamin B12, folate, thyroid, liver, and kidney function
CT
or
MRI scans
of the head—tests that use a computer (CT scan) or magnetic waves (MRI scan) to create detailed images of structures inside the body, in this case the head
Lumbar puncture—collecting a sample of cerebrospinal fluid by inserting a needle between two vertebrae (rarely needed)
Electroencephalogram (EEG)—a test that records the brain's activity by measuring electrical signals from the brain
Doctors must take care not to miss the diagnosis of
depression, which can often present like dementia, particularly in the elderly. Unlike dementia, however, depression is highly treatable.
Treatment
Currently there are no treatments to cure Alzheimer’s disease or many other types of dementia. Researchers are studying various drugs to see if they can improve the symptoms of dementia or slow its course.
Medications
Medications being used or studied for possible use include:
Only two types of medications have been approved by the US Food and Drug Administration (FDA) to reduce the symptoms of Alzheimer's disease: cholinesterase inhibitors and more recently, an NMDA receptor antagonist.
Cholinesterase inhibitors—approved and recommended for mild-moderate Alzheimer's disease:
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)
NMDA receptor antagonist—approved for moderate to severe Alzheimer's disease:
Memantine (Namenda)
These medications have a modest effect, at best, on the progression of the disease.
Lifestyle Management
Since medications cannot be relied upon for dramatic results, behavioral and environmental support is crucial in the management of dementia. These steps include:
Keeping the patient safe in their home or other place of residence
Providing a calm, quiet, predictable environment
Providing appropriate eyewear and hearing aids, easy-to-read clocks, and calendars
Music therapy
Encouraging light exercise to reduce agitation and relieve depression
Discussing healthcare wishes with family members and doctors, and appointing a healthcare proxy and a legal power of attorney
Psychiatric Medications
People with dementia often develop psychiatric symptoms. If these symptoms become severe, medication may be needed, such as:
Antipsychotics—to treat severe confusion, paranoia, and/or hallucinations
Mood stabilizers—to treat dangerous or disruptive behaviors
Caregiver Support
Caring for a person with dementia is extremely difficult and exhausting. Primary caregivers, usually spouses or daughters need emotional support, as well as regular respite. The Alzheimer’s Association website, address below, is an excellent resource for family members and caregivers of those with dementia.
Prevention
There is no known way to prevent Alzheimer's disease. A healthful diet will prevent vitamin B12 deficiency and lower cholesterol. In addition to a healthy diet, exercise can also enhance cardiovascular health, which may delay the onset of vascular dementia.
Limiting alcohol intake can prevent dementia from alcoholism, and avoiding drug abuse and practicing safe sex reduces the risk of AIDS-related dementia. There is also some evidence that engaging in mentally stimulating activity over a lifetime may also reduce the risk of Alzheimer’s disease.
RESOURCES:
Alzheimer's Association http://www.alz.org
American Academy of Neurology http://www.aan.com
American Psychiatric Association http://www.psych.org
CANADIAN RESOURCES:
Alzheimers Association of Canada www.alzheimer.ca
Canadian Psychiatric Association www.cpa-apc.org
Canadian Public Health Association http://www.cpha.ca/en/default.aspx
References:
American Academy of Neurology website. Available at:
http://www.aan.com.
The American Psychiatric Association's Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias of Late Life. American Psychiatric Association; 1997.
Cecil Textbook of Medicine. 21st ed. WB Saunders Company; 2000.
Current Medical Diagnosis & Treatment. 44th ed; 2005.
Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt HP, van den Bussche H. Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials.
BMJ. 2005;331(7512):321-327.
Ledger AJ & Baker FA. An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer’s Disease. Aging & Mental Health. 2007; 11(3): 330-338.
Mayo Foundation for Medical Education and Research website. Available at:
http://www.mayo.edu.
Obrien JT, et al. Dopamine transporter loss visualized with FP-CIT SPECT in the differential diagnosis of dementia with Lewy Bodies. Arch Neurol. 2004; 61: 919-925.
The Merck Manual of Geriatrics. 3rd ed. Merck & Co. Inc.; 1995-2000.
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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.
