Dementia

Risk factors for dementia include: Advancing ageFamily members with dementing illnessDown syndromeApolipoprotein E status (a genetic risk)Elevated cholesterolMultiple strokesHigh blood pressureVitamin deficiencyChronic drug use SymptomsSymptoms 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 locationsThe names of friends, family membersWhere common objects are usually keptSimple mathHow to perform usual tasks, such as cooking, dressing, bathing, etc.How to driveBill payingTrouble concentrating on tasksTrouble completing sentences, due to lost/forgotten words (This may progress to complete inability to speak.)Inability to remember the date, time of day, seasonGetting lost in familiar surroundingsMood swingsWithdrawal, loss of interest in usual activitiesPersonality changesSlow, shuffling walkPoor coordinationSlowness and then loss of purposeful movement Diagnosis Doctors diagnose dementia by: Taking an extensive history from the patient and his or her familyClosely observing the patientPerforming a physical examPerforming 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 functionCT or MRI scans of the headtests 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. TreatmentCurrently there are no treatments to cure Alzheimers 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: Cholinesterase inhibitorsNMDA receptor antagonists Antioxidants ( vitamin E and others) EstrogensAnti-inflammatory agentsGinkgo biloba (herbal supplement) 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 inhibitorsapproved and recommended for mild-moderate Alzheimer's disease: Donepezil (Aricept)Rivastigmine (Exelon)Galantamine (Reminyl)NMDA receptor antagonistapproved 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 residenceProviding a calm, quiet, predictable environmentProviding appropriate eyewear and hearing aids, easy-to-read clocks, and calendarsMusic therapyEncouraging light exercise to reduce agitation and relieve depressionDiscussing 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: Antidepressants Anxiolyticsto treat anxietyAntipsychoticsto treat severe confusion, paranoia, and/or hallucinationsMood stabilizersto treat dangerous or disruptive behaviors Caregiver SupportCaring 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 Alzheimers Association website, address below, is an excellent resource for family members and caregivers of those with dementia.

PreventionThere 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 Alzheimers disease. RESOURCES: Alzheimer's Associationhttp://www.alz.org American Academy of Neurologyhttp://www.aan.com American Psychiatric Associationhttp://www.psych.org CANADIAN RESOURCES: Alzheimers Association of Canadawww.alzheimer.ca Canadian Psychiatric Associationwww.cpa-apc.org Canadian Public Health Associationhttp://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 Alzheimers Disease. Aging & Mental Health . 2007; 11(3): 330-338. Mayo Foundation for Medical Education and Research website. Available at: http://www.mayo.edu. Mendez MF, Cummings JL. Dementia: A clinical Approach . 3rd edition. Butterworth Heinemann, 2003. 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. Last reviewed November 2007 by Ryan Estvez, MD, PhD, MPHPlease 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.