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Alzheimer's disease is the
most common cause of dementia. This topic focuses on other conditions that
cause dementia. For more information on Alzheimer's, see the topic
We all forget things as we get
older. Many older people have a slight loss of memory that does not affect
their daily lives. But memory loss that gets worse may mean that you have
Dementia is a loss of mental skills that affects your
daily life. It can cause problems with your memory and how well you can think
and plan. Usually dementia gets worse over time. How long this takes is
different for each person. Some people stay the same for years. Others lose
Your chances of having dementia rise as you get
older. But this doesn't mean that everyone will get it. By age 85, about 35 out of 100 people have some form of dementia. That means that 65 out of 100 don't have it. Dementia is rare before age 60.1
If you or a loved one has memory loss that is getting worse,
see your doctor. It may be nothing to worry about. If it is dementia, treatment
Dementia is caused by damage
to or changes in the brain. Things that can cause dementia include:
In a few cases, dementia is caused by a problem that can
be treated. Examples include having an underactive thyroid gland (hypothyroidism), not getting enough vitamin B12, and
fluid buildup in the brain (normal-pressure hydrocephalus). In
these cases, treating the problem may cure the dementia.
people, depression can cause memory loss that seems like dementia. Depression
can be treated.
As you age, medicines may affect you more. Taking
some medicines together may cause symptoms that look like dementia. Be sure
your doctor knows about all of the medicines you take. This means all
prescription medicines and all
over-the-counter medicines, herbs, vitamins, and
Usually the first symptom
is memory loss. Often the person who has a memory problem doesn't notice it,
but family and friends do. As dementia gets worse:
Over time, people with dementia may begin to act very
differently. They may become scared and strike out at others, or they may become
clingy and childlike. They may stop brushing their teeth or bathing.
Later, they cannot take care of themselves. They may not know where they
are. They may not know their loved ones when they see them.
There is no single test
for dementia. To diagnose it, your doctor will:
The doctor may do tests to look for a cause that can be
treated. For example, you might have blood tests to check your thyroid or to
look for an infection. You might also have a test that shows a picture of your
brain, like an
MRI or a
CT scan. These tests can help your doctor find a tumor
or brain injury. They can also show if there has been shrinking in parts of the
brain. This can be a sign of dementia.
There are medicines you can
take for dementia. They cannot cure it, but they can slow it down for a while
and make it easier to live with.
As dementia gets worse, a person
may get depressed or angry and upset. Treatment, such as medicines and
counseling, may help. So can getting out more and having an active social
If a stroke caused the dementia, there are things you can
do to reduce the chance of another stroke. Stay at a healthy weight, exercise,
and keep your blood pressure and cholesterol at normal levels. If you have
diabetes, keep your blood sugar in your target range.
both your mind and your body active is a good idea for anyone. So is not
are many things you can do to help your loved one be safe at home. For example,
get rid of throw rugs, and put handrails in bathrooms to help prevent falls.
Post reminder notes around the house. Put a list of important phone numbers by
the telephone. You also can help your loved one stay active. Play cards or
board games, and take walks.
Work with your loved one to make
decisions about the future before dementia gets worse. It is important to write
living will and a
durable power of attorney. A living will states the
types of medical care your loved one wants. A durable power of attorney lets
your loved one pick someone to be the
health care agent. This person makes care decisions
after your loved one cannot.
Watching a loved one slip away can
be sad and scary. Caring for someone with dementia can leave you feeling
drained. Be sure to take care of yourself and to give yourself breaks. Ask
family members to share the load, or get other help.
one will need more and more care as dementia gets worse. In time, he or she may
need help to eat, get dressed, or use the bathroom. You may be able to give
this care at home, or you may want to think about using a nursing home. A
nursing home can give this kind of care 24 hours a day. The time may come when
a nursing home is the best choice.
You are not alone. Many
people have loved ones with dementia. Ask your doctor about local support
groups, or search the Internet for online support groups, such as the
Alzheimer's Association. Help is available.
Learning about dementia:
Living with dementia:
Health Tools help you make wise health decisions or take action to improve your health.
Dementia is caused by damage to or changes in the
Alzheimer's disease, stroke is the most common cause of
dementia. Dementia caused by stroke is called vascular dementia.
Some causes of dementia can be
reversed with treatment, but most cannot.
Common causes of dementia that cannot
be reversed are:
Less common causes of dementia that cannot be reversed
When dementia is caused by certain treatable problems, the treatment may also help the dementia. These treatable problems include:
Some disorders that cause dementia can run in families.
Doctors often suspect an inherited cause if someone younger than 50 has
symptoms of dementia. For more information, see the topic
dementia vary depending on the cause and the
area of the brain that is affected. Symptoms include:
Some types of dementia cause particular symptoms:
Symptoms of dementia that come on suddenly suggest
vascular dementia or possibly
delirium—short-term confusion caused by a new or
It is important to
know that memory loss can be caused by conditions other than dementia, such as
depression, and that those conditions can be treated. Also, occasional trouble
with memory (such as briefly forgetting someone's name) can be a normal part of
aging. But if you are worried about memory loss or if a loved one has memory
loss that is getting worse, see your doctor.
dementia progresses depends on what is causing it and
the area of the brain that is affected. Some types of dementia progress slowly
over several years. Other types may progress more rapidly. If
vascular dementia is caused by a series of small
strokes, the loss of mental skills may be gradual. If
it is caused by a single stroke in a large blood vessel, loss of function may
The course of dementia varies greatly from one
person to another. Early diagnosis and treatment with medicines used for
Alzheimer's (cholinesterase inhibitors such as
donepezil [Aricept]) may help preserve mental functioning for a while in people
who have vascular dementia,
dementia with Lewy bodies, or
Parkinson's disease.2 Even
without these medicines, some people remain stable for months or years, while
others decline rapidly.
Many people with dementia are not aware
of their mental decline. They may deny their condition and blame others for their
problems. Those who are aware may mourn their loss of abilities
and become hopeless and depressed.
Depending on the type of
dementia, the person's behavior may eventually become out of control. The
person may become angry, agitated, and combative or clingy and childlike. He or
she may wander and become lost. These problems can make it difficult for family
members or others to continue providing care at home.
Even with the best care, people with dementia tend to
have a shorter life span than the average person their age. The progression
varies depending on the disease causing the dementia and whether the person has
other illnesses such as diabetes or heart disease. Death usually results from lung or kidney infections
caused by being bedridden.
For more information on
decisions you may face as your loved one's condition progresses, see the topic
Care at the End of Life.
Many older people have a
slight loss of mental skills (usually recent memory) that doesn't affect their
daily functioning. This is called
mild cognitive impairment by some. People who have mild impairment may be in
the early stage of dementia, or they may stay at their present level of ability
for a long time.
Aging is the main risk factor
for all types of
dementia. Some diseases that cause dementia (such as
Alzheimer's disease and some
frontotemporal dementias) may run in families.
You have a greater chance of developing
vascular dementia if you:
Call 911 or other emergency services immediately if signs of a
transient ischemic attack (TIA) develop
suddenly. These may include:
Call a doctor immediately if a
person suddenly becomes confused or emotionally upset or doesn't seem to know
who or where he or she is. These are signs of
delirium, which can be caused by a reaction to
medicines or a new or worsening medical condition.
Call a doctor
if you or a person you are close to has new and troubling memory loss that is
more than an occasional bout of forgetfulness. This may be an early sign of
Occasional forgetfulness or memory loss can be a
normal part of aging. But any new or increasing memory loss or problems with
daily living should be reported to a doctor. Learn the
warning signs of dementia, and talk to a doctor if you
or a family member shows any of these signs. They include increased trouble
finding the right words when speaking, getting lost going to familiar places,
and acting more irritable or suspicious than usual.
The following health professionals can evaluate
symptoms of memory loss or confusion:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Doctors diagnose the cause of
dementia by asking questions about the person's
medical history and doing a physical exam, a
mental status exam, and lab and imaging tests.
Tests can help the doctor learn whether dementia is caused by a treatable
condition. Even for those dementias that cannot be reversed, knowing the type
of dementia a person has can help the doctor prescribe medicines or other
treatments that may improve mood and behavior and help the family.
medical history and physical exam, the doctor will ask
the affected person and a close relative or partner about recent illnesses or
other life events that could cause memory loss or other symptoms such as
behavioral problems. The doctor may ask the person to bring in all medicines he
or she takes. This can help the doctor find out if the problem might be
caused by the person being overmedicated or having a drug interaction.
Although a person may have more than one illness causing dementia,
symptoms sometimes can distinguish one form from another. For example, early in
the course of
frontotemporal dementia, people may display a lack of
social awareness and develop obsessions with eating, neither of which occurs
early in other dementias.
A doctor or other health
professional will conduct a
mental status exam. This test usually involves such
activities as having the person tell what day and year it is, repeat a series
of words, draw a clock face, and count back from 100 by 7s.
tests have been developed to diagnose dementia. Doctors can use one such test,
Addenbrooke's Cognitive Examination, to distinguish
Alzheimer's disease from frontotemporal dementia.
Orientation, attention, and memory are worse in Alzheimer's, while language
skills and ability to name objects are worse in frontotemporal dementia.
Many medical conditions can cause
mental impairment. During a physical exam, the doctor will look for signs of
other medical conditions and have lab tests done to find any treatable
condition. Routine tests include:
Other lab tests that may be done include:
Brain imaging tests such as
CT scans and
MRI may also be done to
make sure another problem isn't causing the symptoms. These tests may rule out
normal-pressure hydrocephalus, or other conditions
that could cause dementia symptoms.
MRI can show shrinkage in
parts of the brain that occurs in some types of dementia. MRI and CT scan also
can show evidence of strokes from
Two other forms of
imaging—single photon emission CT (SPECT) and
PET scan—are not used routinely to diagnose dementia.
But they may be useful if the symptoms are confusing or odd. These tests can
help identify several forms of dementia, including vascular dementia and
In some cases, electrical activity in the brain may be
measured using an
electroencephalogram (EEG). Doctors seldom use this
test to diagnose dementia, but they may use it to distinguish dementia from
delirium and to look for unusual brain activity found
in Creutzfeldt-Jakob disease, a rare cause of dementia.
cases, a brain
biopsy may be done if a treatable cause of dementia is
After death, an
autopsy may be done to find out for sure what caused
dementia. This information may be helpful to family members concerned about
Some cases of
dementia are caused by medical conditions that can be
treated, and treatment can restore some or all mental function. But most of the time, dementia cannot be
Sometimes treating the cause of dementia helps the dementia. For example, the person might:
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:
If possible, make decisions while
your loved one is able to take part in the decision making. These are difficult
but important conversations. Questions include:
Education of the family and other caregivers is critical to successfully caring for someone who has 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. For more
information, see Home Treatment.
The goal of ongoing treatment
dementia is to keep the person safely at home for as
long as possible and to provide support and guidance to the caregivers.
Routine follow-up visits to a health professional (every 3 to 6 months) are necessary to monitor medicines and the person's level of functioning.
Eventually, the family may have to consider whether to place the
person in a care facility that has a dementia unit.
care of a person with dementia is stressful. If you are a caregiver,
seek support from family members or friends. Take care
of your own health by getting breaks from caregiving. Counseling, a support
group, and adult day care or respite care can help you through stressful times
and bouts of burnout.
hard to prevent, because what causes it often is not known. But people who have dementia caused by stroke may be able to prevent future declines by lowering their risk of heart disease and stroke. Even if you don't have these known risks, your overall health can benefit from these strategies:
Home treatment for
dementia involves teamwork among health professionals
and caregivers to create a safe and comfortable environment and to make tasks
of daily living as easy as possible. People who have mild dementia can be involved in planning for the future and organizing the home and daily tasks.
Work with the team of health professionals to:
The team can also help you learn how to manage behavior problems. For example, you can learn ways to:
Caregivers should remember to
seek support from other family and friends. For more
information, see the topic
Even with the best care,
a person with progressive dementia will decline, perhaps to the point where the caregiver is no longer physically, emotionally, or financially able to provide
Making the decision about
nursing home placement is often very difficult. Every family needs to consider
its own financial situation, emotional capacity, and other issues.
Doctors use medicines to treat
dementia in the following ways:
For more information, see the topics:
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
The Alzheimer's Association is a national organization that
provides educational materials, support groups, and community services for
people dealing with Alzheimer's disease. It has more than 200 local chapters
throughout the United States. The organization publishes a newsletter as well
as a wide range of brochures and videos. The Web site includes a lot of useful
information for people with Alzheimer's and other dementias, as well as for
The AGS Foundation for Health in Aging was started by
the American Geriatrics Society (AGS). The foundation works on behalf of older
adults in the areas of wellness and preventive care, self-responsibility and
independence, and connections to family and community.
This website has stories about healthy aging, information on caring for elders at home,
and tips on winter safety, preparing for emergencies, and meeting the
challenges of healthy aging. The site also has links to many other Internet
resources on aging.
This organization supports and assists
people who are providing long-term care at home. It also provides education,
research, services, and advocacy.
The National Institute on Aging (NIA), one of the
centers of the U.S. National Institutes of Health, leads a broad scientific
effort to understand the nature of aging and to extend the healthy, active
years of life. The NIA funds research and provides information about health and
research advances to the public and interested groups.
CitationsBeers MH, et al., eds. (2004). Merck Manual of Health and Aging. Whitehouse Station, NJ: Merck Research Laboratories.Drugs for cognitive loss and dementia (2010). Medical Letter on Drugs and Therapeutics: Drugs of Choice, 8(91): 19–24.Warner J, et al. (2010). Dementia, search date April 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.Tzourio C, et al. (2003). Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Archives of Internal Medicine, 163(9): 1069–1075.Birks J, Grimley Evans J (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).Spector A, et al. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia. British Journal of Psychiatry, 183: 248–254.Graff MJ, et al. (2006). Community-based occupational therapy for patients with dementia and their caregivers: Randomised controlled trial. BMJ, 333(1196). Also available online: http://www.bmj.com/cgi/content/full/333/7580/1196.Other Works ConsultedBourgeois JA, et al. (2008). Dementia section of Delirium, dementia, and amnestic and other cognitive disorders. In RE Hales et al., eds., American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 304–363. Washington DC: American Psychiatric Publishing.Knopman DS (2009). Alzheimer disease and other dementing illnesses. In EG Nabel, ed., ACP Medicine, section 11, chap. 11. Hamilton, ON: BC Decker.Knopman DS, et al. (2001, reaffirmed 2004). Practice parameter: Diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 56: 1143–1153.Langa KM, et al. (2004). Mixed dementia: Emerging concepts and therapeutic implications. JAMA, 292(23): 2901–2908.U.S. Preventive Services Task Force (2003). Screening for dementia: Recommendation and rationale. Available online: http://www.uspreventiveservicestaskforce.org/3rduspstf/dementia/dementrr.htm.
June 23, 2011
Anne C. Poinier, MD - Internal Medicine & Peter J. Whitehouse, MD - Neurology
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