Dementia

A group of diseases that damage your brain and cause progressive cognitive decline are known as dementia. These neurological disorders impact your memory, thinking, personality, judgement and the ability to perform daily tasks. The mild to severe cognitive symptoms found in dementia are not a normal part of the aging process.

The most common type of dementia is Alzheimer's disease (senile dementia). The disease accounts for 60-80% of cases. While there's currently no cure for most cases of dementia, research focuses on treating conditions that cause abnormal changes within the brain.

What is dementia?

Dementia is the gradual loss of cognitive function. The disease progresses in stages, depending on varying factors – including your age, type of dementia and underlying health conditions.

The brain changes found in dementia damage the tissues in your brain. Your brain tissue contains important cells and blood vessels that support and help your brain communicate to other parts of your body that control your movement, behavior and how you interpret senses.

What is the main cause of dementia?

The most common cause of dementia is Alzheimer’s disease. Several other underlying causes and risk factors of dementia include:

• Mild cognitive impairment (MCI)
• Multiple sclerosis (MS)
• Parkinson’s disease
• Huntington’s disease
• Heart disease
• Brain injury
• Stroke
• High blood pressure (hypertension)
• Infections, like herpes or Lyme disease
• Depression
• Smoking & excessive alcohol use
• Family history of dementia

What makes dementia worse?

Untreated vascular risk factors, like high blood pressure, can accelerate the progression of dementia, especially Alzheimer's disease. Dehydration, malnutrition and infections like pneumonia can also make dementia symptoms worse. Head injuries from accidents and falls may also increase the loss of cognitive function.

Dementia symptoms

Over 7 million adults aged 65 and above are affected by some type of dementia. Learning to recognize the differences between aging-problems that affect memory and dementia-related memory loss is key to managing symptoms and slowing the disease progression.

With dementia, the memory and cognitive changes are mild at first. A friend, caregiver or family member may be the first one to notice symptoms.

Common symptoms of dementia include:

• Confusion
• Concentration issues
• Language and processing trouble
• Loss of muscle function
• Memory loss
• Mood changes
• Psychological changes

Stages of dementia

The three stages of dementia include: early (mild), middle (moderate) and late stage (severe). The hallmark symptoms don’t always follow a typical pattern – every case of dementia is unique. Each dementia stage can last for several years, with middle-stage dementia usually being the longest stage.

Early-stage dementia symptoms include:

• Difficulty planning or organizing
• Losing or misplacing items
• Forgetting recently learned information
• Coming up with the right words
• Trouble following a conversation

For some, mild cognitive impairment is considered the first stage of dementia.

Middle-stage dementia symptoms include:

• Difficulty expressing emotions
• Sudden change in mood
• Confusion about place and time
• Forgetting important personal information
• Trouble expressing thoughts
• Needing help with personal care
• Withdrawn in social settings
• Wandering or becoming lost

Sundowning syndrome – or sundowning dementia – is a set of symptoms that may appear in middle-stage dementia. These symptoms increase from late afternoon into the night and include agitation, pacing, confusion, disorientation and trouble sleeping.

Late-stage dementia symptoms include:

• Needing 24/7 help with personal care
• Loss of awareness
• Limited speech and difficulty communicating
• Inability to walk or sit
• Trouble eating and swallowing

As dementia progresses into the middle and end stages, caregiver support or dementia hospice care is needed to ensure a comfortable and safe environment.

Dementia diagnosis

There’s no established test for dementia. A dementia diagnosis can be difficult to confirm, since symptoms are related to other disorders. Specialists including neurologists, neuropsychologists and geriatricians often help with dementia diagnosis.

If you’re having memory loss issues or recognize signs of cognitive decline in a friend or family member, it’s important you speak with a doctor. If someone noticed your symptoms first, it’s best to bring them to the appointment as well.

During the visit, your doctor will discuss your medical and family history. They’ll review your current medications and discuss your symptoms in length. A series of tests including laboratory tests, imaging tests and neurocognitive tests may be ordered.

Testing for dementia includes:

• Neurological exam: Tests your eye movements, reflexes and balance.
• Cognitive testing: Includes verbal and written testing that evaluates your mental abilities.
• Spinal tap (lumbar puncture): Checks your cerebrospinal fluid (CSF) for neurodegenerative diseases.
• Blood or urine tests: Looks for vitamin deficiencies and checks your thyroid levels.
• CT or MRI scan: Looks for signs of stroke or bleeding in the brain.

Dementia treatment options

If your testing indicates a dementia diagnosis, our experienced team will meet with you and your family to develop a comprehensive treatment plan. Our social workers are also available to provide support, counseling, education and dementia-related resources.

Dementia medications

It’s possible to improve your quality of life while delaying dementia progression and alleviating your symptoms with dementia medications.

Medications for dementia include cholinesterase inhibitors approved by the FDA to treat Alzheimer’s disease. Cholinesterase inhibits the breakdown of acetylcholine, a chemical messenger critical for learning and memory.

The most common prescribed cholinesterase inhibitors include:

• Galantamine (Razadyne): Approved to treat mild to moderate Alzheimer’s disease.
• Donepezil (Aricept): Approved for all stages of Alzheimer’s disease.
• Rivastigmine (Exelon): Approved to treat mild to moderate Alzheimer’s disease.

Other dementia medications include:

• Suvorexant (Belsomra): Helps insomnia in mild to moderate Alzheimer’s disease.
• Brexpiprazole (Rexulti): Helps treat agitation associated with dementia due to Alzheimer’s disease.
• Memantine (Namenda): Helps with cognitive decline symptoms by controlling the level of glutamate, a chemical in the brain involved in learning and memory.

Dementia therapies

Neuroscience physical therapy, which includes physical, occupational and speech therapies, has been shown to help individuals stay as independent as possible.

Having a supportive and safe home environment is also important. A family member or caregiver may take measures like installing safety locks, removing tripping hazards and using devices that help memory such as reminders and labels. Many people find reminders on cell phones or other devices helpful.

Treatment for reversible forms of dementia

Sometimes, it’s possible to reverse cognitive decline symptoms if the underlying cause is found. This is especially true if your dementia is caused by:

• Alcoholism
• Brain tumors
• Infections such as Lyme disease
• Heart and lung issues
• Reactions to medication

Preventing dementia

If you’re concerned about developing dementia, you can take steps that may help delay the disease progression.

Healthy lifestyle steps you can take to mitigate your risk of developing dementia include:

• Avoid smoking and alcohol
• Maintain a healthy diet and weight
• Stay physically and mentally active
• Manage blood sugar and high blood pressure