Dementia is a progressive condition. It presents initially with mild signs and symptoms that usually go unnoticed. These include restlessness and agitation, depression, anxiety, forgetfulness and confusion. Gradually the patient may progress to a state in which he/she complains of tremors, balance and coordination problems, decline of thinking and planning capacity, delusions, distorted memory, impaired speech and difficulty in swallowing and/or eating.

• Falling

  BACKGROUND: Walking is a cognition intensive activity and impaired walking is associated with an increased fall risk in people with Alzheimer's dementia (AD). [ncbi.nlm.nih.gov]

  Fourth, the only fall-related injury we examined was hip fracture. [doi.org]

• Weight Loss

  Feeding and eating difficulties leading to weight loss are common in the advanced stages of dementia. [ncbi.nlm.nih.gov]

  Follow us Top Categories Lifestyle Diseases Heart Diseases Bone Health Cancer Hub Brain Diseases Recent Posts After surgery for weight loss, run! August 8, 2019 Copper is for pots. Not in your brain or liver. [logintohealth.com]

  Eating and swallowing difficulties may place an individual at greater risk for choking and aspiration pneumonia (Bourgeois & Hickey, 2009) and may eventually result in malnutrition, dehydration, and weight loss (Hanson, Ersek, Lin, & Carey, 2013; Jensen [asha.org]

  Despite her weight loss, then, he declined medical intervention. In February, Mrs. Jewell began refusing food altogether and soon slipped into a coma. Dr. Jewell and his children were with her when she died, at 89. [nytimes.com]

• Down Syndrome

  Down's syndrome Down's syndrome increases the likelihood of Alzheimer's disease at a young age. [marham.pk]

  Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer's disease. Risk factors you can change You might be able to control the following risk factors for dementia. Diet and exercise. [mayoclinic.org]

  Down syndrome increases the likelihood of young-onset Alzheimer's. Early signs Early signs of dementia can include: Changes in short-term memory. Changes in mood. Trouble finding the right words. Apathy. Confusion. Being repetitive. [medicalnewstoday.com]

  Most people with Down syndrome develop Alzheimer’s. This may be because people with Down syndrome have an extra copy of chromosome 21, which contains the gene that generates harmful amyloid. [nia.nih.gov]

  This is not useful in the presence of Down's syndrome. CSF examination may occasionally be helpful if Creutzfeldt-Jakob disease or other forms of rapidly progressive dementia are suspected [ 7 ]. [patient.info]

• Fatigue

  Difficulty in concentrating, fatigue, and sleep disturbance do not. 17 No studies to date have examined anxiety disorders other than GAD in this population. [web.archive.org]

  Difficulty swallowing, bowel problems such as constipation and diarrhoea, fatigue, memory loss – all of these can be combatted to varying extents with careful nutrition. [telegraph.co.uk]

  These are normal parts of aging and can also occur due to other factors, such as fatigue. Still, you shouldn’t ignore the symptoms. If you or someone you know is experiencing a number of dementia symptoms that aren’t improving, talk with a doctor. [healthline.com]

  Figures and Tables - Analysis 4.4 Comparison 4 Trazodone versus Placebo, Outcome 4 Occurence of Fatigue. Figures and Tables - Analysis 4.5 Comparison 4 Trazodone versus Placebo, Outcome 5 Occurence of Tremor. [doi.org]

  […] symptoms of DTs): Most common in the first 12 to 48 hours after the last drink Most common in people with past complications from alcohol withdrawal Usually generalized tonic-clonic seizures Symptoms of alcohol withdrawal, including: Anxiety, depression Fatigue [medlineplus.gov]

• Nocturnal Awakening

  awakenings assessed with: actigraphy follow‐up: 10 weeks The mean number of nocturnal awakenings in the placebo group was 34 The number of nocturnal awakenings was, on average, 6 fewer in the melatonin group (2.65 more to 14.65 fewer) ‐ 33 (1 RCT) LOW [doi.org]

  awakenings (MD -3.71, 95% CI -8.2 to 0.8; N 30; one study). [ncbi.nlm.nih.gov]

• Hypophonia

  A 42-year-old woman presented with a 6-month history of diffuse headache of moderate intensity and gradual onset of generalized weakness, imbalance, apathy, memory decline, hypophonia, dysphagia, constipation and urinary incontinence. [ncbi.nlm.nih.gov]

• Constipation

  A 42-year-old woman presented with a 6-month history of diffuse headache of moderate intensity and gradual onset of generalized weakness, imbalance, apathy, memory decline, hypophonia, dysphagia, constipation and urinary incontinence. [ncbi.nlm.nih.gov]

  […] in people with dementia -- 21.Delirium in dementia -- 22.Psychosis in people with dementia -- pt. 6 Physical health problems -- 23.Sensory impairment -- 24.Falls -- 25.Nutrition Note continued: 26.Protecting and caring for skin -- 27.Continence -- 28.Constipation [worldcat.org]

  Difficulty swallowing, bowel problems such as constipation and diarrhoea, fatigue, memory loss – all of these can be combatted to varying extents with careful nutrition. [telegraph.co.uk]

  There were no statistical differences found in adverse events affecting other body systems or particular symptoms (e.g. dizziness, constipation). No statistical differences were found in measures of cognitive function (e.g. the MMSE). [doi.org]

  Infection Medication Not taking medication Surgery with anesthesia Dehydration High/low blood sugar Pain Constipation Diarrhea What puts someone at risk for developing Delirium? Some causes are medication, infection, and being hospitalized. [oceanmedicalcenter.com]

• Dysphagia

  Evidence on the benefits and risks of modifying food and fluids is mandatory to improve the care of people with dementia and dysphagia. [ncbi.nlm.nih.gov]

  Leder, Comments on Selected Recent Dysphagia Literature, Dysphagia, 27, 4, (562), (2012). [doi.org]

  […] progressive aphasia experience gradual loss of language function but relatively well-preserved memory; and individuals with Binswanger's disease (a type of vascular dementia) experience stroke-related neurological symptoms, including dysarthria and dysphagia [asha.org]

• Fecal Incontinence

  Experiences urinary and fecal incontinence. Average duration of this stage is 3.5 months to 9.5 months. Stage 7 Severe Alzheimer’s Speech ability declines to about a half-dozen intelligible words. [dementiacarecentral.com]

• Hearing Impairment

  We found an increased risk of incident dementia with hearing impairment in both our novel data and the meta-analysis. [ncbi.nlm.nih.gov]

  Future research should differentiate between dementia types and test specific hypotheses concerning how hearing impairment may contribute causally to specific dementias. [doi.org]

  Examples of other conditions that increase the risk of delirium include: Brain disorders such as dementia, stroke or Parkinson's disease Previous delirium episodes Visual or hearing impairment The presence of multiple medical problems Complications Delirium [mayoclinic.org]

• Delusion

  False beliefs (delusions) are common, especially paranoid delusions involving others stealing from them or conspiring against them. [web.archive.org]

  Dementia is a collective term that refers to a decline in brain activity resulting in loss of memory, deceased capacity to think and make logical decisions, impaired speech and motor functioning and delusions. [symptoma.com]

  […] include physical/verbal aggression, agitation, disinhibition, restlessness, wandering, culturally inappropriate behaviors, sexual disinhibition, and hoarding, and the psychological symptoms of dementia are anxiety, depressive mood, hallucinations and delusions [ncbi.nlm.nih.gov]

• Withdrawn

  In these trials, different types of antipsychotics prescribed at different doses were withdrawn. Both abrupt and gradual withdrawal schedules were used. [ncbi.nlm.nih.gov]

  Use of physical restraint in people withdrawn from antipsychotics versus people continuing on antipsychotics compared with baseline. 2.5. Mortality in people withdrawn from antipsychotics versus people continuing on antipsychotics. 2.6. [doi.org]

  Patients may become irritable, agitated, hyperactive, and hyperalert, or they may become quiet, withdrawn, and lethargic. Very old people with delirium tend to become quiet and withdrawn—changes that may be mistaken for depression. [merckmanuals.com]

• Aggressive Behavior

  This study classified agitated behaviors into 5 main subtypes: physically agitated behaviors, destructive behaviors, verbally agitated behaviors, handling things behavior, and aggressive behaviors. [ncbi.nlm.nih.gov]

  Lewy body dementia may also cause aggressive behavior or depression, tremors, and an increased risk of falling. The Roots of Compassion & Kindness Apply to Everything We Do Read Our Story [homewatchcaregivers.com]

  Behavior; Combative Behavior; Violent Behavior; Wandering off 294.8 - Persistent Mental Disorders Due to Conditions Classified Elsewhere, Other; Amnestic Disorder NOS; Dementia NOS; Epileptic Psychosis NOS; Mixed Paranoid and Affective Organic Psychotic [web.archive.org]

  According to Cohen-Mansfield (1999) four distinct categories of agitation are: (1) physically non-aggressive behavior; (2) verbally non-aggressive behavior; (3) physically aggressive behavior; and (4) verbally aggressive behavior. [doi.org]

• Emotional Lability

  Behavioral and cognitive changes include mental slowness (bradyphrenia), emotional lability, personality changes, and depression. 15 Depression is common in VaD, occurring in up to 20% of cases, and is disproportionately prominent in those cases with [doi.org]

  EMOTIONAL LABILITY Patients with delirium may display a wide range of emotions, including anxiety, sadness or tearfulness, and euphoria. They may have more than one of these emotions during the course of delirium. [web.archive.org]

• Psychiatric Manifestation

  The first step to better understand the psychiatric manifestations of dementia is to appropriately recognize and describe the psychopathology and accurately distinguish between similar symptoms (e.g., depression vs. apathy). [doi.org]

• Urinary Incontinence

  A 42-year-old woman presented with a 6-month history of diffuse headache of moderate intensity and gradual onset of generalized weakness, imbalance, apathy, memory decline, hypophonia, dysphagia, constipation and urinary incontinence. [ncbi.nlm.nih.gov]

  Specifically, HICPAC recommends not using a catheter to manage urinary incontinence in the PA/LTC setting. [choosingwisely.org]

  Hashimoto MImamura TTanimukai SKazui HMori E Urinary incontinence: an unrecognised adverse effect with donepezil. Lancet 2000;356 (9229) 568 PubMed Google Scholar 47. Gill SSMamdani MNaglie G et al. [doi.org]

  Normal pressure hydrocephalus (NPH): Gait instability, urinary incontinence, and dementia are the signs and symptoms typically found in patients who have NPH. Considered a rare cause of dementia, it primarily affects persons older than 60 years. [caregiver.org]

• Agitation

  Effects of the BACE intervention on agitation of demented residents in long-term care. Gerontologist 2003 ; 43 : 233. 26 Cohen-Mansfield, J, Jensen, B. [doi.org]

  Currently there are relatively few studies of antidepressants for the treatment of agitation and psychosis in dementia. [ncbi.nlm.nih.gov]

• Confusion

  Treating conditions that can lead to confusion often greatly improve mental function. [nlm.nih.gov]

  These include restlessness and agitation, depression, anxiety, forgetfulness and confusion. [symptoma.com]

  This may include behavioral changes, confusion, confusion, delusions and hallucinations, communication difficulties. Every experience of dementia is different. Dementia has different causes. [marham.pk]

  Further understanding of what exactly causes Alzheimer’s disease will help to clear any confusion and hopefully lead to better treatments plans and, ultimately, a cure. [alzheimers.net]

• Forgetful

  They often know about their forgetfulness. Not everyone with MCI develops dementia. [nlm.nih.gov]

  They may forget to eat, initiate eating less often, or have difficulty determining the need to eat (Arrighi et al., 2013; Bourgeois & Hickey, 2009). [asha.org]

  In… Read More memory function In memory abnormality: Diffuse brain diseases …a characteristic early sign of senility, as well as of hardening of the brain arteries (cerebral arteriosclerosis) at any age, with exaggerated forgetfulness for recent events [britannica.com]

• Personality Change

  From Wikidata Jump to navigation Jump to search long-term brain disorders causing personality changes and impaired memory, reasoning, and normal function senility Dementia rare dementia edit English dementia long-term brain disorders causing personality [wikidata.org]

  […] long-term brain disorders causing personality changes and impaired memory, reasoning, and normal function [commons.wikimedia.org]

• Irritability

  We present the case of a 34-year-old Jordanian woman who was referred to mainstream mental health services because of irritability, agitation, loss of appetite, withdrawal from family activities and sleeping difficulties. [ncbi.nlm.nih.gov]

  Findings from a study of GAD in patients with dementia indicate that restlessness, irritability, muscle tension, fear, and respiratory symptoms of anxiety significantly correlate with excessive anxiety and worry. [web.archive.org]

There are no definitive diagnostic tests for dementia. There are however, a number of screening tests available, such as:

• Mini Mental State Examination (MMSE)
• Trail-making test
• Clock-drawing test
• Montreal Cognitive Assessment (MOCA)

Laboratory tests

Routine blood tests may be performed to rule out reversible causes such as tests for vitamin B12 levels, thyroid function tests, complete blood count, liver enzymes, renal function tests, etc.

Imaging 

• CT scan
• PET scan 
• MRI

Other tests

• Brain biopsy

Test results

Diagnosis is based on history physical examination and by the help of test results.

Medications

Currently, no medications have been shown to prevent or cure dementia [8]. Anti-psychotic drugs, cholinesterase inhibitors and anti depressants may be given as needed.

Food and nutrition

Careful assessment for potentially treatable causes of swallowing and appetite problems, honest communication about uncertainties over prognosis and the impact of interventions and ascertainment of individuals' values and beliefs make for better care for people with dementia and better decisions about feeding [9].

Comorbidity (the presence of more than one disease process) is the rule rather than the exception for dementia in elderly persons [7]. Prognosis depends upon the stage of disease.

Stage 1

In this stage, the effected person does not act differently. Just a slight memory loss is evident, which is still more than normal memory loss at old age.

Stage 2

Small changes occur in the affected person’s behaviour. He sometimes takes a bit too long in solving some queries or making a quick decision. He faces problems in terms of time management. But he is still able to lead his life without being taken care of.

Stage 3

In this stage, there are behavioural changes, agitation and restlessness and inability to complete household tasks. The affected person finds it difficult to care for himself.

Stage 4

The disease becomes severe. More loss of memory occurs. Rapid personality changes occur during this stage.

Stage 5

The disease gets more violent with increased memory loss, hallucinations, extreme confusion, agitation and personality changes. The affected person is unable to function without help.

Alzheimer disease is the most common form of dementia [1]. The etiology of AD remains, in large part, unresolved, however, RORA (Retinoic Acid Receptor-related Orphan Receptor) emerges as a gene with a probable central role in the AD pathology/etiology [2].

The main reversible causes of dementia include vitamin B12 deficiency, hypothyroidism, neurosyphilis and Lyme disease. Other causes of dementia include old age, trauma to the head, cognitive impairment, progressive supranuclear palsy, Krabbe’s disease, Nieman Pick disease type C, Ataxia syndrome and acidemias. The production of abnormal level of protein in the brain is also one of the main causes of dementia.

Incidence

Dementia is a fairly common disease and according to the World Alzheimer’s Report 2009, it was estimated that there were 35.6 million cases of dementia worldwide in 2010.

Sex

Studies reveal that dementia is slightly more common in females.

Age

The incidence of dementia increases with age, with dementia affecting 5% of the population older than 65 and 20–40% of those older than 85 [3].

Dementia occurs due to degeneration of neurons in the brain, particularly of the cerebral cortex and later, of other parts like cerebellum. The exact pathophysiology behind dementia is still unclear. Discussed below is the pathogenesis of 2 common etiologies of this condition.

Vascular dementia

Two criteria that have been suggested for the pathologic diagnosis of vascular dementia include:

• Multiple large and/or strategic infarcts in cerebrum [4]. The neuropathology of the dementia is caused by the breakdown of small cerebral vessels (silent microbleeds), that the microbleeds result from pulse-induced damage to the cerebral vessels, and that pulse becomes increasingly destructive with age, because of the age-related stiffening of the aorta and great arteries, which causes an increase in the intensity of the pressure pulse [5]. 
• A threshold of 3 or more microscopic infarcts identified in a systematic screening of cerebral cortex and deep cerebral structures [6].

Alzheimer disease

In this disease, there is progressive atrophy of first the neurons of hippocampus and temporal lobe, and then gradually of the frontoparietal lobes and finally the sensory and motor cortex. It is characterized by the presence of amyloid plaques which are eosinophilic deposits of A beta peptides, and intraneuronal neurofibrillary tangles.

Some of the most promising strategies for the prevention of dementia include vascular risk factor control, cognitive activity, physical activity, social engagement, diet, and recognition of depression [10].

Dementia is a collective term that refers to a decline in brain activity resulting in loss of memory, deceased capacity to think and make logical decisions, impaired speech and motor functioning and delusions. It is not a disease itself, instead it is a collection of many disorders which may be alike or, in many cases, differ from each other. Dementia is commonly associated with Alzheimer disease, but it occurs in many more diseases and conditions. It occurs mostly at the age of 65-75 and is known to be the disease of the old.

However, if a person gets old and becomes forgetful, it does not mean he has dementia. This is because some memory loss in old age is quite natural. But along with memory loss, if that person’s actions are different, for example, in the way of his communication towards others or his decisions are somewhat absurd, this may point towards dementia and thorough testing and evaluation by the clinician is in order.

Definition

Dementia is a term used to describe brain disorders in which there is progressive loss of memory, thinking and motor ability.

Cause

The most common causes of dementia include old age, Alzheimer disease and vascular disorders. Some people may be genetically prone to this condition.

Symptoms

Dementia presents initially with restlessness, slight memory loss and depression. It may progress to severe memory loss, confusion, hallucinations, delusions, tremors, impaired speech, motor dysfunction and difficulty in eating. In the end, the affected person is unable to function on his own.

Treatment

Dementia has no cure. It may be symptomatically treated with proper diet and some medication.

1. Thompson SBN. Dementia and memory: a handbook for students and professionals. Aldershot: Ashgate 2006.
2. Howard R, McShane R, Lindesay J, et al. Donepezil and memantine for moderate-to-severe Alzheimer's disease. N Engl J Med 2012; 366:893.
3. Raina P, Santaguida P, Ismaila A, et al. Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Ann Intern Med 2008; 148:379.
4. Jellinger KA. The pathology of "vascular dementia": a critical update. J Alzheimers Dis. May 2008;14(1):107-23.
5. Sonnen JA, Larson EB, Crane PK, et al. Pathological correlates of dementia in a longitudinal, population-based sample of aging. Ann Neurol. Oct 2007;62(4):406-13
6. AD2000 Collaborative Group, Bentham P, Gray R, et al. Aspirin in Alzheimer's disease (AD2000): a randomised open-label trial. Lancet Neurol 2008; 7:41.
7. Bennett DA, Schneider JA, Arvanitakis Z, et al. Neuropathology of older persons without cognitive impairment from two community-based studies. Neurology. Jun 27 2006;66(12):1837-44.
8. Quinn JF, Raman R, Thomas RG, et al. Docosahexaenoic acid supplementation and cognitive decline in Alzheimer disease: a randomized trial. JAMA 2010; 304:1903.
9. Wolfson C, Wolfson DB, Asgharian M, et al. A reevaluation of the duration of survival after the onset of dementia. N Engl J Med 2001; 344:1111.
10. Verghese J, Crystal HA, Dickson DW, Lipton RB. Validity of clinical criteria for the diagnosis of dementia with Lewy bodies. Neurology. Dec 10 1999;53(9):1974-82.