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

  If pain is a falls risk factor, this represents a potentially important point of intervention for falls prevention. Falls are a major cause of disability and loss of independent living status in older people. [doi.org]

  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]

• 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. Continue reading the main story [web.archive.org]

• Fatigue

  […] 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]

  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]

  Memory lapses are a normal part of aging and can also occur due to other factors, such as: fatigue lack of concentration multitasking Still, don’t ignore the symptoms. [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]

• Nocturnal Awakening

  […] minutes less in the trazodone group (60.4 less to 19.6 more) ‐ 30 (1 RCT) ⊕⊕⊝⊝ LOW 1, 2 Number of nocturnal awakenings assessed with: actigraphy follow‐up: 2 weeks The mean number of nocturnal awakenings in the placebo group was 26 The number of nocturnal [doi.org]

  95% CI 1.9 to 15.1; N = 30; one study) in patients with moderate-to-severe AD, but it did not affect the amount of time spent awake after sleep onset (MD -20.41, 95% CI -60.4 to 19.6; N = 30; one study), or the number of nocturnal awakenings (MD -3.71 [ncbi.nlm.nih.gov]

• Whipple Disease

  Castle J, Sakonju A, Dalmau J, Newman-Toker DE: Anti-Ma2-associated encephalitis with normal FDG-PET: a case of pseudo-Whipple’s disease. Nat Clin Pract Neurol 2006, 2: 566–572; quiz 573. PubMed CrossRef Google Scholar 14. [doi.org]

• 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]

  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]

  Delirium can also be caused by severe illness, surgery, pain, dehydration, constipation, poor nutrition or a change in medication. [alzheimers.org.uk]

• 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]

  Dementia and dysphagia. Geriatric Nursing, 29, 275–285. Elliot, G. M. (2015). Montessori methods for dementia: Focusing on the person and the prepared environment. Oakville, ON: DementiAbility Entreprises. [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

  KEYWORDS: Alzheimer’s disease; Cognitive impairment; Deafness; Dementia; Hearing impairment; Hearing loss; Systematic review [ncbi.nlm.nih.gov]

  […] years have a hearing impairment (pure-tone audiometric thresholds >25 dB hearing loss [HL] in the better ear; [ 2 ]). [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]

  The program begins at admission to the hospital, with screening for delirium risk factors, including cognitive impairment, sleep deprivation, immobility, dehydration, and vision or hearing impairment. [health.harvard.edu]

• Sweating

  Fatigue Headache Insomnia (difficulty falling and staying asleep) Irritability or excitability Loss of appetite Nausea, vomiting Nervousness, jumpiness, shakiness, palpitations (sensation of feeling the heart beat) Pale skin Rapid emotional changes Sweating [medlineplus.gov]

  Blood group antigens are found on red blood cells, platelets, leukocytes, plasma proteins, certain tissues, and various cell surface enzymes, and also exist in soluble form in body secretions such as breast milk, seminal fluid, saliva, sweat, gastric [ncbi.nlm.nih.gov]

• 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]

  Symptoms of DLB include having difficulties staying focused, experiencing delusions, and problems with movement and sleep. It is closely related to Parkinson’s disease. [alzheimers.org.uk]

• 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]

  Reduced awareness of the environment This may result in: An inability to stay focused on a topic or to switch topics Getting stuck on an idea rather than responding to questions or conversation Being easily distracted by unimportant things Being withdrawn [mayoclinic.org]

• Mood Swings

  Communicating with a person living with a dementia Where to find help and support People living with a dementia can experience mood swings as they cope with their condition. [nidirect.gov.uk]

  Dementia and other disorders Sometimes dementia may be accompanied by other mental disorders like mood swings, anxiety and depression and confusion. Many other illnesses can cause dementia. [news-medical.net]

  swings Stages of Dementia Usually, dementia goes through these stages. [webmd.com]

  They might experience changes in personality and behaviour, mood swings, anxiety and depression. People with dementia can lose interest in seeing others socially. [dementiauk.org]

• 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]

  Mood changes leading to aggressive behavior Poor performance of job duties As dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of oneself. [medlineplus.gov]

  Disturbance; Aggressive 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 [web.archive.org]

  "They end up being on lots of medications for aggressive behaviors." The goal, she says, is giving them back control over their lives. [cnbc.com]

• Emotional Outbursts

  Mood swings and emotional outbursts may be treated with mood-stabilizing drugs. Agitation and psychosis (hallucinations and delusions) may be treated with antipsychotic medication or, in some cases, anticonvulsants. [emedicinehealth.com]

• 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]

  […] catheter to manage urinary incontinence. [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]

• Cognitive Impairment

  Practice guideline update summary: mild cognitive impairment: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(3):126-135. [medlineplus.gov]

  Validation therapy was developed by Naomi Feil between 1963 and 1980 for older people with cognitive impairments. [ncbi.nlm.nih.gov]

  Three basic elements for a diagnosis of VaD are 1) evidence of dementia or cognitive impairment, 2) evidence of CVD, and 3) evidence of a casual relationship between cognitive impairment and CVD. [doi.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]

  Apathy, depression, irritability, agitation, and anxiety are the most frequently detected neuropsychiatric symptoms of AD. [ncbi.nlm.nih.gov]

• Confusion

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

  The symptoms get worse over time and include: memory loss confusion and needing help with daily tasks problems with language and understanding changes in behaviour. [alzheimers.org.uk]

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

  They will likely advise you to call if symptoms become worse (such as obvious changes in behavior, personality, memory, or speech) or if new symptoms appear, such as sudden weakness or confusion. [hopkinsmedicine.org]

• Forgetful

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

  […] an acquaintance Forgetting the most recent events Normally, knowledge and experiences built over years, old memories, and language would stay intact. [cdc.gov]

  A person with dementia may also display other changes in their short-term memory, such as: forgetting where they placed items struggling to remember why they entered a particular room forgetting what they were supposed to do on any given day 2. [healthline.com]

  Other Types of Memory Loss Dementia is not temporary confusion or forgetfulness that might result from an infection that heals without treatment. It can also come from an underlying illness or side effects of medications. [webmd.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]

  A condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems. Symptoms may also include personality changes and emotional problems. [icd9data.com]

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.