Edit concept Create issue ticket

Dementia

Dementing Neurological Disease or Syndrome

Dementia is a loss of cognitive abilities severe enough to interfere with normal activities of daily living. It is most common in elderly individuals, with advancing age being the strongest risk factor. The most common cause of dementia is Alzheimer disease (AD), but there are numerous other known causes. Most types of dementia are nonreversible. Symptoms vary depending on the cause and the area of the brain that is affected.


Presentation

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.

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]
Weight Loss
  • Weight loss, malnutrition and dehydration are common problems for people with dementia.[ncbi.nlm.nih.gov]
  • This can lead to weight loss. Driving may be dangerous and not possible for someone with dementia. Lewy body dementia Lewy body dementia is a particular form of dementia that can be mistaken for Alzheimer's.[patient.info]
  • Some patients have problems remembering to eat and may develop pronounced weight loss. In late stages of dementia, patients often cannot recognize family members and their ability to communicate effectively is markedly impaired.[medicinenet.com]
Fatigue
  • 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]
  • HSV persists in the peripheral nervous system and can be triggered by stress,illness or fatigue. [150] High proportions of viral-associated proteins in amyloid-containing plaques or neurofibrillary tangles (NFTs) highly confirm the involvement of HSV-[en.wikipedia.org]
Down Syndrome
  • Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer's disease. Mild cognitive impairment. This involves difficulties with memory but without loss of daily function. It puts people at higher risk of dementia.[mayoclinic.org]
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]
  • 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]
  • Other drugs that cause dry mouth , constipation , and sedation ("anticholinergic side effects") may cause dementia or dementia symptoms.[emedicinehealth.com]
  • [Expert consensus] Physical problems Examples of physical problems that could potentially affect a person’s wellbeing include, but are not limited to: joint and muscular pain undiagnosed pain incontinence dizziness constipation urinary tract infection[pathways.nice.org.uk]
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]
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]
  • 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]
Delusion
  • 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]
  • The individual may: Recognize faces but forget names Mistake a person for someone else Delusions—such as thinking he/she needs to go to work — may set in, even though he/she no longer has a job There is a strong need for holding something close for tactile[alzfdn.org]
  • Validating a loved one’s perceptions via “therapeutic fibbing” can be the kindest, most respectful way to handle hallucinations and delusions. 120 Comments Medical Tests Used to Diagnose Alzheimer’s Disease If a loved one is experiencing unusual memory[agingcare.com]
Withdrawn
  • Thirty-five patients were withdrawn from the study because of adverse reactions, deterioration or death: 25 (31.3%) during active treatment [23 (52.3%) who received buprenorphine], and ten (12.2%) in the placebo group.[ncbi.nlm.nih.gov]
  • Common symptoms of mild dementia include: memory loss of recent events personality changes , such as becoming more subdued or withdrawn getting lost or misplacing objects difficulty with problem-solving and complex tasks, such as managing finances trouble[healthline.com]
  • For others there will be a shift to a different but more constant mood state — usually this is a more withdrawn and depressed state, although some people will become more happy-go-lucky than they used to be, Dr Farrow says. 9.[abc.net.au]
  • Mood, behaviour and personality changes may mean that someone with dementia is not able to interact with others in a social situation and they can become quite withdrawn.[patient.info]
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]
  • "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]
  • […] is a needed before prescribing antipsychotic medication for symptoms of dementia. [91] Antipsychotic drugs should be used to treat dementia only if non-drug therapies have not worked, and the person's actions threaten themselves or others. [92] [93] Aggressive[en.wikipedia.org]
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]
  • 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]
Confusion
  • These include restlessness and agitation, depression, anxiety, forgetfulness and confusion.[symptoma.com]
  • 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]
  • Search Our Award Winning Knowledge Base for Answers to your Questions About Alzheimer's and dementia Confusion about Alzheimer's and dementia on the part of family and friends The confusion is felt on the part of patients, family members, the media, and[alzheimersreadingroom.com]
  • Treating conditions that can lead to confusion often greatly improve mental function.[nlm.nih.gov]
Forgetful
  • People with Alzheimer's disease could prepare a meal and not only forget to serve it but also forget they made it. 3.[brain.northwestern.edu]
  • Early (Mild) In this stage, people may: Forget words or misplace objects Forget something they just read Ask the same question over and over Have increasing trouble making plans or organizing Not remember names when meeting new people Middle (Moderate[alzfdn.org]
  • They often know about their forgetfulness. Not everyone with MCI develops dementia.[nlm.nih.gov]
  • Other symptoms of changes in short-term memory include forgetting where they left an item, struggling to remember why they entered a particular room, or forgetting what they were supposed to do on any given day. 2.[healthline.com]
  • Although she thought that they took her belongings, she wrote: "I'll try not to forget to be grateful to them." The diaries show that even as the dementia progressed, Aki was aware of her cognitive decline compounded by family losses.[ncbi.nlm.nih.gov]
Agitation
  • 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]
  • A retrospective chart review of 5 patients with dementia of mixed etiologies was conducted comparing pretreatment and posttreatment scores on the Cohen-Mansfield Agitation Inventory.[ncbi.nlm.nih.gov]
  • The proposed techniques are able to recognise agitation and unusual patterns with an accuracy of up to 80%.[ncbi.nlm.nih.gov]
  • The analyzed group consisted of 96 residents (78 female) with moderate and severe cognitive impairment in whom pain was assessed with the Abbey Pain Scale (APS) and agitation with the Cohen-Mansfield Agitation Inventory (CMAI).[ncbi.nlm.nih.gov]
  • Dementia may cause your loved one to become agitated. Behavior changes and emotional distress are common. Some people experience mild agitation, which makes them act in ways that are out of character.[psychguides.com]
Personality Change
  • 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.[symptoma.com]
  • A Mental Health Condition Dementia is an umbrella term for conditions involving cognitive impairment, with symptoms that include memory loss, personality changes, and issues with language, communication, and thinking.[dementia.org]
  • Cognitive functions that may be affected by dementia include the following: Decision making, judgment Memory Spatial orientation Thinking, reasoning Verbal communication Dementia also may result in behavioral and personality changes, depending on the[healthcommunities.com]
  • But a person with Alzheimer's disease can show drastic personality changes, becoming extremely confused, suspicious, or fearful. 10.[brain.northwestern.edu]
Irritability
  • We have also developed a hierarchical information fusion approach for detecting agitation, irritability and aggression. We have conducted evaluations using sensory data collected from homes of people with dementia.[ncbi.nlm.nih.gov]
  • These include changes in mood, such as increased irritability, depression, and anxiety. They also include changes in personality and behavior.[healthinaging.org]
  • Some behavior issues you might encounter include: Demands for attention Pacing, searching, or rummaging Hitting Biting Yelling Threatening Stubborn refusals to participate Irritability and frustration A patient may become agitated for physical, medical[psychguides.com]
  • […] gradual loss of memory of recent events and lack of ability to learn new things increasing tendency to repeat oneself, misplacing objects, becoming confused and lost in familiar places slow disintegration of judgment and reasoning abilities increasing irritability[medbroadcast.com]
  • Patients may respond to loss of independence and memory with irritability, hostility, and agitation.[merckmanuals.com]

Workup

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.

Slowing
  • Electroencephalography demonstrated bifrontal slowing with left-sided emphasis, and captured two focal onset partial seizures with the clinical correlate of the syndrome described above.[ncbi.nlm.nih.gov]
  • Given that there is currently no definite cure for dementia and the cost of care for this condition soars dramatically, slowing the decline and maintaining independent living are important goals for supporting people with dementia.[ncbi.nlm.nih.gov]
  • […] processes within psychiatric and psychological specialties, and this has been acknowledged within medical and neurology-based disciplines.Arts-based therapies are generally considered as interventions managing manifestations of dementia, as they may help to slow[ncbi.nlm.nih.gov]
  • However, there are medications that can relieve symptoms and slow down the progression of the disease. Medications such as donepezil*, rivastigmine, and galantamine may be used to slow down memory loss.[medbroadcast.com]
  • There are no treatments to stop the diseases that cause dementia – while some treatments can help people to live with their symptoms a little better , there are no treatments that slow or stop diseases like Alzheimer’s.[alzheimersresearchuk.org]
Generalized Slowing
  • Ischemic vascular dementia (IVD): IVD is the second most common dementia, characterized by an abrupt loss of function or general slowing of cognitive abilities that interferes with what are called “executive functions” such as planning and completing[caregiver.org]

Treatment

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].

Prognosis

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.

Etiology

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.

Epidemiology

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].

Sex distribution
Age distribution

Pathophysiology

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.

Prevention

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].

Summary

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.

Patient Information

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.

References

Article

  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.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2017-08-09 18:13