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What is dementia?

Dementia is a medical condition that affects a person’s memory and other aspects of thinking such as communication and problem-solving. It is most common in older people aged 70 and above, but it can sometimes be seen in younger people as well. The risk of dementia increases with age. Dementia is a progressive disorder, meaning that it gets worse over time.

 

Dementia can interfere with a person’s ability to perform their daily activities like managing finances, driving, taking medications, and planning meals. Eventually, more basic functions like bathing, grooming, and eating can be affected. As dementia progresses, a person may no longer be able to safely live on their own. Patients may need extra help at home from family and caregivers or may need to consider a facility that can provide around the clock care. There is no cure for dementia, but there are numerous medical and non-medical treatments and strategies that can help manage it and improve symptoms. 

Types of Dementia
Alzheimer dementia


Alzheimer dementia is by far the most common type of dementia. It accounts for 60-80% of all cases of dementia. It affects mostly memory, but can also affect language, judgement, and spatial cognition. It usually starts slowly and progresses with time. 


For more information visit alz.org and healthinaging.org.


To learn about stages of Alzheimer disease, visit alz.org/alzheimers-dementia/stages. 


To view the 10 Early Warning Signs of Dementia created by the the Alzheimer Association, visit alz.org.


Vascular dementia


Vascular dementia is a type of dementia caused by damage to brain cells from impaired blood flow. This vascular damage can be from strokes or other vascular disease. Vascular dementia is the second most common type of dementia and is often mixed with Alzheimer dementia. The types of thinking that are affected by vascular dementia depend on the areas of the brain affected. The progression of vascular dementia can be gradual, or involve sudden deterioration from multiple strokes. 


Lewy body dementia


Lewy body dementia is a less common type of dementia, accounting for 5-10% of cases. Typical symptoms include hallucinations, acting out dreams, fluctuations in alertness, memory impairment, and movement problems such as rigid muscles, hunched posture, and slow shuffling gait. The progression of lewy body dementia is usually faster than Alzheimer dementia. 


Frontotemporal dementia


Frontotemporal dementia is not very common and is usually diagnosed at a younger age than other types of dementia. It affects a person’s behavior, personality, and language skills. There are several subtypes of frontotemporal dementia, including behavior variant frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA). 

What can be confused with dementia?
Normal Aging


It is normal to have some age-related changes in memory and cognition. The important distinction is that normal age-related changes in cognition are mild and don’t affect daily activities. Examples of normal aged-related changes include forgetting to pay a bill once in a while, needing to write down appointments, occasionally having trouble finding the right word, or sometimes forgetting today’s date. 


For more information, visit alz.org/alzheimers-dementia/10_signs  

Mild Cognitive Impairment


Mild cognitive impairment is classified by mild changes in memory and thinking which are noticeable and may be picked up on a memory evaluation performed by a professional such as a doctor or psychologist.  Even though these mild changes are apparent, they are not severe enough to affect the patient’s day to day activities such as driving, shopping, or managing finances. People with mild cognitive impairment are at a higher risk of developing dementia in the future. In some cases, mild cognitive impairment may be a very early stage of dementia. 


For more information, visit alz.org/alzheimers-dementia/what-is-dementia/related_conditions


Depression


Sometimes depression can cloud thinking and impair memory. People with depression may also show decreased motivation during testing, leading to poor performance on memory evaluations. The difference between dementia and memory impairment due to depression is that memory impairment due to depression improves as the depression is treated. 


Depression and dementia may also coexist. Many people living with dementia experience changes in mood such as depression, which can be treated with talk therapy and medication. 
Talk to your doctor if you have questions or concerns about depression. 


Delirium


Delirium is an altered and confused mental state that develops over a short period of time and usually has a reversible cause, such as medication or illness. Dementia, however, develops more slowly and is not reversible. 


For more on delirium, visit our page on delirium or visit healthinaging.org/a-z-topic/delirium. 

How is dementia diagnosed?

Dementia can be diagnosed by a healthcare provider such as a primary care doctor, geriatrician, neurologist, psychiatrist, or clinical psychologist. There is no one test that definitively gives the diagnosis of dementia. Rather, the provider must take a thorough history of the nature of symptoms, time course, progression, functional impairment, life situation, mood, medications, and related medical history.

 

Additional information provided by a family member or close friend is essential. A cognitive evaluation is performed by the provider which tests memory and other cognitive functions in a standardized manner. The provider also performs a physical exam to evaluate for any related physical signs, such as tremor or muscle rigidity. Blood work is reviewed to evaluate for other medical causes for memory impairment, such as electrolyte abnormalities or vitamin deficiencies. The healthcare provider may also order an imaging study of the brain to get more information. 


Talk to your doctor or dementia specialist if you have questions or concerns about the diagnosis of dementia. 
For more information, visit healthinaging.org/a-z-topic/dementia/tests 

Treatment and Management

Although dementia does not have a cure, management and treatment strategies can optimize quality of life and day-to-day function. Practicing healthy habits, getting regular medical care, and staying physically, mentally, and socially active can help patients maintain cognitive function.


Patients with later stage dementia may develop behavior disturbances, which can be distressing to patients, families, and caregivers. Examples of behavior disturbances include anxiety, depression, sleep problems, irritability, wandering, physical aggression, and hallucinations. In cases of dementia with behavioral disturbances, it is especially important to create a multidimensional care plan to minimize symptoms, distress, and caregiver burden. 


Caregiver Education


Educating families and caregivers about prognosis, symptoms, and management is essential. Many caregivers experience significant stress and burden, which can negatively affect their own health and the well-being of their loved one. Education programs can teach caregivers how to effectively manage challenging situations and behaviors. Caregivers can also discover resources in their communities for things like support groups, legal advice, in-home caregiving, respite care, adult daycare, and living facilities. Education can help prepare families and caregivers for future challenges that may arise. In late stages of dementia, palliative care or hospice services may be appropriate. Hospice is well-suited for patients with end stage dementia who want to remain in their homes and prioritize comfort. 


For great sources of caregiver education, visit


Alzheimer Association Help and Support page
alz.org/help-support 
This page on the Alzheimer Association website features helpful information such as types of care available, stages and behaviors of dementia, what to expect, and support programs. You can also find a 24 hour dementia helpline (800-272-3900), links to local resources, education courses, and online tools. 


Alzheimer Association Stages and Behaviors page
alz.org/help-support/caregiving/stages-behaviors 
Find more about the stages of dementia, caregiving tailored to each stage, and how to tackle challenging behaviors such as wandering or hallucinations. 


Alzheimer Association Training and Education Center
training.alz.org/
This page features free e-learning courses on topics like understanding dementia, challenging conversations, effective communication, and legal and financial planning.


Community Resource Finder 
communityresourcefinder.org/ 
This site allows you to search for services such as home care, home health, geriatric care managers, elder law attorneys, transportation, hospice, and housing in your area. 


UCLA Alzheimer’s and Dementia Care Program 
uclahealth.org/dementia/caregiver-education 
This website offers a wealth of excellent caregiver education videos on topics like agitation, anxiety, refusal to bathe, wandering, and lack of eating. It also features free caregiver education webinars taught by UCLA faculty on topics like travelling with a loved one with dementia, aggressive behavior, and caregiver burden. 

 


Environment Modification


People with dementia are strongly affected by their environment, and new or unfamiliar places may be frightening. Careful adjustment to environments often have a significant positive impact on mood, behavior, and functioning. 
People with dementia are easily affected by the mood and behavior of those around them. Don’t raise your voice or display anger, as this will often cause confusions and anxiety, making communication more difficult. Use a calming and positive tone, smile, and try again later if your loved one is frustrated or not cooperating. 


People with dementia may become frustrated and upset when they don’t understand. Remember to speak in simple sentences, and if necessary ask to ensure you have been understood. Remind them who you are and what you are doing. Avoid asking patients with dementia to perform complicated tasks or multiple tasks at once. 


An interactive and familiar routine can do wonders for a person with dementia by making them feel safe, secure, and engaged. Try to create a familiar and pleasant environment with photographs and familiar objects, as well as a trusted family member or friend nearby. Create a routine with enjoyable activities that aren’t boring or too overwhelming for the patient. They may enjoy such activities as taking walks, listening to music, or making artwork. 


Try putting reminders around the house to keep your loved one oriented. For example, put clocks, calendars, photographs, and the day’s schedule in a noticeable place. 


For excellent tips on how to optimize the daily routine of your loved one, visit

alz.org/help-support/caregiving/daily-care 


Safety Measures


It is important for families and caregivers to ensure the safety of patients with dementia. Patients may have impaired judgement and lack safety awareness. Safety concerns depend on the person’s stage and severity of judgement. For example, a person with early or mild dementia may need to stop driving or take precautions to avoid financial scams. In later stages of dementia, other safety concerns such as wandering or access to dangerous objects in the home may become issues.

 

With some creativity and ingenuity, solutions to common safety concerns can be found. For example, door locks, wander alarms, GPS tracking devices, and medical alert bracelets can reduce danger with wandering behavior. Removing throw rugs, installing bathroom grab bars, and keeping hallways well lit can reduce fall risk. Keeping weapons, sharp objects, and hazardous chemicals hidden away and locked up will ensure the patient’s safety. 


For a great home safety checklist broken down by each room of the home, visit

alz.org/media/Documents/alzheimers-dementia-home-safety-checklist-ts.pdf 


To learn more about the stages of dementia and for articles on how to tackle challenging behaviors such as wandering or hallucination, visit alz.org/help-support/caregiving/stages-behaviors 


Medications


Medications for dementia are solely meant to improve symptoms. No dementia medications have been shown to cure, reverse, or even stop the progression of dementia. Medications should be used cautiously and carefully because every medicine can have adverse side effects. Older people with dementia are especially prone to adverse effects, and may not be able to communicate if they have a bothersome side effect. Side effects are common, disruptive, and sometimes dangerous, so weighing the risks and benefits is essential. In general, the philosophy in geriatrics is to use the fewest medications at the lowest possible dose to achieve the desired effect. 


Acetylcholinesterase inhibitors


Examples: donepezil (Aricept), rivastigmine (Exelon)
This class of medication is FDA approved for the treatment of mild, moderate, and severe dementia
Scientific evidence shows that these medicines may slightly slow progression of cognitive decline, behavior problems, and loss of function. 
Side effects include diarrhea, headaches, dizziness, insomnia, and dangerously slow heart rate.


Memantine


Also known as trade name Namenda
This medication is FDA approved for the treatment of moderate to severe dementia. 
Evidence shows that this medicine has a minimal effect on thinking, function, and behavior. 
Common side effects are dizziness, confusion, constipation, and headache. 


Antidepressants


Examples include citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), and mirtazapine (Remeron)
People with dementia may experience depressive symptoms, such as low mood, fatigue and loss of appetite which can lead to worsening cognition, function, and behavior. Treating depression can ease these symptoms. 
Depending on the medication, side effects may include nausea, weight gain, sexual side effects, and insomnia. 
Mood stabilizers
Examples include divalproex sodium (Depakote) and carbamazepine (Tegretol)
In some instances, people with dementia can experience mood disorders resembling mania. Symptoms may include pressured speech, insomnia, hyperactivity, and emotional instability. Mood stabilizers may improve these symptoms. 
Depending on the medication, side effects may include nausea, sedation, tremor, and abnormal blood tests. 


Antipsychotics


Examples include haloperidol (Haldol), quetiapine (Seroquel), and olanzapine (Zyprexa)
These medications are sometimes used to treat psychotic features of dementia such as delusions, hallucinations, and aggression. However, scientific studies have shown they increase the risk of death when used in people with dementia. Therefore, a careful risk vs. benefit analysis is essential. These medicines are only recommended when safer alternatives have been exhausted and patients are at risk of harming themselves or others. 
Side effects include heart rhythm abnormalities, sedation, elevated blood sugar, tremor, and abnormal muscle movements. 


More information on medications for memory, visit

alz.org/alzheimers-dementia/treatments/medications-for-memory 


For more information on medications for behavior, visit

alz.org/alzheimers-dementia/treatments/treatments-for-behavior 

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