Dementia

Condition Basics

What is dementia?

We all forget things as we get older. Many older people have a slight loss of memory that does not affect their daily lives. But memory loss that gets worse may mean that you have dementia.

Dementia is a loss of mental skills that affects your daily life. It can cause problems with memory, problem-solving, and learning. It also can cause problems with thinking and planning.

Dementia usually gets worse over time. But how quickly it gets worse is different for each person. Some people stay the same for years. Others lose skills quickly.

Your chances of having dementia rise as you get older. But this doesn't mean that everyone will get it.

What causes it?

Dementia is caused by damage to or changes in the brain. Alzheimer's disease is the most common cause. Strokes are the second most common cause. Other causes include diseases such as Parkinson's disease and frontotemporal dementia.

What are the symptoms?

Usually the first symptom of dementia is memory loss. Often the person with memory loss doesn't notice it. As dementia gets worse, the person may have trouble doing things that take planning. The person may have trouble using or understanding words or may get lost in well-known places.

How is it diagnosed?

There is no single test for dementia. To diagnose dementia, your doctor will do a physical exam and ask questions about illnesses and life events. Your doctor may test your memory by asking you to tell what day and year it is, repeat a series of words, or draw a clock face.

How is dementia treated?

Medicines for dementia can make it easier to live with. They may help improve mental function, mood, or behavior. An active social life, counseling, and sometimes medicine may help with changing emotions.

How can you care for someone who has dementia?

Care needs will change over time. You'll work with health professionals to create a safe and comfortable environment and make tasks of daily living easier. You can help by making sure the person eats well. You can also help manage sleep problems. The person may also need help with bladder and bowel control.

Cause

Dementia is caused by damage to or changes in the brain. Things that can cause dementia include:

• Alzheimer's disease. This is the most common cause.
• Strokes, tumors, or head injuries. This type of dementia is called vascular dementia.
• Diseases. These include Parkinson's disease, dementia with Lewy bodies, and frontotemporal dementia.

Some disorders that cause dementia can run in families. Doctors often suspect an inherited cause if someone younger than 50 has symptoms of dementia.

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Symptoms

Usually the first symptom of dementia is memory loss. Often the person who has the memory problem doesn't notice it, but family and friends do.

People who have dementia may have increasing trouble with:

• Recalling recent events. They may forget appointments or lose objects.
• Recognizing people and places.
• Keeping up with conversations and activity.
• Finding their way around familiar places, or driving to and from places they know well.
• Keeping up personal care such as grooming or bathing.
• Planning and carrying out routine tasks. They may have trouble following a recipe or writing a letter or email.

What Happens

How quickly dementia progresses depends on what is causing it and the area of the brain that is affected. Some types of dementia progress slowly over several years. Other types may progress more quickly.

The course of dementia varies greatly from one person to another. An early diagnosis and treatment with medicines may help for a while. Even without these medicines, some people remain stable for months or years, while others get worse quickly.

Many people with dementia aren't aware of their mental decline.

Over time, depending on the type of dementia, the way the person behaves may change. The person may become angry or agitated, or clingy and childlike. They may wander and become lost.

Even with the best care, people who have dementia tend to have a shorter life span than the average person their age.

When to Call a Doctor

Call 911 or other emergency services immediately if signs of a stroke or transient ischemic attack (TIA) develop suddenly. These may include:

• Numbness, weakness, or inability to move the face, arm, or leg, especially on one side of the body.
• Vision problems in one or both eyes, such as dimness, blurring, double vision, loss of vision, or feeling like a shade is being pulled down over the eyes.
• Confusion, or trouble speaking or understanding.
• Trouble walking, dizziness, or loss of balance or coordination.
• Severe headache with no known cause.

Call a doctor now if a person shows signs of delirium, which can be caused by a reaction to medicines or a new or worsening medical condition. These signs include:

• Suddenly becoming confused or emotionally upset.
• Seeming to not know who they are or where they are.
• Having a hard time focusing their attention.

Call a doctor if you or a person you are close to has new and troubling memory loss that is more than an occasional bout of forgetfulness. This may be an early sign of dementia.

Watchful waiting

Occasional forgetfulness or memory loss can be a normal part of aging. But any new or increasing memory loss or problems with daily living should be reported to a doctor. Learn the warning signs of dementia, and talk to a doctor if you or a family member shows any of these signs. They include increased trouble finding the right words when speaking, getting lost going to familiar places, and acting more irritable or suspicious than usual.

Exams and Tests

To diagnose dementia, your doctor will:

• Do a physical exam.
• Ask questions about recent and past illnesses and life events. The doctor will want to talk to a close family member to check details.
• Ask you to do some simple things that test your memory and other mental skills. Your doctor may ask you to tell what day and year it is, repeat a series of words, or draw a clock face.

The doctor may do tests to look for a cause that can be treated. For example, you might have blood tests to check your thyroid or to look for an infection. You might also have a test that shows a picture of your brain, like an MRI or a CT scan. These tests can help your doctor find a tumor or brain injury.

Knowing the type of dementia a person has can help the doctor prescribe medicines or other treatments. It can also help the person and their family or friends plan for lifestyle changes and decisions that need to be made after the diagnosis.

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Treatment Overview

Medicines for dementia might slow it down for a while and make it easier to live with. Medicines can't cure it. But they may help improve mental function, mood, or behavior.

If a stroke caused the dementia, doing things to reduce the chance of another stroke may help. These things include eating healthy foods, being active, staying at a weight that's healthy for you, and not smoking.

As dementia gets worse, a person may get depressed or angry and upset. An active social life, counseling, and sometimes medicine may help with changing emotions.

The goals of ongoing treatment are to keep the person safely at home as long as possible and to provide support and guidance to the caregivers.

The person will need routine follow-up visits. The doctor will monitor medicines and the person's level of functioning.

Self-Care

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Eat a variety of healthy foods, including fruits, vegetables, whole grains, low-fat dairy, and lean proteins. If you are not hungry, try snacks or nutritional drinks such as Boost, Ensure, or Sustacal.
• If you have problems sleeping, there are things that can help. Here are some tips.
  • Try not to nap too close to your bedtime.
  • Exercise regularly. Walking is a good choice.
  • Try a glass of warm milk or caffeine-free herbal tea before bed.
• Do tasks and activities during the time of day when you feel your best. It may help to develop a daily routine.
• Post labels, lists, and sticky notes to help you remember things. Write your activities on a calendar you can easily find. Put your clock where you can easily see it.
• Stay active. Take walks in familiar places, or with friends or loved ones. Try to stay active mentally too. Read and work crossword puzzles if you enjoy these activities.
• Your doctor will let you know whether it is safe for you to drive. Your state driver's license bureau can do a driving test if there is any question.
• Carry a cell phone in case you fall and need help. Or you can wear a device around your neck or wrist. You push a button that sends a signal for help.

Acknowledge your emotions and plan for the future

• Talk openly and honestly with your doctor.
• Let yourself grieve. It is common to feel angry, scared, frustrated, anxious, or depressed.
• Get emotional support from family, friends, a support group, or a counselor experienced in working with people who have dementia.
• Ask for help if you need it.
• Tell your doctor how you feel. You may feel upset, angry, or worried at times. Many things can cause this, including poor sleep, medicine side effects, confusion, and pain. Your doctor may be able to help you.
• Plan for the future.
  • Talk to your family and doctor about preparing a living will and other important papers while you can make decisions. These papers tell your doctors how to care for you at the end of your life.
  • Consider naming a person to make decisions about your care if you are not able to.

Medicines

Doctors use medicines to try to help with dementia. Medicines don't work for everyone. But for some people they may help by:

• Maintaining mental function for as long as possible.
• Managing mood or behavior problems. These include depression, insomnia, hallucinations, and agitation.
• Preventing more strokes in people who have dementia caused by stroke (vascular dementia).

Medicines to help maintain mental function

These medicines may include:

• Cholinesterase inhibitors. Examples are donepezil and galantamine.
• Memantine.

Medicines that may help manage mood or behavior problems

Many behavior problems can be managed without medicines.

In some cases, the doctor may prescribe:

• Antidepressants. Examples are citalopram and trazodone.
• Antipsychotic drugs. Examples are olanzapine and risperidone.

Medicines to prevent future strokes

The doctor may prescribe medicines for high blood pressure and high cholesterol. These drugs can't reverse existing dementia. But they may prevent future strokes and heart disease that can lead to more brain damage.

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Caring for Someone Who Has Dementia

Taking care of the person

• If the person takes medicine for dementia, help them take it exactly as prescribed. Call the doctor if you notice any problems with the medicine.
• Make a list of the person's medicines. Review it with all of their doctors.
• Help the person eat healthy foods. Try to serve fruits, vegetables, whole grains, low-fat dairy, and lean proteins every day. If the person is not hungry at mealtimes, give snacks at midmorning and in the afternoon. Offer drinks such as Boost, Ensure, or Sustacal if the person is losing weight.
• Encourage exercise. Walking and other activities may slow the decline of mental ability. Help the person stay active mentally with reading, crossword puzzles, or other hobbies.
• Talk openly with the doctor about any behavior changes. Many people who have dementia become easily upset or agitated or feel worried. There are many things that can cause this, such as medicine side effects, confusion, and pain. It may be helpful to:
  • Keep distractions to a minimum. It may also help to keep noise levels low and voices quiet.
  • Develop simple daily routines for bathing, dressing, and other activities. And remind the person often about upcoming changes to the daily routine, such as trips or appointments.
  • Ask what is upsetting the person. Keep in mind that people who have dementia don't always know why they are upset.
• Take steps to help if the person is sundowning. This is the restless behavior and trouble with sleeping that may occur in late afternoon and at night. Try not to let the person nap during the day. Offer a glass of warm milk or caffeine-free tea before bedtime.
• Be patient. A task may take the person longer than it used to.
• For as long as the person is able, allow them to make decisions about activities, food, clothing, and other choices. Let the person be independent, even if tasks take more time or are not done perfectly. Tailor tasks to the person's abilities. For example, if cooking is no longer safe, ask the person to set the table or make simple dishes such as a salad. When the person needs help, offer it gently.

Staying safe

• Make your home (or the person's home) safe. Tack down rugs, and put no-slip tape in the tub. Install handrails, and put safety switches on stoves and appliances. Keep rooms free of clutter. Make sure walkways around furniture are clear. Do not move furniture around, because the person may become confused.
• Use locks on doors and cupboards. Lock up knives, scissors, medicines, cleaning supplies, and other dangerous things.
• Do not let the person drive or cook if they can't do it safely. Their doctor will let you know whether it's safe for the person to drive. Your state driver's license bureau can do a driving test if there is any question.
• Get medical alert jewelry for the person so that you can be contacted if they wander away. If possible, provide a safe place for wandering, such as an enclosed yard or garden.

Taking care of yourself

• Ask your doctor about support groups and other resources in your area.
• Take care of your health. Be sure to eat healthy foods and get enough rest and exercise.
• Take time for yourself. Respite services provide someone to stay with the person for a short time while you get out of the house for a few hours.
• Make time for an activity that you enjoy. Read, listen to music, paint, do crafts, or play an instrument, even if it's only for a few minutes a day.
• Spend time with family, friends, and others in your support system.

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