Dementia

DEFINITION

Dementia is a chronic illness characterized by a progressive, irreversible decline in mental ability, accompanied by changes in behavior, personality, and, in the late stage, motor functions.

The contemporary Diagnostic and Statistical Manual of Mental Disorders (DSM-5, fifth edition) of the American Psychiatric Association (APA) has replaced the term “dementia” with “major neurocognitive disorder” and “mild neurocognitive disorder.”

The APA claim that since the word “dementia” is in widespread use and is easily understood by everyone, it will probably remain in use rather than the newly introduced term.

As such, the time will be used below and refers to a major neurocognitive disorder. In dementia, there is commonly a loss of memory and the skills required to carry out activities of daily living.

The changes are severe enough to seriously impair the person’s ability to function or to interact socially, and include changes due to diseases (e.g., Alzheimer’s and Creutzfeldt-Jakob diseases);

changes due to stroke (vascular dementia) or repeated blows to the head (dementia pugilistica, as experienced by boxers); and damage due to long-term alcohol abuse.

There are over 70 different variants of dementia, but Alzheimer’s disease (AD) is considered the form that causes the most complications.

DEMOGRAPHICS

The demographic dissemination of dementia varies somewhat according to its cause. Dementia tends to occur in older populations, and the rate of occurrence doubles every five years after the age of 65.

The global predominance of dementia from all causes is between 5% and 7% in adults above the age of 65 and tends to be higher among women than men.

This difference is partly due to women having a longer life expectancy than men. Global systematic reviews and meta-analyses have reported lower rates of dementia in sub-Saharan Africa and higher in Latin America correlated to the rest of the world.

Recent research indicates that dementia in many individuals has overlapping causes, so it is not always simple to assess the actual rates of occurrence of the different types.

For example, Alzheimer’s disease and multi-infarct dementia are found together in about 15%–20% of cases.

Over half of all nursing home admissions occur because of dementia. Surveys have found that dementia is the condition most feared by older adults in the United States.

Alzheimer’s disease 

According to the Alzheimer’s Association (AA), AD is the sixth-leading cause of death in the United States and the fifth-leading cause of death for persons 65 years of age or older.

Data collected between 2000 and 2008 showed a decline in the death rates of most major diseases; however, the death rate for AD increased by 66% over this same time frame.

The predominance of dementia increases rapidly with age. It affects about 1% of people from the age of 60 to 64 years and approximately doubles every five years after age 60, affecting 30% to 50% of adults by age 85.

In total, AD afflicts about 5.4 million individuals in the United States, two-thirds of whom are women.

Researchers do not know yet if the sex ratio reflects the fact that women tend to live longer than men, and so the men who do survive to older ages tend to be hardier or more resilient, or whether female sex is itself a risk factor for AD.

Multi-infarct dementia

Multi-infarct dementia (MID), also called vascular dementia, is responsible for 15%–20% of instances of dementia (not counting cases in which it present with AD).

Dissimilar to AD, MID is more prevalent in men than in women. Heart disease, diabetes, high blood pressure, and smoking history are all danger factors for MID.

Scientists in Sweden have suggested that MID is underdiagnosed and may coexist with other dementias more frequently than is presently recognized.

Dementia with Lewy bodies

Dementia with Lewy bodies (DLB), also called by such other names as Lewy body dementia, is now believed to be the second most prevalent form of dementia after Alzheimer’s disease.

However, because researchers do not entirely understand the relationship between Lewy bodies, AD, and Parkinson’s disease, the demographic distribution is unclear.

Other Dementias

Frontal lobe dementia (FLD), Pick’s disease (also called Pick’s dementia), Huntington’s disease, Parkinson’s disease, human immunodeficiency virus (HIV) infection, alcoholism, head trauma, and other causes of dementia account for about 10% of all cases.

In FLD and Pick’s disease, women appear to be affected slightly more often than men.

Dementia pugilistica, dementia typically occurring in boxers that develops due to repeated head injury, is thought to affect at least 15% of fighters and has been increasingly found in players of such other contact sports as football.

Dementia pugilistica is more commonly known as chronic traumatic encephalopathy or CTE as of 2018.

DESCRIPTION

The interpretation of dementia has become more comprehensive over the past few decades.

Although earlier descriptions of dementia emphasized memory loss, the current DSM-5 defines dementia (major neurocognitive disorder) as a drop-in mental ability severe enough to interfere with the independence and daily life.

It includes a decline in intellectual function, including difficulties with language, simple calculations, planning and judgment, abstract reasoning, and memory loss.

Dementia is not caused simply by aging, although it is pretty standard in older people. Many researchers regard it as resulting from injuries, infections, brain diseases, tumors, biochemical changes within the brain, or other disorders.

Researchers have recently found a possible connection between dementia and attention deficit hyperactivity disorder (ADHD).

Argentine researchers reported in 2010 that adults with symptoms of ADHD are more than three times more likely than other adults to develop Lewy body dementia later in life, though further research is needed.

The most common types of dementia are AD, vascular dementia, Lewy body dementia, frontotemporal dementia, and HIV-associated dementia. Mixed dementia points out having more than one type.

Risk factors 

Certain factors, such as older age, family history of dementia, Down syndrome, and having mild cognitive impairment, put people at higher risk of dementia.

Other risk factors can be addressed to reduce risk. These include heavy alcohol use, such as cardiovascular factors as high blood pressure or high cholesterol, depression, diabetes, smoking, and sleep apnea.

Genetic factors present a role in a few types of dementia, but the significance of these factors in the evolution of dementia varies greatly.

AD is well-known, for instance, to possess an autosomal (non-sex-related) superior pattern in most early-onset events, additionally as in some late-onset cases, and to show different degrees of penetrance (frequency of expression) in late-life patients.

Researchers have not yet found how the genes associated with dementia interact with other risk factors to produce or trigger dementia.

CAUSES AND SYMPTOMS

Causes

Dementia can be caused by as many as 80 different illnesses and conditions, going from dietary deficiencies and metabolic disorders to head traumas and inherited diseases.

Types of dementia and their causes include:

• Primary dementia. Those dementias are characterized by damage to or wasting away of the brain tissue itself. They include AD, Pick’s disease, and frontal lobe dementia.
• Multi-infarct dementia. Also known as vascular dementia, this type is induced by blood clumps in the small blood vessels in the brain. When the chunks severe the blood supply into the brain tissue, the brain cells are corrupted and may die.
• Lewy body dementia. Lewy bodies are spots of injury found on damaged nerve cells in particular parts of the brain. They are combined with AD and Parkinson’s illnesses. However, researchers still do not know if dementia with Lewy bodies is unique dementia or diversity of AD or Parkinson’s disease.
• Dementia is associated with alcoholism or exposure to heavy metals (e.g., arsenic, antimony, bismuth, mercury).
• Dementia-related to infectious diseases. These infections may be caused by viruses (e.g., HIV, viral encephalitis), spirochetes (e.g., Lyme disease, syphilis), or prions (e.g., Creutzfeldt-Jakob disease).
• Dementia is linked to abnormalities in the structure of the brain. These can include an accumulation of spinal fluid inside the brain (hydrocephalus), cancers, or blood collecting under the membrane covering the brain (subdural hematoma).
• Dementia is caused by injury. These include dementia pugilistica, also called chronic traumatic encephalopathy, which results from a repeated head injury, or post-traumatic dementia, which results from one severe traumatic brain injury. Symptoms of dementia might not appear until years after the injury.
• Mixed dementia. Autopsy studies of people 80 years of age and older who had dementia show a combination of AD, vascular disease, and Lewy body dementia.

Dementia may also be connected with depression, low thyroid hormone levels, niacin, or vitamin (B12) insufficiency. Dementia associated with these conditions is often reversible.

EARLY-ONSET ALZHEIMER’S DISEASE

In initial-onset AD, which accounts for 2%–7% of AD cases, the symptoms develop before age 60. Early-onset AD usually is caused by an inherited genetic mutation and is prevalent in persons with Down syndrome.

LATE-ONSET ALZHEIMER’S DISEASE

Research indicates that late-onset AD, also called sporadic AD, is a polygenic illness; its evolution is influenced by more than one gene.

As of 2018, at least 20 genes were associated with the development of AD. Finding genetic risk factors like these helps scientists understand how AD develops and identify possible treatments to study.

Specifically, the National Institute on Aging supports several major genetics research programs, including the Alzheimer’s Disease Genetics Study, the Alzheimer’s Disease Genetics Consortium, the Dominantly Inherited Alzheimer Network (DIAN), and the National Cell Repository for Alzheimer’ Disease (NCRAD).

The Alzheimer’s Disease Genetics Consortium helps to collect and conduct GWAS for tens of thousands of samples from people who have late-onset AD.

MULTI-INFARCT DEMENTIA

 While the main risk factors for MID are high blood pressure (hypertension), advanced age, smoking, diabetes mellitus (diabetes), hypercholesterolemia (high cholesterol), and cardiovascular and cerebrovascular disease, there is a hereditary form of MID labeled CADASIL, which means for “cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.”

CADASIL may cause psychiatric disturbances and severe headaches as well as dementia.

Several studies have documented a link between elevated levels of an amino acid called homocysteine in the blood and the chance of acquiring dementia, primarily vascular dementia.

As homocysteine concentration can be modified by diet, the finding proposes that this risk factor for dementia may be controllable.

FRONTAL LOBE DEMENTIAS

Researchers believe that between 25% and 50% of cases of FLD involve genetic factors. Pick’s disease seems to have a significantly smaller genetic factor than FLD.

It is still unknown what other risk factors combine with inherited traits to influence the development of frontal lobe dementias.

FAMILIAL BRITISH DEMENTIA

Familial British dementia (FBD) is an uncommon autosomal dominant illness, first reported in the 1940s in a prominent British family extending over nine generations.

FBD resembles AD in that the individual develops progressive dementia affiliated to amyloid buildups in the brain. 

In 1999, a mutated gene that develops the amyloid responsible for FBD was discovered on human chromosome 13.

It was reported that this mutation results in the production of an amyloidogenic fragment called amyloid-Bri (ABri). Studies of this mutation are yielding further clues as to the development of both FBD and AD.

CREUTZFELDT-JAKOB DISEASE

Although random mutations in prion proteins cause Creutzfeldt-Jakob disease (CJD), researchers believe that 5% to 15% of cases may have a genetic component; mutations are inherited.

The genetic (hereditary) part of its cause is called familial CJD, or fCJD.

Symptoms

Dementia is manifested by a gradual impoverishment of thought and other mental activities, regardless of its cause.

Losses finally affect virtually every aspect of cognitive functioning. Specific symptoms may vary, depending on the type of dementia, and tend to exist along a continuum.

Personality changes and behavioral disturbances can occur early or late in the disease. The types of symptoms such as motor or other neuralgic deficits occur at specific stages dependent on the type of dementia.

Psychosis has been found to occur in 10% of patients with dementia. Common signs and symptoms include changes in:

• Attention. Being easily distracted; having difficulty sustaining attention unless the input is restricted or simplified; difficulty holding information in mind long enough to do a mental calculation; experiencing decreased information-processing speed-thinking/processing takes longer than usual.
• Learning and memory. Episodic memory deficits, including difficulty remembering specific autobiographical events, situations, and experiences; short-term/working memory deficits, rapid forgetting of information recently seen or heard; difficulty acquiring and retaining new information.
• Reasoning and controlling functioning. Distress setting goals and planning, among other things, dependence on others to prepare activities and create decisions; poor judgment and impaired reasoning and problem-solving abilities, such as making decisions without regard to safety; difficulty multitasking and handling complex tasks; the difficulty is responding to feedback, self-monitoring, and correcting one’s errors; difficulty keeping up with shifting conversations; absence of inhibition; loss of mental flexibility.
• Perceptual capacity. Difficulty finishing previously normal activities or navigating in friendly environments; inability to recognize ordinary people, everyday objects, and sounds; getting lost in familiar places; increased use of notes and maps; failure to find things in direct view independent of visual acuity.
• Language. Less concise (empty) discourse with fewer ideas; economy of utterances and stereotypy of speech; repetitious or perseverative language; word-finding difficulties; difficulty recalling names of family and friends; tangential language; circumlocution; grammatical errors, including omission or incorrect use; use of jargon and loss of meaningful speech; difficulty following and maintaining conversation; in bilingual patients, errors in selecting and maintaining the appropriate language during conversation; regression to primary language in bilingual patients; language comprehension deficits; difficulty following multi-step commands; impaired ability to compose meaningful written language; reading comprehension difficulties.
• Social cognition and behavior. Inappropriate behavior outside of socially acceptable range; inability to read facial expressions and other social cues; loss of empathy and judgment; mood fluctuations, including agitation and crying; restlessness; depression; adverse reaction to questioning; combativeness/hostility/aggressiveness; compulsive or obsessive behaviors; erratic or strange behaviors; loss of initiative/motivation; paranoia and delusions of persecution.

ALZHEIMER’S DISEASE

 Dementia connected to AD often progresses slowly; it may be accompanied by irritability, wide mood swings, and personality changes in the early stage.

In second-stage AD, the individual usually gets lost easily, is disoriented concerning time and space around, and may become angry, uncooperative, or aggressive.

In final-stage AD, the individual is entirely disabled, has lost management over bowel and bladder operation, and cannot swallow or eat.

The risk of seizures increases as the individual progresses from early to end-stage AD. Death often results from an infection or malnutrition.

MULTI-INFARCT DEMENTIA

In MID, symptoms are more likely to occur after age 70. In the early stages, the individual retains his or her personality more thoroughly than an individual with AD.

Another unique feature of this type of dementia is that it often progresses in a stepwise fashion; that is, the individual shows rapid changes in functioning and stays at a plateau for a while instead of showing a continuous drop.

The symptoms of MID can also have a “patchy” quality; that is, some of the individual’s mental functions can be severely affected while others remain relatively undamaged. MID’s specific symptoms involve:

• Exaggerated reflexes.
• An atypical gait (fashion of walking).
• Deprivation of bladder or bowel control.
• Inappropriate laughing or crying.

DEMENTIA WITH LEWY BODIES

 This mode of dementia may blend certain features of AD, such as harsh memory loss and confusion, with specific symptoms associated with Parkinson’s disease, such as rigid muscles, a shuffling gait, and shaking or trembling of the hands.

Visual hallucinations may be one of the initial indications of dementia, including Lewy bodies.

FRONTAL LOBE DEMENTIAS

The frontal-lobe dementias are gradual in onset. Pick’s disease is most likely to develop in persons between the ages of 40 and 60, while FLD typically begins before age 65.

The first symptoms of FLD often include socially inappropriate behavior (e.g., rude remarks, sexual gestures, lack of personal hygiene).

Individuals usually are obsessed with eating and may put non-food items in their mouths and make frequent sucking or smacking noises.

In the later stages of FLD or Pick’s disease, the individual may develop muscle weakness, twitching, and delusions or hallucinations.

CREUTZFELDT-JAKOB DISEASE

 Dementia associated with CJD occurs most often in persons between ages 40 and 60 years of age.

It is mainly preceded by several weeks in which the individual complains of uncommon tiredness, anxiety, loss of appetite, or difficulty concentrating.

The first sign that a person may have CJD is rapidly advancing dementia, which leads to memory loss, hallucinations, and personality changes.

These symptoms are followed by irregular body movements, seizures, rigid posture, speech problems, and balance/coordination dysfunction.

This type of dementia typically progresses a lot more rapidly than other dementias, commonly over a few months.

DIAGNOSIS

In some instances, a patient’s primary physician may diagnose dementia; in multiple cases, however, the patient will be sent to a neurologist or a specialist in geriatric medicine.

The differential diagnosis of dementia is difficult because of the number of likely causes because higher than one cause may be present. Hence, dementia may coexist with other illnesses like depression and delirium.

Delirium is a brief disturbance of consciousness marked by confusion, restlessness, inability to focus attention, hallucinations, or delusions.

In older folks, delirium is regularly a side effect of surgical procedures, medications, infectious diseases, or dehydration.

Delirium may be distinguished from dementia because delirium usually comes on abruptly (in a couple of hours or days) and can vary in harshness—it is generally worse at night.

Dementia evolves much more slowly, during months or even years, and the patient’s symptoms are nearly stable.

It is attainable for a person to have delirium and dementia at the exact moment.

Another essential diagnostic distinction in elderly patients is between dementia and age-connected memory impairment (AAMI).

Older adults with AAMI have a soft degree of memory loss; they do not acquire new information as fast as younger people, and they can take longer to recall a specific factor to balance their check-book, but they do not have the degree of memory degradation that distinguish dementia, and they are not getting progressively worse.

Other problems that may be mistakenly labeled as dementia include psychosis, depression, and the side effects of various medications.

The DSM-5 specifies that specific criteria must be met for an individual to be diagnosed with dementia.

The criteria for dementia (major cognitive disorder) are:

• Proof of severe cognitive decline from a previous level of performance in one or more cognitive domains: learning and memory, language, executive function, complex attention, perceptual-motor, or social cognition. Evidence of decline is established on: concern of the person, a knowledgeable informant, or the clinician that there has been a severe drop of cognitive function; and a considerable impairment in cognitive performance, instead documented by standardized neuropsychological testing, or in its absence, another quantified clinical assessment.
• The cognitive deficits meddle with independence in everyday activities. At a minimum, assistance should be required with complex instrumental activities of daily living, such as paying bills or managing medications.
• The cognitive deficits do not happen exclusively in the circumstance of delirium.
• Other mental illness does not better explain the cognitive shortage(e.g., major depressive disorder, schizophrenia).

Examination

PATIENT HISTORY

The doctor will begin by taking a complete history containing the patient’s profession and educational degree and medicinal history.

The professional and academic records support the examiner to create a more accurate appraisal of the range of the patient’s memory damage and other evidence of intellectual deterioration. 

In some instances, the professional history can indicate exposure to heavy metals or other toxic matters.

A complete medical record enables the doctor to assess such possibilities as delirium, depression, alcohol-related dementia, dementia connected to head trauma or dementia generated by infection.

It is especially critical for the doctor to have a complete list of all the patient’s meds, including over-the-counter concoctions, due to the chance that the patient’s symptoms are connected to side effects.

MENTAL STATUS EXAMINATION

A mental status examination (MSE) assesses the patient’s ability to communicate, follow instructions, recall information, and perform rudimentary tasks, including movement and coordination. His or her emotional condition and overall sense of space-time.

 The MSE involves the doctor’s causal evaluation of the patient’s image, vocal tone, facial appearances, posture, gait, and legal questions or instructions.

One common form that has been used since 1975 is the Folstein Mini-Mental Status Examination or MMSE. 

Inquiries being pertinent to diagnosing dementia involve asking the patient to count in backward from 100 by 7s, to create change, to name the current president, to repeat a short phrase after the examiner, to draw a clock face or geometric figure, and to follow a set of instructions involving movement (e.g., throwing a ball or folding paper).

The analyst may test the patient’s abstract reasoning ability by asking him or her to explain a familiar proverb or test the patient’s judgment by asking about a problem with a commonsense solution, such as what a person should do when a prescription exhaust.

NEUROLOGICAL EXAMINATION

 A neurological analysis involves an evaluation of the patient’s cranial nerves and reflexes. The cranial nerves control the ability to speak and see, hear, taste, and smell.

The patient may be asked to extend the tongue, follow the tester’s finger with the eyes, raise the eyebrows, etc.

The patient is also asked to perform specific actions that test coordination and spatial orientation, such as touching the tip of the nose with the eyes shut.

The doctor will commonly feel or tap particular body areas, being the knee or the sole, to evaluate the patient’s reflexes. Failure to react to the touch or tap may indicate damage to certain parts of the brain.

Tests

LABORATORY TESTS

 Blood and urine specimens are gathered to rule out such diseases as thyroid deficiency, heavy metal poisoning, HIV infection, syphilis, niacin (vitamin B12) deficiency, anemia, liver disease, medication response, or kidney failure.

A lumbar perforation (spinal tap) can be done to rule out the possibility of neurosyphilis.

DIAGNOSTIC IMAGING

The patient can be given a CT (computed tomography) scan or MRI (magnetic resonance imaging) scan to expose evidence of strokes, degradation of the brain tissue in some areas, blood clumps or cancers, a buildup of spinal fluid, or bleeding into the brain tissue.

PET (positron emission tomography) or SPECT (single-photon emission computed tomography) imaging is not used commonly to diagnose dementia but can be used to rule out AD or frontal lobe degeneration if a patient’s CT or MRI scan is inconclusive.

TREATMENT

Traditional

Traditional methods for treating dementia are proven to be effective at slowing some of the symptoms associated with dementia.

In some cases, cognitive function can be improved but not corrected. Some types of dementia respond better to treatment than others.

In all cases, proper care and support for the individual who has dementia are helpful, whether provided at home or in an institution.

REVERSIBLE AND RESPONSIVE DEMENTIAS

 Certain types of dementia can be reversed, and a couple of types reacts to specific treatments associated with their root causes.

Dementia connected to nutritional deficiencies or metabolic diseases is treated with suitable vitamins or thyroid medicament.

Dementia-related to HIV infection often responds well to zidovudine (Retrovir), a drug given to prevent AIDS (acquired immune deficiency syndrome) from replicating. MID is usually treated by regulating the patient’s blood tension and diabetes;

Simultaneously, procedures for these illnesses cannot revert damage already done to brain tissue; they can slow down the progress of dementia.

Patients with alcohol-caused dementia frequently improve over the long term if they can stop drinking. 

Dementias connected to head traumas, hydrocephalus, and cancers are handled by surgery.

It is crucial to evaluate and treat elderly patients for depression because the symptoms of depression in older people often mimic dementia.

This condition is sometimes called pseudodementia. In addition, patients with both depression and dementia frequently show specific improvement in intellectual operation when the depression is treated.

IRREVERSIBLE DEMENTIAS

There are no meds or surgical techniques to cure AD, frontal lobe dementias, multi-infarct dementia, or dementia with Lewy bodies.

There are also no treatments that reverse or stop the progression of these dementias.

Early intervention may help minimize complications and allow the patient to compensate for the alterations in functioning, culminating in an improved quality of life.

It may also allow the patient and family to plan for the future and to identify resources.

BEHAVIORAL TREATMENT

Behavioral methods may decrease the frequency or harshness of problem behaviors such as aggression or socially unacceptable conduct.

Problem behavior can be a response to frustration or overstimulation

. Understanding and modifying the situations that trigger problem behaviors may be adequate;

strategies can involve breaking down intricate tasks such as dressing up or feeding into more straightforward steps or lowering the environment’s activity to refrain confusion and agitation.

Enjoyable activities, such as crafts, games, and music, can provide therapeutic stimulation and improve mood.

HOME MODIFICATION

Customizing the environment can enhance safety and comfort while at the same time lowering agitation.

Domestic modifications for safety include removing or locking such hazards as sharp knives, dangerous chemicals, and tools.

Childproof latches may be used to limit access as well. Bed rails and bathroom security rails can be necessary safety measures.

Confusion may be reduced with the use of simpler decorative schemes and the presence of familiar objects.

Covering or disguising doors can reduce the impulse to wander. Placing the bed because of the bathroom can decrease incontinence.

LONG-TERM CARE

Long-term institutional care may be required for persons with dementia, as severe cognitive losses frequently anticipate death by several years. Beforehand planning for the financial difficulty of nursing home care is crucial. 

Valuable information regarding budgeting planning for continuing care is obtainable through the Alzheimer’s Association.

Family members or other people caring for a person with dementia are often subject to severe stress. They may acquire feelings of rage, guilt, resentment, and hopelessness, on top of the sorrow they acknowledge for their loved ones and themselves.

Depression is an immensely common aftermath of being a full-time caretaker for an individual with dementia. Backing groups can be an important way to cope with the stress of caregiving.

Contact numbers are available from the Alzheimer’s Association; they may also be available through a local social service agency.

The primary goals of treatment for progressive dementias are preserving as much functioning and independence as possible and maintaining the quality of life as long as possible. Caring for a person with dementia can be difficult and complex.

The patient must cope with functional and cognitive limitations, while family members or other caregivers must consider increasing responsibility for the person’s physical needs.

The patient and family should be educated early on in the disease progression to help them anticipate and plan for inevitable changes.

Drugs

Periodically, new drugs are studied for the treatment of dementia.

The only drugs approved by the U.S. Food and Drug Administration (FDA) as of 2018 for the symptomatic treatment of dementia are donepezil (Aricept), rivastigmine (Exelon), galantamine (Lycoremine, Nivalin, Razadyne, Razadyne ER, Reminyl), and memantine (Namenda).

The first three are called cholinesterase inhibitors (which prevent the breakdown of acetylcholine, a chemical in the brain that is thought to help with memory and thinking).

At the same time, the last one is classified as a noncompetitive low-to-moderate affinity N-methyl-D-aspartate (NMDA) receptor antagonist and works by regulating the activity of glutamate.

The cholinesterase inhibitor drugs may provide temporary improvement in cognitive functioning for a relatively large percentage of patients with mild-to-moderate dementia. Adverse effects may include nausea, vomiting, and diarrhea.

Memantine is prescribed for moderate-to-severe dementia only; one common side effect is dizziness. Doctors sometimes prescribe both types of drugs for their patients.

However, drug therapy can be complicated by forgetfulness, especially if the medicine must be taken several times per day.

Sedating and anticholinergic drugs are to be avoided as they tend to worsen dementia.

Psychotic symptoms involving paranoia, delusions, and hallucinations may be cured with antipsychotic medicaments such as chlorpromazine, haloperidol, chlorpromazine, clozapine, and risperidone.

Adverse effects of these drugs can be significant. Antianxiety drugs like diazepam (Valium) may improve behavioral symptoms, especially agitation and anxiety, although buspirone (BuSpar) has fewer side effects.

The anticonvulsant carbamazepine (Tegretol) is occasionally prescribed for unrest.

Depression is treated with anti-depressants, usually beginning with selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) or paroxetine (Paxil).

In general, medications are administered cautiously in the lowest possible doses to individuals with dementia to minimize side effects. Supervision of taking drugs is generally required.

Research is ongoing on how the brain and AD are intertwined and how studies of the brain lead to advances in the diagnosis and treatment of AD and other dementias.

Swiss researchers reported that new technologies, such as digital holographic microscopy (DHM), allow more thorough observation of neuronal activity in the brain, allowing for better testing of the effects of AD drugs.

Alternative therapies

No alternative therapies have been found to prevent conclusively, reverse, or slow dementias except for those caused by nutrient deficiencies.

However, some alternative therapies may help treat the specific symptoms associated with dementia.

Aromatherapy and music therapy have shown promise for relieving symptoms of agitation and promoting calm in patients with dementia.

Sage and ginkgo Biloba have also shown some effectiveness in clinical trials with treating symptoms of AD and dementia, respectively.

Though past studies touted the success of ginkgo Biloba, the research found the herb to make little difference in the cognitive health of participants of a large-scale study.

Further research is needed to test the efficacy of herbal and nutritional supplements in treating symptoms of dementia.

PROGNOSIS

The predictions for reversible dementia connected to nutritional or thyroid problems are commonly fair once the cause has been recognized and treated. 

The prognoses for dementias connected to alcoholism or HIV infection depend on the patient’s age and the severity of the underlying disorder.

For those with irreversible, progressive dementia, the outlook often includes slow deterioration in mental and physical capacities, ending in death.

Eventually, help is usually required when swallowing, walking, and even sitting become difficult.

Aid can consist of preparing special diets that can be more easily consumed and making surroundings safe in case of falls.

Lift assists in such areas as the bathroom can also be helpful. On average, people with AD live eight years past their diagnosis, ranging from 1–20 years. 

Subjects with frontal lobe dementia or Pick’s disease live on average between five and ten years after diagnosis.

The course of Creutzfeldt-Jakob disease is much more rapid, with patients living between five and twelve months after diagnosis.

Vascular dementia is usually progressive, with death resulting from stroke, infection, or heart disease.

PREVENTION

Dementia induced by repeated hits to the head can be prevented by avoiding sports in which head trauma is common.

Alcohol abuse–related dementia can be prevented by avoiding excessive alcohol consumption or minimized by receiving early treatment for alcoholism.

Good nutrition can prevent nutrient-deficiency dementia. Unfortunately, most forms of dementia cannot be stopped.

Resources

WEBSITES