Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning. Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment or language, and the inability to perform some daily activities such as paying bills or becoming lost while driving.
Though memory loss generally occurs in dementia, memory loss alone doesn't mean you have dementia. There is a certain extent of memory loss that is a normal part of aging. Many causes of dementia symptoms exist. Alzheimer's disease is the most common cause of a progressive dementia. Some causes of dementia may be reversible.
Dementia symptoms vary depending on the cause, but common signs and symptoms include:
- Memory loss
- Difficulty communicating or finding words
- Difficulty with complex tasks
- Difficulty with planning and organizing
- Difficulty with coordination and motor functions
- Problems with disorientation, such as getting lost
- Personality changes
- Inability to reason
- Inappropriate behavior
When to see a doctor
See your primary care doctor if you or a loved one experiences memory problems or other dementia symptoms. Some treatable medical conditions can cause dementia symptoms, so it's important that a doctor determine the underlying cause.
Alzheimer's disease and several other types of dementia worsen over time. Early diagnosis gives you time to plan for the future while you can participate in making decisions. Dementia involves damage of nerve cells in the brain, which may occur in several areas of the brain.
Types of dementias that are not reversible and worsen over time include:
- Alzheimer's disease. In people age 65 and older, Alzheimer's disease is the most common cause of dementia. People generally may develop symptoms after age 60, but some people may have early-onset forms of the disease, often as the result of a defective gene. Alzheimer's disease usually progresses slowly over about eight to 10 years. Your cognitive abilities slowly decline. Eventually, the affected areas of your brain don't work properly, including parts of your brain that control memory, language, judgment and spatial abilities.
- Vascular dementia. Vascular dementia, the second most common type of dementia, occurs as a result of brain damage due to reduced or blocked blood flow in blood vessels leading to your brain. Blood vessel problems may be caused by stroke, infection of a heart valve (endocarditis) or other blood vessel (vascular) conditions. Symptoms usually start suddenly and often occur in people with high blood pressure or people who have had strokes or heart attacks in the past.
- Lewy body dementia. Lewy body dementia affects approximately 10 percent of people with dementia, making it one of the most common types of dementia. Lewy body dementia becomes more common with age. Lewy body dementia symptoms are similar to symptoms of Alzheimer's disease. Its unique features include fluctuations between confusion and clear thinking (lucidity), visual hallucinations, and tremor and rigidity (parkinsonism). People with Lewy body dementia often have a condition called rapid eye movement (REM) sleep behavior disorder that involves acting out dreams.
- Frontotemporal dementia. This type of dementia tends to occur at a younger age than does Alzheimer's disease, generally between the ages of 50 and 70. This is a group of diseases characterized by the breakdown (degeneration) of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language. Signs and symptoms of frontotemporal dementia can include inappropriate behaviors, language problems, difficulty with thinking and concentration, and movement problems.
- Brain tumors. Dementia rarely can result from damage caused by a brain tumor.
- Anoxia. This condition, also called hypoxia, occurs when organ tissues aren't getting enough oxygen. Anoxia may occur due to severe asthma, heart attack, carbon monoxide poisoning or other causes.
- Nutritional deficiencies. Dementia-like symptoms can occur as a result of not drinking enough liquids (dehydration); not having enough thiamine (vitamin B-1), a condition common in people with chronic alcoholism; and not having enough vitamins B-6 and B-12 in your diet.
- Age. As you age, the risk of Alzheimer's disease, vascular dementia and several other dementias greatly increases, especially after age 65. However, dementia isn't a normal part of aging, and dementia can occur in younger people.
- Family history. If you have a family history of dementia, you're at greater risk of developing the condition. However, many people with a family history never develop symptoms, and many people without a family history do.
- Heavy alcohol use. People who consume large amounts of alcohol may have a higher risk of dementia.
- Atherosclerosis. This buildup of fats and other substances in and on your artery walls (plaques) can reduce the blood flow to your brain and lead to stroke. Reduced blood flow to your brain can also cause vascular dementia.
- Blood pressure. Several studies show high blood pressure may increase your risk of developing dementia.
- Cholesterol. If you have high levels of low-density lipoprotein (LDL) cholesterol, you may have an increased risk of developing vascular dementia or Alzheimer's disease.
- Depression. Although not yet well understood, late-life depression, especially in men, may be an indication of the development of dementia.
- Diabetes. If you have diabetes, you may have an increased risk of developing Alzheimer's disease and vascular dementia.
- High estrogen levels. Women taking estrogen and progesterone years after menopause may be at greater risk of developing dementia.
- Obesity. Being overweight or obese during the middle of your life may increase your risk of developing dementia when you're older.
- Smoking. Smoking may increase your risk of developing dementia and blood vessel (vascular) diseases.
Dementia can affect the functioning of many body systems and, therefore, the ability to carry out day-to-day tasks. Dementia may lead to several problems, including:
- Inadequate nutrition. Many people with dementia will eventually reduce or stop eating and drinking. They may forget to eat or think they've already eaten. Changes in meal times or noise distractions in their environment may affect whether they eat. Often, advanced dementia causes you to lose control of the muscles used to chew and swallow. This may put you at risk of choking or aspirating food in your lungs. If this happens, it can block breathing and cause pneumonia. You also lose the feeling of hunger and, with it, the desire to eat.
- Reduced hygiene. In moderate to severe stages of dementia, you'll eventually lose the ability to independently complete daily living tasks. You may no longer be able to bathe, dress, brush your hair or teeth, or use the toilet on your own.
- Difficulty taking medications. Because your memory is affected, remembering to take the correct amount of medications at the right time can be challenging.
- Deterioration of emotional health. Dementia changes behaviors and personality. Some of the changes may be caused by the actual deterioration happening in your brain, while other behavioral and personality changes may be emotional reactions to coping with the changes in your brain. Dementia may lead to depression, aggression, confusion, frustration, anxiety, a lack of inhibition and disorientation.
- Difficulty communicating. As dementia progresses, you may lose the ability to remember the names of people and things. You may have trouble communicating with others or understanding others.
- Delusions and hallucinations. You may experience delusions in which you have false ideas about another person or situation. Some people, especially those with Lewy body dementia, may have visual hallucinations.
- Sleep difficulties. You may experience sleep difficulties, such as waking up very early in the morning. Some people with dementia may have restless legs syndrome or rapid eye movement (REM) sleep behavior disorder, which also can interfere with sleep.
- Personal safety challenges. Because of a reduced capacity for decision-making and problem-solving, some day-to-day situations can present safety issues for people with dementia. These include driving, cooking, falling, getting lost and negotiating obstacles.
Most likely, you'll first see your primary care doctor if you have concerns about dementia. In some cases, you may be referred to a doctor trained in nervous system conditions (neurologist).
Most types of dementia can't be cured. However, doctors will help you manage your symptoms. Treatment of dementia symptoms may help slow or minimize the development of symptoms.
- Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment.
- Memantine. Memantine (Namenda) works by regulating the activity of glutamate. Glutamate is another chemical messenger involved in brain functions, such as learning and memory.
- Other medications. Your doctor may prescribe other medications to treat other symptoms or conditions, such as a sleep disorder.
- Occupational therapy. Your doctor may suggest occupational therapy to help you adjust to living with dementia. Therapists may teach you coping behaviors and ways to adapt movements and daily living activities as your condition changes.
Several dementia symptoms and behavior problems may be treated initially using nondrug approaches, such as:
- Modifying the environment. Reducing clutter and distracting noise can make it easier for someone with dementia to focus and function. It also may reduce confusion and frustration.
- Modifying your responses. A caregiver's response to a behavior can make the behavior, such as agitation, worse. It's best to avoid correcting and quizzing a person with dementia. Reassuring the person and validating his or her concerns can defuse most situations.
- Modifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine during the day also help reduce confusion in people with dementia.
People with dementia will experience progression of their symptoms and behavior problems over time. Caregivers may need to adapt the following suggestions to individual situations:
- Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present only one idea or instruction at a time. Use gestures and cues, such as pointing to objects.
- Encourage exercise. Exercise benefits everyone, including people with dementia. The main benefits of exercise include improved strength and cardiovascular health. Some research also shows physical activity may slow the progression of impaired thinking (cognitive) function in people with dementia. Exercise can also lessen symptoms of depression, help retain motor skills and create a calming effect.
- Encourage participation in games and thinking activities. Participating in games, crossword puzzles and other activities in which people are using thinking (cognitive) skills may help slow mental decline in people with dementia.
- Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave night lights on to prevent disorientation. Limiting caffeine during the day, discouraging daytime napping and offering opportunities for exercise during the day may help prevent nighttime restlessness.
- Encourage keeping a calendar. Keeping a reminder calendar may help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one.
- Plan for the future. Develop a plan with your loved one that identifies goals for care in the future. Several support groups, legal advisers, family members and others can help you. You'll need to consider financial and legal issues, safety and daily living concerns, and long-term care options.
Some alternative medicine options for Alzheimer's disease and other forms of dementia that have been studied include:
- Vitamin E. Some studies have shown that vitamin E may slow the progression of Alzheimer's disease.
- Omega-3 fatty acids. Omega-3, a type of polyunsaturated fatty acid found in fish and nuts, may reduce the risk of heart disease, stroke and mild cognitive impairment.
- Coenzyme Q10. This antioxidant occurs naturally in your body. It's also necessary for normal cell reactions.
- Ginkgo. Extracts from the leaves of the Ginkgo biloba tree have antioxidant and anti-inflammatory properties that may protect cells in your brain from breaking down.
- Music therapy, which involves listening to soothing music
- Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia
- Aromatherapy, which uses fragrant plant oils
- Massage therapy
Receiving a diagnosis of dementia can be devastating to you and your loved ones. Many details need to be considered to ensure that you and those around you are as prepared as possible for dealing with a condition that's unpredictable and continually changing. Throughout the disease, you may experience a wide range of feelings. Here are some suggestions you can try to help yourself cope:
- Learn as much as you can about memory loss, dementia and Alzheimer's disease.
- Write about your feelings about having dementia in a journal.
- Join a local support group.
- Get individual or family counseling.
- Talk to a member of your church or another person who can help you with your spiritual needs.
- Stay active and involved, volunteer, exercise, and participate in activities for people with memory loss.
- Maintain contact and spend time with friends and family.
- Participate in an online community of people who are having similar experiences.
- Find new ways to express yourself, such as through painting, singing or writing.
- Delegate help with decision-making to someone you trust.
- Be patient with yourself.
There's no sure way to prevent dementia, but there are steps you can take that might help. More research is needed, but it may be beneficial to do the following:
- Keep your mind active. Mentally stimulating activities, such as puzzles and word games, and memory training may delay the onset of dementia and help decrease its effects.
- Be physically and socially active. Physical activity and social interaction may delay the onset of dementia and reduce its symptoms.
- Quit smoking. Some studies have shown smoking in middle age and older may increase your risk of dementia and blood vessel (vascular) conditions. Quitting smoking may reduce your risk.
- Lower your blood pressure. High blood pressure may lead to a higher risk of some types of dementia.
- Pursue education. People who have spent more time in formal education appear to have a lower incidence of mental decline, even when they have brain abnormalities.
- Maintain a healthy diet. Eating a healthy diet is important for many reasons, but a diet rich in fruits, vegetables and omega-3 fatty acids, commonly found in certain fish and nuts, may promote overall health and lower your risk of developing dementia.