Dementia: A Slow, Silent Thief
Dementia is a group of progressive symptoms that slowly but steadily robs people of their ability to think, reason, remember, learn, and function. It’s a painful way for a life full of love and productivity to end; painful both for the person afflicted and for the friends and family members who must watch their loved one’s personality and capabilities change so dramatically.
What is Dementia?
Dementia is not really the name of a specific disease. It is the name of a group of symptoms that occur due to a variety of different medical conditions that affect the brain.
What Causes Dementia?
A lot of different medical conditions can lead to dementia. Perhaps the most well known is ]]>Alzheimer’s disease]]> , in which abnormal and destructive changes occur within the brain’s structure. Other conditions that may also cause dementia include:
- Multiple small strokes (vascular dementia)
- ]]>Stroke]]> in certain locations
- ]]>Huntington’s disease]]>
- ]]>Parkinson’s disease]]>
- ]]>Creutzfeldt-Jakob disease]]> (or slow-virus infections) and other brain infections
- ]]>Multiple sclerosis]]>
- Severe brain injury
- Severe ]]>Thyroid dysfunction]]>
- Severe ]]>Vitamin B12]]> deficiency
- Late stage ]]>Syphilis]]>
What Are the Symptoms of Dementia?
People with dementia may have a variety of symptoms, such as:
- Gradually worsening memory loss (to previously known people, places, tasks)
- Difficulty concentrating
- Increasingly poor judgment
- Sleep problems
- Difficulty performing activities of daily living, including problems washing and dressing oneself, loss of bladder and bowel control
- Loss of language skills, eventually leading to the complete inability to speak
- Personality changes, including mood swings, depression, irritability, combativeness, agitation, or hallucinations
- Loss of executive function, the ability to perform calculations, pay bills, spell, and balance a check book
How Is Dementia Diagnosed?
Dementia is diagnosed by testing various mental functions, including memory, thinking, concentration, orientation, and judgment. When these tests are repeated over time, the results will become progressively more abnormal.
Can Dementia Be Cured?
Sometimes, medical testing reveals other problems that might be responsible for the symptoms of dementia (such as infections or chemical imbalances). In these cases, correcting the underlying problem might lead to improvement in the dementia. When dementia is due to ]]>Alzheimer’s disease]]> or another progressive illness (such as ]]>Parkinson’s disease]]>), there are no treatments to halt its progression.
How Is Dementia Treated?
If testing doesn’t uncover a curable cause for dementia, the only treatments are those that attempt to improve its symptoms. ]]>Rivastigmine]]> (Exelon), ]]>donepezil ]]>(Aricept), ]]>memantine ]]>(Namenda, Axura), and ]]>galantamine ]]>(Razadyne® (formerly available as Reminyl, Razadyne ER) are medications used in the treatment of Alzheimer’s Disease that try to slow the loss of function and improve thinking. Other medications that are under investigation include. beta- and gamma-secretase inhibitors, which interfere with the formation of abnormal plaques in the brain, and vaccines.
Dementia patients who are agitated, suspicious, combative, or who have unwanted thoughts or hallucinations may be treated with anti-psychotic medications.
Other important treatments for dementia involve making sure that the individual is in a safe environment as his or her judgment becomes increasingly impaired. Trying to keep the dementia patient as well-oriented as possible (by the presence of clocks and calendars) can be helpful. Although activity should be encouraged, it’s important to make sure that the activities are not frustrating to the patient.
Support for the Caregiver
Finally, if you are a caregiver for someone with dementia, make sure that you have some kind of respite care available. It’s an exhausting, emotionally-wrenching job to take care of someone you love who is undergoing changes and progressively becoming severely debilitated. You also need care, and should have regular breaks from your duties, so that you stay fresh and energized. Don’t be afraid to seek support from family, friends, your religious community, support groups, doctor, or social service organizations.
Alzheimer’s Disease Education and Referral Service (ADEAR) at the National Institute on Aging
Alzheimer Society Canada
Public Health Agency of Canada
Alzheimer’s Disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed March 17, 2008.
Beer, MH. Behavior disorders in dementia. Merck Manual of Geriatrics. 2000-2003.
Defilippi, JL, Crismon ML. Antipsychotic agents in patients with dementia. Pharmacotherapy. 2000;20(1)23-33.
Fago, J. Dementia: causes, evaluation, and management. Hospital Practice. 2001;36(1):59-66,69.
Farlow MR. Alzheimer’s disease. Continuum Lifelong Learning. Neurol. 2007;13(2):39-68.
Mace, N, Rabins PV. The Thirty-Six Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life. 4th Ed. Baltimore, MD: The Johns Hopkins University Press;2006.
Petersen RC, Thomas RG, Grundman M, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment (published electronically April 13, 2005). N Engl J Med. 2005;352(23):2379-2388.
Raskind MA, Peskind ER. Advances in the pathophysiology and treatment of psychiatric disorders: implications for internal medicine. Medical Clinics of North America. 2001;85(3).
Rosack, J. Antipsychotics effective for elderly patients with dementia. Psychiatric News. 2003;38(8)32.
Sano M, Ernesto C, Thomas RG, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. N Engl J Med. 1997;336:1216-1222.
Last reviewed March 2008 by ]]>J. L. Chang, MD, FAASM, D, ABSM]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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