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    Dementia

    Chronic brain syndrome; Lewy body dementia; DLB; Vascular dementia; Mild cognitive impairment; MCI

    Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.

    Causes

    Dementia usually occurs in older age. It is rare in people under age 60. The risk of dementia increases as a person gets older.

    Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer's disease is the most common type of dementia.

    Lewy body disease is a leading cause of dementia the elderly. People with this condition have abnormal protein structures in certain areas of the brain.

    Dementia also can be due to many small strokes. This is called vascular dementia.

    The following medical conditions can also lead to dementia:

    • Huntington's disease
    • Brain injury
    • Multiple sclerosis
    • Infections that can affect the brain, such as HIV /AIDS, syphilis,and Lyme disease
    • Parkinson disease
    •   Pick disease
    • Progressive supranuclear palsy

    Some causes of dementia may be stopped or reversed if they are found soon enough, including:

    • Brain injury
    • Brain tumors
    • Chronic alcohol abuse
    • Changes in blood sugar, sodium, and calcium levels (dementia due to metabolic causes)
    • Low vitamin B12 level
    • Normal pressure hydrocephalus
    • Use of certain medicines, including cimetidine and some cholesterol drugs

    Symptoms

    Dementia symptoms include difficulty with many areas of mental function, including:

    • Emotional behavior or personality
    • Language
    • Memory
    • Perception
    • Thinking and judgment (cognitive skills)

    Dementia usually first appears as forgetfulness.

    Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere withdaily activities. They are often aware of the forgetfulness. Not everyone with MCI develops dementia.

    Symptoms of MCI include:

    • Difficultydoing more than one task at a time
    • Difficulty solving problems or making decisions
    • Forgetting recent events or conversations
    • Taking longer todo more difficult mental activities

    Early symptoms of dementia can include:

    • Difficultywith tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines
    • Getting lost on familiar routes
    • Language problems, such as troublewith the names of familiar objects
    • Losing interest in things previously enjoyed, flat mood
    • Misplacing items
    • Personality changes and loss of social skills, which can lead to inappropriate behaviors

    As dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of oneself. Symptoms may include:

    • Change in sleep patterns, often waking up at night
    • Difficultywith basic tasks, such as preparing meals, choosing proper clothing, or driving
    • Forgetting details about current events
    • Forgetting events inone's own life history, losing self-awareness
    • Having hallucinations, arguments, striking out, and violent behavior
    • Having delusions, depression, agitation
    • More difficulty reading or writing
    • Poor judgment and loss of ability to recognize danger
    • Using the wrong word, not pronouncing words correctly, speaking in confusing sentences
    • Withdrawing from social contact

    People with severe dementia can no longer:

    • Perform basic activities of daily living, such as eating, dressing, and bathing
    • Recognize family members
    • Understand language

    Other symptoms that may occur with dementia:

    • Incontinence
    • Swallowing problems

    Exams and Tests

    A skilled health care provider can often diagnose dementia with the following steps:

    • Complete physical exam, including nervous system exam
    • Asking about the person’s medical history and symptoms
    • Mental function tests (mental status examination)

    Other tests may be ordered to find out if other problems may be causing dementia or making it worse. These conditions include:

    • Anemia
    • Brain tumor
    • Chronic infection
    • Intoxication from medications
    • Severe depression
    • Thyroid disease
    • Vitamin deficiency

    The following tests and procedures may be done:

    • B12 level
    • Blood ammonia levels
    • Blood chemistry (chem-20)
    • Blood gas analysis
    • Cerebrospinal fluid (CSF) analysis
    • Drug or alcohol levels (toxicology screen)
    • Electroencephalograph (EEG)
    • Head CT
    • Mental status test
    • MRI of head
    • Thyroid function tests
    • Thyroid stimulating hormone level
    • Urinalysis

    Treatment

    Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time.

    Stopping or changing medicines that make confusion worse may improve brain function.

    Some kinds of mental exercises can help dementia.

    Treating conditions that can lead to confusion often greatly improve mental functioning. Such conditions include:

    • Anemia
    • Congestive heart failure
    • Decreased blood oxygen (hypoxia)
    • Depression
    • Heart failure
    • Infections
    • Nutritional disorders
    • Thyroid disorders

    Medicines may be used to:

    • Slow the rate at which symptoms worsen, though improvement with these drugs may be small
    • Control problems with behavior such as loss of judgment or confusion

    Outlook (Prognosis)

    People with mild cognitive impairment do not always develop dementia. When dementia does occur, it usually gets worse and often decreases quality of life and lifespan. Families will likely need to plan for their loved one’s future care.

    When to Contact a Medical Professional

    Call your health care provider if:

    • Dementia develops or a sudden change in mental status occurs
    • The condition of a person with dementia gets worse
    • You are unable to care for a person with dementia at home

    Prevention

    Most causes of dementia are not preventable.

    Risk of vascular dementia may be reduced by:

    • Eating healthy foods
    • Exercising
    • Quitting smoking
    • Controlling high blood pressure
    • Managing diabetes

    References

    Apostolova LG, DeKosky ST, Cummings JL. Dementias. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 66.

    Bayer A. Presentation and clinical management of dementia. In: Fillit HM, Rockwood K, Woodhouse K, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 7th ed. Philadelphia, Pa; 2010:chap 52.

    Camicioli R, Rockwood K. Dementia diagnosis. In: Fillit HM, Rockwood K, Woodhouse K, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 7th ed. Philadelphia, Pa; 2010:chap 51.

    Knopman DS. Alzheimer’s disease and other dementias. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 409.

    Qaseem A, et al., American College of Physicians/American Academy of Family Physicians Panel on Dementia. Current pharmacologic treatment of dementia: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2008;148:370-378.

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        Review Date: 9/25/2013

        Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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