Dementia

What is Dementia?

Dementia is a loss of brain function that occurs with certain diseases. It can affect memory, thinking, language, judgment and behavior. Typically, these changes are significant enough to affect one's ability to perform basic tasks such as driving, managing the finances, cooking, or taking medications appropriately. For more information about dementia or to schedule an appointment, call (206) 341-1900.

Most types of dementia are degenerative, meaning the changes in the brain that are causing the dementia cannot be stopped or reversed. Dementia is rare in people under age 60, though the risk increases with age. The most common causes of degenerative dementia are:

  • Alzheimer's disease
  • Brain impairment due to vascular problems (such as a series of small strokes, known as multi-infarct dementia). 
  • Lewy body disease, in which abnormal protein structures, called Lewy bodies, develop in parts of the brain associated with thinking and movement (also known as Lewy body dementia). 

Dementia is also associated with other diseases and conditions, including:

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

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

  • Brain tumors
  • Changes in blood sugar, sodium, and calcium levels
  • Low vitamin B12 levels
  • Normal pressure hydrocephalus - a condition causing excess fluid and pressure on the brain
  • Use of certain medications
  • Thyroid conditions

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Risk Factors for Dementia

Most causes of degenerative dementia are not preventable.

You can reduce the risk of vascular dementia (which includes multi-infarct dementia, caused by a series of small strokes), by quitting smoking and controlling high blood pressure and diabetes. Eating a low-fat diet and exercising regularly may also reduce the risk of vascular dementia.

Symptoms of Dementia

Dementia interferes with many areas of mental functioning, from memory to language to abstract thinking. Though individual symptoms of dementia vary greatly depending on the cause, some common signs and symptoms include:

  • Memory loss
  • Difficulty communicating or remembering words
  • Inability to learn or remember new information
  • Difficulty with planning and activities requiring multiple steps
  • Impaired coordination and motor functions
  • Personality changes
  • Inability to reason
  • Agitation
  • Hallucinations

Because other medical conditions can cause dementia symptoms, it's important to see a doctor as early as possible to determine the underlying cause. Early diagnosis is also important so that treatment can begin before symptoms get worse.

Diagnosing Dementia

There is no single test to diagnose dementia. Instead, the disorder is diagnosed by documenting which symptoms are present and ruling out other conditions that might be causing the signs and symptoms. Because of the complexity of the disorder, a patient may undergo a variety of tests. Examples of diagnostic tests for dementia include:

  • Mental status assessment - In these tests cognitive function is evaluated by measuring abilities such as language, learning, attention, recall and reasoning. A complete medical history looks at a range of factors that can cause dementia symptoms including prescription drugs, head trauma, thyroid disease, chronic infections and others.
     
  • Blood tests - Blood tests performed in the lab can reveal problems caused by infections, vitamin deficiency, anemia, medication levels and dysfunction of the thyroid or other organs.
     
  • Brain imaging - Brain imaging tests help rule out structural abnormalities in the brain brought on by blood clots, brain tumor or stroke. Types of studies used most often are magnetic resonance imaging (MRI) and computed tomography (CT). In some patients, another scanning technique may be performed depending on individual needs.
     
  • Other tests - Other tests that sometimes help provide a diagnosis include an electroencephalogram (EEG) or an electromyogram (EMG), procedures which record activity in the brain and muscles respectively. Urine and spinal fluid tests may also be performed.

At Virginia Mason, patients benefit from a multidisciplinary approach for the most accurate and timely diagnosis possible. If the diagnosis is a dementia that is known to worsen over time, an accurate diagnosis provides the patient and family members time to plan for the future while the patient can still participate in making decisions.

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Treatment of Dementia

The goal of treatment is to control the symptoms of dementia, which vary from patient to patient depending on the cause. Mental functioning can be greatly improved if the underlying disorder is a treatable condition, such as:

  • Anemia
  • Hypoxia (decreased oxygen)
  • Heart failure
  • Infection
  • Depression
  • Thyroid disorders
  • Nutritional deficiencies

Medications that treat behavior problems may also be useful to control symptoms such as loss of judgment, agitation and confusion. Possible medications include:

  • Antipsychotics (haloperidol, risperdal, olanzapine)
  • Mood stabilizers/antidepressants (fluoxetine, imipramine, citalopram)
  • Drugs affecting serotonin levels (trazodone, buspirone)
  • Stimulants (methylphenidate)

Certain drugs are sometimes effective for slowing the rate at which symptoms worsen. However the benefit from these drugs is often small or not detectable, and patients and their families may find the side effects intolerable. Drugs currently approved to treat dementia include:

  • Donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne, formerly called Reminyl)
  • Memantine (Namenda)

Providers from Speech and Language, Occupational Therapy and Physical Therapy can assist with setting up offsetting systems and programs of physical and cognitive activation to help sustain function and maximize abilities.

Family and caregivers can sometimes help patients manage confusion or disorientation at home by:

  • Keeping lights on at night.
  • Avoiding arguing with or correcting the patient; follow the patient's lead in conversation or change the subject.
  • Reward appropriate behaviors and ignore inappropriate ones to control unacceptable or dangerous behaviors.
  • Stick to a simple activity schedule.

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