Dementia is the name given to a group of disorders of the brain. They progressively damage the ability of the brain to function normally. In order to be diagnosed with dementia, there must be:

• A disturbance in memory
• A decline in one or more cognitive domains that cause functional impairment in:
  • Language
  • Visuospatial function
  • Executive function (foresight, planning, anticipation, insight)
  • Praxis (learned motor skills)

Causes of dementia include:

• Alzheimer's disease —the most common cause of dementia
• Brain damage after multiple small strokes (so-called vascular dementia)
• Alcoholism
• AIDS
• Multiple sclerosis
• Huntington's disease
• Parkinson's disease
• Creutzfeldt-Jakob disease
• Lewy body dementia
• Pick's disease (fronto-temporal dementia)
• Normal pressure hydrocephalus
• Untreated syphilis
• Toxic levels of metals, such as aluminum (can sometimes occur in dialysis patients)
• Vitamin B12 deficiency
• Thiamine deficiency

Risk factors for dementia include:

• Advancing age
• Family members with dementia
• Down syndrome
• Apolipoprotein E status (a genetic risk)
• Elevated cholesterol
• Multiple strokes
• High blood pressure
• Diabetes
• High cholesterol
• Obesity
• Lack of physical activity
• Vitamin deficiency
• Chronic drug use
• Long-term use of hormone replacement therapy
• Repetitive head trauma (eg, may occur with contact sports)
• Overweight or obese

They often begin mildly and progress over time. Symptoms vary according to the cause of the dementia, but often include:

• Increasing trouble remembering things, such as:
  • How to get to familiar locations
  • What the names of family and friends are
  • Where common objects are usually kept
  • How to do simple math
  • How to do usual tasks, such as cooking, dressing, bathing, etc.
  • How to drive
  • How to pay bills
• Having difficulty concentrating on tasks
• Having difficulty completing sentences due to lost/forgotten words (may progress to complete inability to speak)
• Forgetting the date, time of day, season
• Getting lost in familiar surroundings
• Having mood swings
• Being withdrawn, losing interest in usual activities
• Having personality changes
• Walking in a slow, shuffling way
• Having poor coordination
• Losing purposeful movement

Doctors diagnose dementia by:

• Getting an extensive medical history from you and your family
• Closely observing you
• Doing a physical and neurological exam
• Doing mental status and psychological tests

There are no blood tests or exams that can definitively diagnose Alzheimer's disease. Certain types of brain imaging such as a SPECT or a PET scan may aid in a diagnosis. Tests to rule out other causes of dementia and other medical conditions that may mimic dementia include:

• Blood tests for syphilis , vitamin B12 , folate , thyroid, liver, and kidney function
• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the head
• PET or SPECT scans—tests that use dyes to measure the activity levels of various areas of the brain (used in some cases)
• Lumbar puncture —a test of the cerebrospinal fluid (CSF) from the lower back; may be done to look for infection or bleeding
• Electroencephalogram (EEG) —a test that records the brain's activity by measuring electrical signals from the brain

The doctor will also check to see if you have depression . It can often present like dementia.

Currently, there are no treatments to cure many types of dementia. Various drugs are being studied to see if they can decrease the symptoms of dementia or slow its course.

Medicine being used or studied for possible use include:

• Cholinesterase inhibitors
• NMDA receptor antagonists
• Antioxidants (eg, vitamin E )
• Estrogens—Long-term use of estrogen therapy may put you at a higher risk for stroke , fractures , and gallbladder disease
• Anti-inflammatory agents
• Ginkgo biloba (herbal supplement)—There are mixed reports on the effectiveness of this herb.

Only two types of medications have been approved to reduce the symptoms of Alzheimer's disease:

• Cholinesterase inhibitors—approved and recommended for mild to moderate Alzheimer's disease:
  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Reminyl)
• NMDA receptor antagonist—approved for moderate to severe Alzheimer's disease:
  • Memantine (Namenda)

These medications only have a modest effect on the disease.

This type of support is critical for people with dementia. Behavioral and environmental support includes:

• Keeping you safe in your home
• Providing a calm, quiet, predictable environment
• Providing appropriate eyewear and hearing aids, easy-to-read clocks, and calendars
• Music therapy and/or dance therapy
• Encouraging light exercise to reduce agitation and relieve depression
• Discussing healthcare wishes with family members and doctors, and appointing a healthcare proxy and a legal power of attorney

People with dementia often develop psychiatric symptoms and may need appropriate treatment, such as:

• Antidepressants
• Anxiolytics—to treat anxiety
• Antipsychotics—to treat severe confusion, paranoia, and/or hallucinations
  • These must be used with caution. There are reports of increased risk for stroke or death in elderly patients with dementia.
• Mood stabilizers—to treat dangerous or disruptive behaviors

Caring for a person with dementia is very difficult. Those providing care will need support . The Alzheimer’s Association is an excellent resource for families and caregivers.