Alzheimer's disease is the most common cause of dementia. This topic focuses on other conditions that cause dementia. For more information on Alzheimer's, see the topic Alzheimer's Disease.
We all forget things as we get older. Many older people have a slight loss of memory that does not affect their daily lives. But memory loss that gets worse may mean that you have dementia.
Dementia is a loss of mental skills that affects your daily life. It can cause problems with your memory and how well you can think and plan. Usually dementia gets worse over time. How long this takes is different for each person. Some people stay the same for years. Others lose skills quickly.
Your chances of having dementia rise as you get older. But this doesn't mean that everyone will get it. By age 85, about 35 out of 100 people have some form of dementia. That means that 65 out of 100 don't have it. Dementia is rare before age 60.1
If you or a loved one has memory loss that is getting worse, see your doctor. It may be nothing to worry about. If it is dementia, treatment may help.
Dementia is caused by damage to or changes in the brain. Things that can cause dementia include:
In a few cases, dementia is caused by a problem that can be treated. Examples include having an underactive thyroid gland (hypothyroidism), not getting enough vitamin B12, and fluid buildup in the brain (normal-pressure hydrocephalus). In these cases, treating the problem may cure the dementia.
In some people, depression can cause memory loss that seems like dementia. Depression can be treated.
As you age, medicines may affect you more. Taking some medicines together may cause symptoms that look like dementia. Be sure your doctor knows about all of the medicines you take. This means all prescription medicines and all over-the-counter medicines, herbs, vitamins, and supplements.
Usually the first symptom is memory loss. Often the person who has a memory problem doesn't notice it, but family and friends do. As dementia gets worse:
Over time, people with dementia may begin to act very differently. They may become scared and strike out at others, or they may become clingy and childlike. They may stop brushing their teeth or bathing.
Later, they cannot take care of themselves. They may not know where they are. They may not know their loved ones when they see them.
There is no single test for dementia. To diagnose it, your doctor will:
The doctor may do tests to look for a cause that can be treated. For example, you might have blood tests to check your thyroid or to look for an infection. You might also have a test that shows a picture of your brain, like an MRI or a CT scan. These tests can help your doctor find a tumor or brain injury. They can also show if there has been shrinking in parts of the brain. This can be a sign of dementia.
There are medicines you can take for dementia. They cannot cure it, but they can slow it down for a while and make it easier to live with.
As dementia gets worse, a person may get depressed or angry and upset. Treatment, such as medicines and counseling, may help. So can getting out more and having an active social life.
If a stroke caused the dementia, there are things you can do to reduce the chance of another stroke. Stay at a healthy weight, exercise, and keep your blood pressure and cholesterol at normal levels. If you have diabetes, keep your blood sugar in your target range.
Keeping both your mind and your body active is a good idea for anyone. So is not smoking.
There are many things you can do to help your loved one be safe at home. For example, get rid of throw rugs, and put handrails in bathrooms to help prevent falls. Post reminder notes around the house. Put a list of important phone numbers by the telephone. You also can help your loved one stay active. Play cards or board games, and take walks.
Work with your loved one to make decisions about the future before dementia gets worse. It is important to write a living will and a durable power of attorney. A living will states the types of medical care your loved one wants. A durable power of attorney lets your loved one pick someone to be the health care agent. This person makes care decisions after your loved one cannot.
Watching a loved one slip away can be sad and scary. Caring for someone with dementia can leave you feeling drained. Be sure to take care of yourself and to give yourself breaks. Ask family members to share the load, or get other help.
Your loved one will need more and more care as dementia gets worse. In time, he or she may need help to eat, get dressed, or use the bathroom. You may be able to give this care at home, or you may want to think about using a nursing home. A nursing home can give this kind of care 24 hours a day. The time may come when a nursing home is the best choice.
You are not alone. Many people have loved ones with dementia. Ask your doctor about local support groups, or search the Internet for online support groups, such as the Alzheimer's Association. Help is available.
Learning about dementia:
Living with dementia:
Health Tools help you make wise health decisions or take action to improve your health.
|Decision Points focus on key medical care decisions that are important to many health problems.|
|Alzheimer's or Other Dementia: Should I Move My Relative Into Long-Term Care?|
Some causes of dementia can be reversed with treatment, but most cannot.
Common causes of dementia that cannot be reversed are:
Less common causes of dementia that cannot be reversed include:
When dementia is caused by certain treatable problems, the treatment may also help the dementia. These treatable problems include:
Some disorders that cause dementia can run in families. Doctors often suspect an inherited cause if someone younger than 50 has symptoms of dementia. For more information, see the topic Alzheimer's Disease.
Symptoms of dementia vary depending on the cause and the area of the brain that is affected. Symptoms include:
Some types of dementia cause particular symptoms:
It is important to know that memory loss can be caused by conditions other than dementia, such as depression, and that those conditions can be treated. Also, occasional trouble with memory (such as briefly forgetting someone's name) can be a normal part of aging. But if you are worried about memory loss or if a loved one has memory loss that is getting worse, see your doctor.
How quickly dementia progresses depends on what is causing it and the area of the brain that is affected. Some types of dementia progress slowly over several years. Other types may progress more rapidly. If vascular dementia is caused by a series of small strokes, the loss of mental skills may be gradual. If it is caused by a single stroke in a large blood vessel, loss of function may occur suddenly.
The course of dementia varies greatly from one person to another. Early diagnosis and treatment with medicines used for Alzheimer's (cholinesterase inhibitors such as donepezil [Aricept]) may help preserve mental functioning for a while in people who have vascular dementia, dementia with Lewy bodies, or Parkinson's disease.2 Even without these medicines, some people remain stable for months or years, while others decline rapidly.
Many people with dementia are not aware of their mental decline. They may deny their condition and blame others for their problems. Those who are aware may mourn their loss of abilities and become hopeless and depressed.
Depending on the type of dementia, the person's behavior may eventually become out of control. The person may become angry, agitated, and combative or clingy and childlike. He or she may wander and become lost. These problems can make it difficult for family members or others to continue providing care at home.
Even with the best care, people with dementia tend to have a shorter life span than the average person their age. The progression varies depending on the disease causing the dementia and whether the person has other illnesses such as diabetes or heart disease. Death usually results from lung or kidney infections caused by being bedridden.
For more information on decisions you may face as your loved one's condition progresses, see the topic Care at the End of Life.
Many older people have a slight loss of mental skills (usually recent memory) that doesn't affect their daily functioning. This is called mild cognitive impairment by some. People who have mild impairment may be in the early stage of dementia, or they may stay at their present level of ability for a long time.
You have a greater chance of developing vascular dementia if you:
Call a doctor immediately if a person suddenly becomes confused or emotionally upset or doesn't seem to know who or where he or she is. These are signs of delirium, which can be caused by a reaction to medicines or a new or worsening medical condition.
Call a doctor if you or a person you are close to has new and troubling memory loss that is more than an occasional bout of forgetfulness. This may be an early sign of dementia.
Occasional forgetfulness or memory loss can be a normal part of aging. But any new or increasing memory loss or problems with daily living should be reported to a doctor. Learn the warning signs of dementia, and talk to a doctor if you or a family member shows any of these signs. They include increased trouble finding the right words when speaking, getting lost going to familiar places, and acting more irritable or suspicious than usual.
The following health professionals can evaluate symptoms of memory loss or confusion:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Doctors diagnose the cause of dementia by asking questions about the person's medical history and doing a physical exam, a mental status exam, and lab and imaging tests.
Tests can help the doctor learn whether dementia is caused by a treatable condition. Even for those dementias that cannot be reversed, knowing the type of dementia a person has can help the doctor prescribe medicines or other treatments that may improve mood and behavior and help the family.
During a medical history and physical exam, the doctor will ask the affected person and a close relative or partner about recent illnesses or other life events that could cause memory loss or other symptoms such as behavioral problems. The doctor may ask the person to bring in all medicines he or she takes. This can help the doctor find out if the problem might be caused by the person being overmedicated or having a drug interaction.
Although a person may have more than one illness causing dementia, symptoms sometimes can distinguish one form from another. For example, early in the course of frontotemporal dementia, people may display a lack of social awareness and develop obsessions with eating, neither of which occurs early in other dementias.
A doctor or other health professional will conduct a mental status exam. This test usually involves such activities as having the person tell what day and year it is, repeat a series of words, draw a clock face, and count back from 100 by 7s.
Other tests have been developed to diagnose dementia. Doctors can use one such test, Addenbrooke's Cognitive Examination, to distinguish Alzheimer's disease from frontotemporal dementia. Orientation, attention, and memory are worse in Alzheimer's, while language skills and ability to name objects are worse in frontotemporal dementia.
Many medical conditions can cause mental impairment. During a physical exam, the doctor will look for signs of other medical conditions and have lab tests done to find any treatable condition. Routine tests include:
Other lab tests that may be done include:
Brain imaging tests such as CT scans and MRI may also be done to make sure another problem isn't causing the symptoms. These tests may rule out brain tumors, strokes, normal-pressure hydrocephalus, or other conditions that could cause dementia symptoms.
Two other forms of imaging—single photon emission CT (SPECT) and PET scan—are not used routinely to diagnose dementia. But they may be useful if the symptoms are confusing or odd. These tests can help identify several forms of dementia, including vascular dementia and frontotemporal dementia.
In some cases, electrical activity in the brain may be measured using an electroencephalogram (EEG). Doctors seldom use this test to diagnose dementia, but they may use it to distinguish dementia from delirium and to look for unusual brain activity found in Creutzfeldt-Jakob disease, a rare cause of dementia.
In rare cases, a brain biopsy may be done if a treatable cause of dementia is suspected.
After death, an autopsy may be done to find out for sure what caused dementia. This information may be helpful to family members concerned about genetic causes.
Some cases of dementia are caused by medical conditions that can be treated, and treatment can restore some or all mental function. But most of the time, dementia cannot be reversed.
Sometimes treating the cause of dementia helps the dementia. For example, the person might:
If the cause of dementia cannot be treated, the doctor will work with the person and caregivers to develop a plan to make life easier and more comfortable. Care plans may include:
If possible, make decisions while your loved one is able to take part in the decision making. These are difficult but important conversations. Questions include:
Education of the family and other caregivers is critical to successfully caring for someone who has dementia. If you are or will be a caregiver, start learning what you can expect and what you can do to manage problems as they arise. For more information, see Home Treatment.
The goal of ongoing treatment for dementia is to keep the person safely at home for as long as possible and to provide support and guidance to the caregivers.
Routine follow-up visits to a health professional (every 3 to 6 months) are necessary to monitor medicines and the person's level of functioning.
Eventually, the family may have to consider whether to place the person in a care facility that has a dementia unit.
Taking care of a person with dementia is stressful. If you are a caregiver, seek support from family members or friends. Take care of your own health by getting breaks from caregiving. Counseling, a support group, and adult day care or respite care can help you through stressful times and bouts of burnout.
Dementia is hard to prevent, because what causes it often is not known. But people who have dementia caused by stroke may be able to prevent future declines by lowering their risk of heart disease and stroke. Even if you don't have these known risks, your overall health can benefit from these strategies:
Home treatment for dementia involves teamwork among health professionals and caregivers to create a safe and comfortable environment and to make tasks of daily living as easy as possible. People who have mild dementia can be involved in planning for the future and organizing the home and daily tasks.
Work with the team of health professionals to:
The team can also help you learn how to manage behavior problems. For example, you can learn ways to:
Even with the best care, a person with progressive dementia will decline, perhaps to the point where the caregiver is no longer physically, emotionally, or financially able to provide care.
Making the decision about nursing home placement is often very difficult. Every family needs to consider its own financial situation, emotional capacity, and other issues.
Doctors use medicines to treat dementia in the following ways:
For more information, see the topics:
|National Institute of Neurological Disorders and Stroke|
|NIH Neurological Institute|
|P.O. Box 5801|
|Bethesda, MD 20824|
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the leading U.S. federal government agency supporting research on brain and nervous system disorders. It provides the public with educational materials and information about these disorders.
|225 North Michigan Avenue, Floor 17|
|Chicago, IL 60601-7633|
The Alzheimer's Association is a national organization that provides educational materials, support groups, and community services for people dealing with Alzheimer's disease. It has more than 200 local chapters throughout the United States. The organization publishes a newsletter as well as a wide range of brochures and videos. The Web site includes a lot of useful information for people with Alzheimer's and other dementias, as well as for their caregivers.
|American Geriatrics Society: The AGS Foundation for Health and Aging|
|The Empire State Building|
|350 Fifth Avenue|
|New York, NY 10118|
The AGS Foundation for Health and Aging was started by the American Geriatrics Society (AGS). The foundation works on behalf of older adults in the areas of wellness and preventive care, self-responsibility and independence, and connections to family and community.
This Web site has stories about healthy aging, information on caring for elders at home, and tips on winter safety, preparing for emergencies, and overcoming the challenges to healthy aging. The site also has links to many other Internet resources on aging.
|Family Caregiver Alliance|
|180 Montgomery Street|
|San Francisco, CA 94104|
This organization supports and assists people who are providing long-term care at home. It also provides education, research, services, and advocacy.
|National Institute on Aging|
|Building 31, Room 5C27|
|31 Center Drive, MSC 2292|
|Bethesda, MD 20892|
The National Institute on Aging (NIA), one of the centers of the U.S. National Institutes of Health, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. The NIA funds research and provides information about health and research advances to the public and interested groups.
- Beers MH, et al., eds. (2004). Merck Manual of Health and Aging. Whitehouse Station, NJ: Merck Research Laboratories.
- Drugs for cognitive loss and dementia (2010). Medical Letter on Drugs and Therapeutics: Drugs of Choice, 8(91): 19–24.
- Warner J, et al. (2010). Dementia, search date April 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Tzourio C, et al. (2003). Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Archives of Internal Medicine, 163(9): 1069–1075.
- Birks J, Grimley Evans J (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).
- Spector A, et al. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia. British Journal of Psychiatry, 183: 248–254.
- Graff MJ, et al. (2006). Community-based occupational therapy for patients with dementia and their caregivers: Randomised controlled trial. BMJ, 333(1196). Also available online: http://www.bmj.com/cgi/content/full/333/7580/1196.
Other Works Consulted
- Bourgeois JA, et al. (2008). Dementia section of Delirium, dementia, and amnestic and other cognitive disorders. In RE Hales et al., eds., American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 304–363. Washington DC: American Psychiatric Publishing.
- Knopman DS (2009). Alzheimer disease and other dementing illnesses. In EG Nabel, ed., ACP Medicine, section 11, chap. 11. Hamilton, ON: BC Decker.
- Knopman DS, et al. (2001, reaffirmed 2004). Practice parameter: Diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 56: 1143–1153.
- Langa KM, et al. (2004). Mixed dementia: Emerging concepts and therapeutic implications. JAMA, 292(23): 2901–2908.
- U.S. Preventive Services Task Force (2003). Screening for dementia: Recommendation and rationale. Annals of Internal Medicine, 139(11): 925–926.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Peter J. Whitehouse, MD - Neurology|
|Last Revised||August 11, 2011|
Last Revised: August 11, 2011
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