Dementia

Dementia is a general term for problems with brain function. A person with dementia has memory loss and a hard time with at least one other brain function such as thinking, speaking, or problem solving. Dementia can affect social functioning, how you do your job, your mood, or your personality. The changes may be hidden for a long time. The earliest forms of this disease are usually not detected by family or friends.

Dementia can be:

  • Irreversible.

  • Potentially reversible.

  • Partially reversible.

  • Progressive. This means it can get worse over time.

CAUSES

Irreversible dementia causes may include:

  • Degeneration of brain cells (Alzheimer's disease or lewy body dementia).

  • Multiple small strokes (vascular dementia).

  • Infection (chronic meningitis or Creutzfelt-Jakob disease).

  • Frontotemporal dementia. This affects younger people, age 40 to 70, compared to those who have Alzheimer's disease.

  • Dementia associated with other disorders like Parkinson's disease, Huntington's disease, or HIV-associated dementia.

Potentially or partially reversible dementia causes may include:

  • Medicines.

  • Metabolic causes such as excessive alcohol intake, vitamin B12 deficiency, or thyroid disease.

  • Masses or pressure in the brain such as a tumor, blood clot, or hydrocephalus.

SYMPTOMS

Symptoms are often hard to detect. Family members or coworkers may not notice them early in the disease process. Different people with dementia may have different symptoms. Symptoms can include:

  • A hard time with memory, especially recent memory. Long-term memory may not be impaired.

  • Asking the same question multiple times or forgetting something someone just said.

  • A hard time speaking your thoughts or finding certain words.

  • A hard time solving problems or performing familiar tasks (such as how to use a telephone).

  • Sudden changes in mood.

  • Changes in personality, especially increasing moodiness or mistrust.

  • Depression.

  • A hard time understanding complex ideas that were never a problem in the past.

DIAGNOSIS

There are no specific tests for dementia.

  • Your caregiver may recommend a thorough evaluation. This is because some forms of dementia can be reversible. The evaluation will likely include a physical exam and getting a detailed history from you and a family member. The history often gives the best clues and suggestions for a diagnosis.

  • Memory testing may be done. A detailed brain function evaluation called neuropsychologic testing may be helpful.

  • Lab tests and brain imaging (such as a CT scan or MRI scan) are sometimes important.

  • Sometimes observation and re-evaluation over time is very helpful.

TREATMENT

Treatment depends on the cause.

  • If the problem is a vitamin deficiency, it may be helped or cured with supplements.

  • For dementias such as Alzheimer's disease, medicines are available to stabilize or slow the course of the disease. There are no cures for this type of dementia.

  • Your caregiver can help direct you to groups, organizations, and other caregivers to help with decisions in the care of you or your loved one.

HOME CARE INSTRUCTIONS

The care of individuals with dementia is varied and dependent upon the progression of the dementia. The following suggestions are intended for the person living with, or caring for, the person with dementia.

  • Create a safe environment.

  • Remove the locks on bathroom doors to prevent the person from accidentally locking himself or herself in.

  • Use childproof latches on kitchen cabinets and any place where cleaning supplies, chemicals, or alcohol are kept.

  • Use childproof covers in unused electrical outlets.

  • Install childproof devices to keep doors and windows secured.

  • Remove stove knobs or install safety knobs and an automatic shut-off on the stove.

  • Lower the temperature on water heaters.

  • Label medicines and keep them locked up.

  • Secure knives, lighters, matches, power tools, and guns, and keep these items out of reach.

  • Keep the house free from clutter. Remove rugs or anything that might contribute to a fall.

  • Remove objects that might break and hurt the person.

  • Make sure lighting is good, both inside and outside.

  • Install grab rails as needed.

  • Use a monitoring device to alert you to falls or other needs for help.

  • Reduce confusion.

  • Keep familiar objects and people around.

  • Use night lights or dim lights at night.

  • Label items or areas.

  • Use reminders, notes, or directions for daily activities or tasks.

  • Keep a simple, consistent routine for waking, meals, bathing, dressing, and bedtime.

  • Create a calm, quiet environment.

  • Place large clocks and calendars prominently.

  • Display emergency numbers and home address near all telephones.

  • Use cues to establish different times of the day. An example is to open curtains to let the natural light in during the day.  

  • Use effective communication.

  • Choose simple words and short sentences.

  • Use a gentle, calm tone of voice.

  • Be careful not to interrupt.

  • If the person is struggling to find a word or communicate a thought, try to provide the word or thought.

  • Ask one question at a time. Allow the person ample time to answer questions. Repeat the question again if the person does not respond.

  • Reduce nighttime restlessness.

  • Provide a comfortable bed.

  • Have a consistent nighttime routine.

  • Ensure a regular walking or physical activity schedule. Involve the person in daily activities as much as possible.

  • Limit napping during the day.

  • Limit caffeine.

  • Attend social events that stimulate rather than overwhelm the senses.

  • Encourage good nutrition and hydration.

  • Reduce distractions during meal times and snacks.

  • Avoid foods that are too hot or too cold.

  • Monitor chewing and swallowing ability.

  • Continue with routine vision, hearing, dental, and medical screenings.

  • Only give over-the-counter or prescription medicines as directed by the caregiver.

  • Monitor driving abilities. Do not allow the person to drive when safe driving is no longer possible.

  • Register with an identification program which could provide location assistance in the event of a missing person situation.

SEEK MEDICAL CARE IF:

  • New behavioral problems start such as moodiness, aggressiveness, or seeing things that are not there (hallucinations).

  • Any new problem with brain function happens. This includes problems with balance, speech, or falling a lot.

  • Problems with swallowing develop.

  • Any symptoms of other illness happen.

Small changes or worsening in any aspect of brain function can be a sign that the illness is getting worse. It can also be a sign of another medical illness such as infection. Seeing a caregiver right away is important.

SEEK IMMEDIATE MEDICAL CARE IF:

  • A fever develops.

  • New or worsened confusion develops.

  • New or worsened sleepiness develops.

  • Staying awake becomes hard to do.