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updated April 16, 2011


Filed under: Amazing Mind
Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting intellectual and social abilities severely enough to interfere with daily functioning. Many causes of dementia symptoms exist. Alzheimer's disease is the most common cause of a progressive dementia.

Memory loss generally occurs in dementia, but memory loss alone doesn't mean you have dementia. Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment or language. Dementia can make you confused and unable to remember people and names. You also may experience changes in personality and social behavior. However, some causes of dementia are treatable and even reversible.

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  • Memory loss
  • Difficulty communicating
  • Inability to learn or remember new information
  • Difficulty with planning and organizing
  • Difficulty with coordination and motor functions
  • Personality changes
  • Inability to reason
  • Inappropriate behavior
  • Paranoia
  • Agitation
  • Hallucinations

When to see a doctor
See a doctor if you or a loved one experiences memory problems or other dementia symptoms. Some medical conditions can cause symptoms of dementia and are treatable, so it's important that a doctor determine the underlying cause.

Alzheimer's disease is a type of dementia that worsens over time. Early diagnosis gives a person time to plan for the future while he or she can participate in making decisions.

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Dementia has many causes. Some dementias such as Alzheimer's disease occur on their own, not as a result of another disease. Much is still unknown about how some diseases may be linked to dementia.


Progressive dementias
Types of dementias that worsen over time include:

  • Alzheimer's disease. Alzheimer's disease is the most common cause of dementia in people age 65 and older. Symptoms usually appear after age 60, but early-onset forms of the disease can occur, usually as the result of a defective gene. Although in most cases the exact cause of Alzheimer's disease isn't known, two types of brain cell (neuron) damage are common. These include plaques and tangles. Plaques are clumps of a normally harmless protein called beta-amyloid, and tangles are fibrous tangles made up of an abnormal protein called tau protein. Alzheimer's disease usually progresses slowly, over seven to 10 years, causing a gradual decline in cognitive abilities. Eventually, the affected areas of the brain don't work properly, including those parts involving memory, movement, language, judgment, behavior and abstract thinking.
  • Lewy body dementia. Dementia with Lewy bodies affects approximately 20 percent of people with dementia, making it one of the most common types of dementia. Lewy body dementia becomes more common with age. Lewy bodies are abnormal clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer's disease and Parkinson's disease. The symptoms of this dementia are similar to Alzheimer's disease, but its unique features often include fluctuations between confusion and clear thinking (lucidity), visual hallucinations, and Parkinson's signs such as tremor and rigidity. People with Lewy body dementia often have a condition called REM sleep behavior disorder that involves acting out dreams, including thrashing or kicking during sleep.
  • Vascular dementia. The second most common dementia after Alzheimer's disease is a result of damage to your brain caused by problems with the arteries serving your brain or heart. Symptoms begin suddenly, often after a stroke, and may occur in people with high blood pressure, or who have had previous strokes or heart attacks. Vascular dementia may also be caused by infection of a heart valve (endocarditis) or a buildup of amyloid protein in the brain's blood vessels (amyloid angiopathy) that sometimes causes "bleeding" (hemorrhagic) strokes.

Several types of vascular dementia exist and vary in their causes and symptoms. Some types affect only one side of the body, and some cause memory loss, confusion and mood changes. In some forms, symptoms may progressively worsen, while in others, they may be temporary. In general, vascular dementia is more common with age. Often this dementia coexists with Alzheimer's disease.

  • Frontotemporal dementia. This less common cause of dementia tends to occur at a younger age than does Alzheimer's disease, generally between the ages of 40 and 70. This is a group of diseases characterized by the degeneration of nerve cells in the frontal and temporal lobes of the brain — the areas generally associated with personality, behavior and language. Signs and symptoms of frontotemporal dementia can include socially inappropriate behaviors, loss of mental flexibility, language problems, and difficulty with thinking and concentration. As with others dementias, the cause isn't known, although in some cases this dementia is related to certain genetic mutations. But many people with frontotemporal dementia have no family history of the disease. One form of this condition is called Pick's disease. Pick's disease affects parts of the brain that contain fibrous tangles made up of the abnormal protein called tau protein. Pick's disease causes progressive dementia.

Other disorders linked to dementia

  • Huntington's disease. This inherited disease causes certain nerve cells in your brain and spinal cord to waste away. Signs and symptoms typically appear during your 30s or 40s. They may include mild personality changes at first — irritability, anxiety and depression — and progress to severe dementia. Huntington's disease also causes difficulty with walking and movement, weakness and clumsiness.
  • Dementia pugilistica. This condition, also called chronic traumatic encephalopathy or boxer's dementia, is caused by repetitive head trauma, such as experienced by boxers. Depending on the part of the brain injured, it can cause dementia signs and symptoms such as memory problems, poor coordination and impaired speech, as well as tremors, slow movement and muscle stiffness (parkinsonism). Symptoms may not appear until many years after the actual trauma. A single traumatic head injury can cause post-traumatic dementia, which is much like dementia pugilistica, but may include long-term memory problems.
  • HIV-associated dementia. Infection with the human immunodeficiency virus (HIV), which causes AIDS, leads to widespread destruction of brain matter and results in impaired memory, apathy, social withdrawal and difficulty concentrating. Often, problems with movement also develop.
  • Creutzfeldt-Jakob disease. This rare, fatal brain disorder most often occurs sporadically in people with no known risk factors. However, a few cases are hereditary or caused by exposure to diseased brain or nervous system tissue. Signs and symptoms usually appear around age 60 and initially include problems with coordination, personality changes, and impaired memory, judgment, thinking and vision. Mental impairment becomes severe as the illness progresses, and it often leads to blindness. Pneumonia and other infections also are common.
  • Secondary dementias. Sometimes, people with other disorders that primarily affect movement, for example, Parkinson's disease, may eventually develop symptoms of dementia. The relationship between these disorders and dementia isn't completely understood.

Dementia causes that can be reversed
Some causes of dementia or dementia-like symptoms can be reversed. Your doctor can identify, treat and sometimes cure these causes:

  • Infections and immune disorders. Dementia can result from fever or other side effects of your body's attempt to fight off an infection. Examples of such infections include brain infections like meningitis and encephalitis, untreated syphilis, Lyme disease, and conditions that cause a completely compromised immune system, such as leukemia. Conditions such as multiple sclerosis that arise from the body's immune system attacking nerve cells also can cause dementia.
  • Subdural hematomas. These are caused by bleeding between the brain's surface and its outer covering.
  • Poisoning. Dementia symptoms can occur as a result of exposure to heavy metals, such as lead or manganese, and other poisons, such as pesticides. People who have abused alcohol and recreational drugs also sometimes display symptoms. In all of these instances, symptoms may go away after treatment or after exposure to the substance has ended.
  • Brain tumors. It's rare, but dementia can be the result of damage caused by a brain tumor.
  • Anoxia. This condition, also called hypoxia, occurs when not enough oxygen gets to organ tissue. Causes include heart attack, severe asthma, carbon monoxide poisoning, strangulation, high-altitude exposure or an overdose of anesthetic. Recovery depends on the severity of the oxygen deprivation. Symptoms may occur during recovery.
  • Heart and lung problems. Your brain can't survive without oxygen. Symptoms may occur in people with chronic lung problems or a heart condition that deprives the brain of the oxygen it needs.

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Many factors can eventually lead to dementia. Some, such as age, can't be changed. Others can be addressed to reduce your risk.

Risk factors that can't be changed

  • Age. The risk of Alzheimer's disease, vascular dementia and several other dementias increases significantly with age. However, dementia isn't a normal part of aging.
  • Family history. People with a family history of dementia are at greater risk of developing it. However, many people with a family history never develop symptoms, and many people without a family history do. If you have specific genetic mutations, you're at significantly greater risk of developing certain types of dementia. Tests to determine whether you have such genetic mutations are available, but only for the disorders in which the specific mutation is known, for example, Huntington's disease.
  • Down syndrome. By the time they reach middle age, most people with Down syndrome develop the plaques and tangles characteristic of Alzheimer's disease, according to studies. Many, but not all, also develop dementia.

Risk factors you can change
To reduce your risk of dementia, you can take steps to control the following factors.

  • Alcohol use. Consuming large amounts of alcohol appears to increase the risk of dementia. Although studies have shown that moderate amounts of alcohol — one drink a day for women and two for men — especially red wine, have a protective effect, abuse of alcohol puts you at increased risk of developing dementia.
  • Atherosclerosis. This buildup of fats and other substances in and on your artery walls (plaques) is a significant risk factor for vascular dementia because it interferes with blood flow to your brain. This can lead to stroke. Studies have also shown a possible link between atherosclerosis and Alzheimer's disease.
  • Blood pressure. Blood pressure that's too high, and also possibly too low, can put you at risk of developing Alzheimer's disease and vascular dementia.
  • Cholesterol. High levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can significantly increase your risk of developing vascular dementia. Some research has also linked it to an increased risk of developing Alzheimer's disease.
  • Diabetes. If you have type 2 diabetes, you're at increased risk of developing both Alzheimer's disease and vascular dementia.
  • High estrogen levels. High levels of total estrogen in women have been associated with greater risk of developing dementia. This can be determined through a blood test.
  • Homocysteine blood levels. Elevated blood levels of homocysteine — a type of amino acid produced by your body — may increase your risk of developing Alzheimer's disease and vascular dementia. When working properly, your body breaks down homocysteine using vitamins B-6, B-12 and folic acid. If this isn't happening properly, it may be because you don't metabolize these vitamins well, or you don't have enough of them in your diet. Blood tests can determine whether you have elevated homocysteine levels.
  • Smoking. Smoking likely increases the risk of developing dementia because it puts you at a higher risk of atherosclerosis and other types of vascular disease.

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  • Inadequate nutrition. Nearly everyone who has dementia will at some point reduce or stop eating and drinking. Often, advanced dementia causes people to lose control of the muscles used to chew and swallow, putting them at risk of choking or aspirating food into their lungs. If this happens, it can block breathing and cause pneumonia. People with advanced dementia also lose the feeling of hunger and, with it, the desire to eat. Depression, side effects of medications, constipation and other conditions such as infections also can decrease a person's interest in food.
  • Reduced hygiene. In the moderate to severe stages of dementia, you lose the ability to independently complete daily living tasks. You may no longer be able to bathe, dress, brush your teeth and go to the toilet on your own.
  • Difficulty taking medications. Because a person's memory is affected, remembering to take the correct amount of medications at the right time can be challenging.
  • Deterioration of emotional health. Dementia changes behaviors and personality. Some of the changes may be caused by the actual deterioration happening in a person's brain, while other behavioral and personality changes may be reactions to the emotional challenges of coping with the deterioration changes. Dementia may lead to depression, aggression, confusion, frustration, anxiety, a lack of inhibition and disorientation.
  • Difficulty communicating. As dementia progresses, the ability to remember the names of people and things may be lost. This makes communication difficult at all levels, whether to let a caregiver know what you need and how you feel or simply to communicate socially. Difficulty communicating can lead to feelings of agitation, isolation and depression.
  • Delirium. This state is characterized by a decline in attention, awareness and mental clarity. Delirium is common in people with dementia, especially when admitted to the hospital. It appears that the sudden change in surroundings, activity level and other routines may be the cause.
  • Problems sleeping. Disruption of the normal sleep-wake cycle — being up at night and sleeping during the day — is very common. Insomnia is another common complication, as are restless legs syndrome and sleep apnea, which also can interfere with sleep.

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Most likely, you'll first see your primary care provider if you have concerns about dementia. In some cases, you may be referred to a doctor who specializes in specific symptoms, such as a neurologist for brain and nerve disorders.


What you can do

  • Make a list of all medications, as well as any vitamins or supplements, being taken.


  • What is likely causing symptoms?
  • Are there other possible causes for symptoms?
  • What kinds of tests are necessary?
  • Is the condition likely temporary or chronic?
  • What's the best course of action?
  • What are the alternatives to the primary approach being suggested?
  • Are there any restrictions?
  • Is there a generic alternative to the medicine being prescribed?
  • Are there any brochures or other printed materials or websites to visit?

Don't hesitate to ask any other questions that come up.

What to expect from your doctor

  • What are the symptoms, for example, trouble finding words, remembering events, focusing attention, changes in personality, getting lost?
  • When did symptoms begin?
  • Have symptoms been continuous or occasional?
  • How severe are symptoms?
  • What, if anything, seems to improve symptoms?
  • What, if anything, appears to worsen symptoms?
  • Are there any activities that have had to stop because of difficulty thinking through them?

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Memory loss and other dementia symptoms have many causes, so diagnosis can be challenging and may require several doctor visits. Diagnosis involves a number of tests.

Medical history and physical exam

  • Medical history. The doctor will ask about how and when symptoms began and about any health issues that may help identify the cause of the problem, for example diabetes, high blood pressure or a family history of dementia.

    In addition, the doctor may request information from your caregiver or family member to find out whether your concerns represent a change from your earlier level of functioning.

  • Physical examination. A physical exam helps your doctor rule out treatable causes of dementia and identify signs of stroke or other disorders that may cause similar symptoms. It also helps your doctor determine the best course of treatment. As part of an exam, your doctor may collect urine or blood samples, check blood pressure and review what medications you're using.

    This examination can also help identify signs of other illnesses, such as heart disease, diabetes or thyroid abnormalities and any medication side effects, which can overlap with dementia.

Cognitive and neuropsychological tests
Anyone screened for dementia needs his or her cognitive function evaluated. A number of tests measure orientation, general intellectual skills, academic skills, language skills, spatial skills, attention, memory, reasoning and judgment. The goal is to determine whether dementia is present, how severe it is and what part of the brain is affected.

Neurological evaluation
This part of the examination evaluates balance, sensory function and reflexes to identify conditions that may affect the diagnosis or are treatable with medication.

Brain scans
A look at your brain can help your doctor identify strokes, tumors or other problems that can cause dementia. Alzheimer's disease changes brain structure over time and can also be seen with a brain scan. Several types of scans are used.

  • CT and MRI scans. The most common imaging techniques for identifying dementia are computerized tomography (CT) and magnetic resonance imaging (MRI). A CT scan is an X-ray technique that produces images of your body that show internal structures in cross section. MRI is a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues in your body. These scans help identify brain-size changes, strokes, and other problems such as excess fluid in the brain (hydrocephalus) or bleeding on the surface of the brain (subdural hematoma).
  • Electroencephalogram (EEG). Using electrodes placed on your scalp, your doctor can detect and record patterns of electrical activity and check for abnormalities. If found, these abnormalities can indicate cognitive dysfunction, a condition common in people with moderate to severe Alzheimer's disease. An EEG may also detect seizures, Creutzfeldt-Jakob disease and other disorders associated with dementia.

Laboratory tests
A variety of lab tests can help rule out other conditions, such as kidney failure, that can contribute to symptoms. Treatable medical conditions are often associated with dementia. Medication and other treatments can improve many symptoms and quality of life.

Tests that help identify treatable medical conditions include:

  • A complete blood count (CBC) to rule out anemia
  • A blood glucose test to rule out diabetes
  • Blood tests to estimate kidney function, to estimate liver function and to measure vitamin B-12 levels
  • A blood or urine screen to identify drugs or alcohol
  • Cerebrospinal fluid analysis (spinal tap) to rule out brain infections
  • Analysis of thyroid and thyroid-stimulating hormone levels to rule out hypothyroidism

Psychiatric evaluation
This examination may be performed to determine whether depression or another psychiatric disorder is contributing to symptoms.

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Treatment of dementia may help slow or minimize the development of symptoms.

  • Cholinesterase inhibitors. These drugs — donepezil (Aricept), rivastigmine (Exelon) and galantamine hydrobromide (Razadyne) — are Alzheimer's drugs that work by boosting levels of a chemical messenger involved in memory and judgment. Side effects can include nausea, vomiting and diarrhea. Although primarily used as Alzheimer's drugs, they're also used to treat vascular, Parkinson's and Lewy body dementias.
  • Memantine (Namenda). This drug for Alzheimer's disease works by regulating the activity of glutamate, another chemical messenger involved in all brain function, including learning and memory. Its most common side effect is dizziness. Some research has shown that combining memantine with a cholinesterase inhibitor may have even better results. Although primarily used to treat Alzheimer's disease, it may help improve symptoms in other dementias.
  • Other medications. Although no standard treatment for dementia exists, some symptoms can be treated. Additional treatments aim to reduce the risk factors for further brain damage.

Treatment of the underlying causes of dementia can also slow or sometimes stop its progress. To prevent a stroke, for example, your doctor may prescribe medications to control high blood pressure, high cholesterol, heart disease and diabetes. Doctors may also prescribe medication to treat conditions such as blood clots, anxiety and insomnia for people with vascular dementia.

In addition, some specific symptoms and behavioral problems can be treated with sedatives, antidepressants and other medications, but some of these drugs may worsen other symptoms.

Creutzfeldt-Jakob disease has no known treatments. Care is focused on making sure the person is comfortable.

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You can take steps to improve quality of life as the disease progresses.

Carry a reminder calendar
Use a calendar to record upcoming events as well as things you want to remember later and activities you need to complete on a daily basis. Then check off those activities when done. If you can make this process a habit when memory problems are mild, you'll be more likely to retain this skill as the disease progresses. For example, if you can't remember if you took your pills or who called that morning, you can check your calendar.

Maintain a calm and stable home environment
A calm and stable home environment reduces problems such as anxiety, agitation and excess confusion. New situations or people, disrupted routines, loud noises, feeling rushed, or being asked to complete multistep tasks can cause frustration and lead to anxiety. When you have dementia such as Alzheimer's disease, becoming upset reduces the ability to think clearly even more.

Establish a nighttime ritual
Dementia behaviors may be worse at night when the person with dementia is more tired, strained by the demands of the day or perhaps confused because of the decrease in daylight. Try to establish going-to-bed rituals that are calming. It can be helpful to retreat from the noise of television, meal cleanup and active family members. Leaving night lights on helps prevent disorientation. In addition, limiting caffeine during the day, avoiding daytime napping and exercising during the day may help prevent nighttime restlessness.

Create a plan
Develop a comprehensive plan that identifies goals for care. Various support agencies, care centers, primary and specialty doctors, legal advisers, and other family members can help achieve these goals. This process may or may not be something in which a person with dementia can participate. Here are some things for families to consider:

  • What is the long-term prognosis, and what is the plan for treatment?
  • Is independent living possible? If not, will care be provided in a family home or a nursing home?
  • Does support need to be provided for things such as meal preparation, daily hygiene and taking medications?
  • If independent or semi-independent living isn't possible, who will be the primary caregiver?
  • What about driving? Should it continue?
  • Are there safety measures, such as installing bed and bathroom safety rails and removing or securing knives and other dangerous substances or objects, that need to be addressed?
  • What assistance is available through adult care centers, in-home nursing care or other agencies?
  • What about legal issues such as a living will and power of attorney for health care issues? What are your wishes?

Keep in mind that the disease will evolve over time, and care needs to be adjusted as symptoms change and progress. People with dementia should be encouraged to continue their normal activities as long as they're safe and the activities don't cause frustration or confusion. Mental, social and physical activities help maintain a person's health and well-being.

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Use caution when considering alternative remedies to ward off or slow the progression of dementia, especially if taking other medications. Dietary supplements, vitamins and herbal remedies aren't regulated, and claims about their benefits are often based on personal testimonials rather than scientific research. Some of the more popular alternatives for Alzheimer's disease and other forms of dementia are:

  • Vitamin E. Some studies have shown that vitamin E can slow the progression of Alzheimer's disease, while other studies have shown no benefit. Doctors warn against taking large doses of vitamin E, especially if you're taking blood thinners, because of an increased risk of bleeding.
  • Omega-3 fatty acids. Omega-3s are a type of polyunsaturated fatty acid (PUFA) found in fish and nuts. Research has linked certain types of omega-3s to a reduced risk of heart disease, stroke, dementia and cognitive decline. The Food and Drug Administration (FDA) permits supplements and foods to display labels with "a qualified health claim" for two omega-3s called docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The FDA recommends taking no more than a combined total of 3 grams of DHA or EPA a day, with no more than 2 grams from supplements. Theories about why omega-3s might influence dementia risk include their benefit to the heart and blood vessels, anti-inflammatory effects, and support and protection of nerve cell membranes. Preliminary evidence also shows that omega-3s may help reduce symptoms of depression. It's thought this is because it's an essential nutrient for brain function.
  • Coenzyme Q10. This antioxidant occurs naturally in your body and is needed for normal cell reactions. This compound hasn't been studied for its effectiveness in treating dementia. A synthetic version of this compound, called idebenone, was tested for Alzheimer's disease, but didn't show favorable results. Little is known about what dosage is considered safe, and too much may lower blood pressure, decrease blood sugar, or cause bruising or bleeding.
  • Ginkgo. Some people believe that extracts from the leaves of the Ginkgo biloba tree have antioxidant and anti-inflammatory properties that may help slow the progression of memory problems associated with dementia. But a recent large-scale study showed no benefit. Be aware that these preparations can interact with blood-thinning medications and cause bleeding.
  • Huperzine A. Made from Chinese club moss, huperzine A appears to work in ways similar to prescription cholinesterase inhibitors. Because of an increased risk of toxic side effects, don't take huperzine A if you're also taking a prescription cholinesterase inhibitor.

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Receiving a diagnosis of dementia can be devastating to you and your loved ones. Many things need to be considered to ensure that you and those around you are as prepared as possible for dealing with a condition that's unpredictable and continually changing.

Care and support for the person with the disease
Throughout the disease you may experience a wide range of feelings. Here are some things you can do to help yourself cope:

  • Write in a journal about your feelings and experiences.
  • Join a local support group.
  • Get individual or family counseling.
  • Stay active and involved, volunteer, exercise and participate in activities for people with memory loss.
  • Maintain contact and share your feelings with friends and family.
  • Delegate help with decision making to someone you trust.
  • Be patient with yourself.

Helping someone with dementia

Caregiver support
Providing care for a person with dementia is physically and emotionally demanding. Often, the primary caregiver is a spouse or other family member. Feelings of anger and guilt, frustration and discouragement, worry and grief, and social isolation are common. If you're a caregiver for someone with dementia:

  • Take care of your physical, emotional and spiritual health
  • Learn as much about the disease as you can
  • Join a support group

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There's no sure way to prevent dementia, but there are steps you can take that might help. More research is needed, but it can't hurt to do the following:

  • Keep your mind active. Mentally stimulating activities may increase your ability to cope with or compensate for the changes associated with dementia. This includes such things as doing puzzles and word games, learning a language, playing an instrument, reading, writing, painting or drawing. Not only can these activities delay the onset of dementia, but they can help decrease its effects — the more frequent the activity, the more beneficial the effects.
  • Be physically and socially active. Physical and social activities can delay the onset of dementia and also reduce its symptoms. The more frequent the activities, the more significant their effects. Examples of physical activity are walking, swimming and dancing. Social activities include traveling, attending the theater and art exhibits, and playing cards or games.
  • Lower your homocysteine levels. Early research has shown that high doses of three B vitamins — folic acid, B-6 and B-12 — help lower homocysteine levels and appear to slow the progression of Alzheimer's disease.
  • Lower your cholesterol levels. The deposits that occur in the brains of people with high cholesterol are one of the causes of vascular dementia. So lowering your cholesterol levels can help prevent this condition. Statin drugs, which help lower cholesterol levels, also may help lower the risk of developing dementia.
  • Control your diabetes. Controlling diabetes can reduce your risk of developing Alzheimer's disease and vascular dementia.
  • Quit smoking. Although some studies indicate that only current smoking increases dementia risk, at least one large study found that heavy smoking (more than two packs a day) in midlife more than doubles your risk, even two decades later.
  • Lower your blood pressure. Keeping blood pressure at normal levels can significantly reduce your risk of Alzheimer's disease and vascular dementia.
  • Pursue education. People who've spent more time in formal education appear to have a lower incidence of mental decline, even when they have brain abnormalities. Researchers think that education may help your brain develop a strong nerve cell network that compensates for nerve cell damage caused by Alzheimer's disease.
  • Maintain a healthy diet. Eating a healthy diet is important for many reasons, but studies show that a diet rich in fruits, vegetables and omega-3 fatty acids, commonly found in certain fish and nuts, can have a protective effect and decrease your risk of developing dementia.
  • Get your vaccinations. Those who receive vaccinations for influenza, tetanus, diphtheria and polio appear to have a significantly reduced risk of Alzheimer's disease, so staying current on your vaccinations could have a protective effect against developing dementia.

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