About Aging and Dementia

What is Dementia?

Dementia is a general term that describes a collection of symptoms like loss of memory, language, problem-solving, and other cognitive abilities.

What is the Most Common Form of Dementia?

Alzheimer's disease is the most common type of dementia, accounting for 60-80% of cases. This irreversible neurodegenerative disease erodes memory and thinking skills. Alzheimer's symptoms typically first appear in people in their mid-60s. Over time, Alzheimer's disease limits the capacity to carry out basic tasks. Alzheimer's disease is the sixth leading cause of death in the United States. 

AD currently has no cure, but treatments can temporarily slow the worsening of symptoms and improve quality of life. Current research is focused on finding more effective ways to treat the disease, delay its onset, and prevent it.

What are the Some Other Types of Dementia?

Dementia can have many causes, depending on the changes happening in the brain. Most dementias are progressive and worsen over time. These include:

• Lewy body dementia: Caused by abnormal protein deposits in neurons. Also associated with a type of dementia found with Parkinson's disease.
• Vascular dementia: Caused by disruption of blood flow to the brain.
• Frontotemporal dementia: Caused by atrophy (shrinking) of the frontal and temporal lobes of the brain, which are associated with personality, behavior, and language.
• Mixed dementia: A combination of multiple types of dementia
• Young-onset dementia: Develops in people under the age of 65.
• Creutzfeldt-Jakob disease: A rare neurodegenerative condition that affects muscle coordination, thinking, and memory.
• Wernicke-Korsakoff Syndrome: a neurodegenerative disorder caused by a thiamine (vitamin B1) deficiency and linked to alcohol abuse and malnutrition.

Some conditions can cause dementia-like symptoms but can be reversed with treatment. These include:

• Infections
• Metabolic issues
• Nutrient deficiencies
• Side effects from certain medicines 

Is Dementia Part of Normal Aging?

No, dementia is not an inevitable part of aging. While some cognitive decline is common as we age, dementia is a serious condition that requires a detailed diagnosis and specialist care. Recognizing the symptoms and getting an evaluation when these symptoms begin to show is key.

What are the Symptoms of Dementia?

• Agitation
• Anxiety
• Confusion 
• Depression
• Difficulty communicating
• Hallucinations
• Inappropriate or unusual behavior
• Issues with sense of direction
• Loss of coordination
• Memory loss
• Paranoia
• Personality changes
• Poor problem-solving and reasoning
• Trouble with complex tasks and organizing

What Are the Risk Factors for Dementia?

We are learning more every day about the causes and risk factors for dementias like Alzheimer's disease. Some factors are out of our control, such as:

• Age
• Family history/Genetics
• Other genetic conditions
  • Creutzfeldt-Jakob disease
  • Down syndrome
  • Huntington's disease
  • Parkinson's disease

There are some lifestyle changes and behaviors that have been shown to reduce the risk and severity of dementia, including:

• Eating a healthy diet
• Getting regular exercise
• Avoiding obesity
• Eliminating smoking
• Reducing alcohol consumption
• Managing your cardiovascular risk factors:
  • Atherosclerosis
  • Diabetes 
  • High blood pressure
  • High cholesterol
• Treating depression and anxiety
• Getting enough sleep 
• Limit sleep medicine, sedatives, and medicine that can impact memory 

How is Dementia Diagnosed?

No single test can be used to diagnose dementia. Working with a care team that can provide comprehensive testing can help pinpoint the cause. A comprehensive team can also help educate families and assess the severity of the condition to determine what steps to take to maintain agency and dignity while remaining safe. Diagnosis typically includes:

• Review of medical history 
• Physical exam
• Cognitive and neuropsychological testing for:
  • Focus
  • Memory
  • Orientation
  • Reasoning 
  • Speech
• Neurological evaluation
  • Visual perception
  • Movement
  • Balance
  • Reflexes
• Diagnostic Imaging
  • CT 
  • MRI
  • CT-PET
• Laboratory testing
• Psychiatric evaluation

How is Dementia Treated?

Because most types of dementia can't be cured, treatment focuses on managing symptoms and slowing cognitive decline. 

Medications

Some medications have been shown in clinical trials to slow cognitive decline for some forms of dementia, such as Alzheimer's disease. These include:

• Cholinesterase inhibitors
  • Donepezil
  • Rivastigmine
  • Galantamine
• Memantine
• Lecanemab 
• Donanemab

Some of these medications may have serious side effects, including life-threatening conditions like brain swelling, seizures, bleeding, and allergic reactions. 

Behavioral Adjustments, Therapies, and Environmental Changes

Several dementia symptoms and behavior problems can be addressed without medication. And it's important to make practical changes to maintain quality of life and safety. These include:

• Making changes to the environment
  • Reducing clutter
  • Decreasing noise 
  • Removing dangerous objects 
• Creating structure
• Simplify tasks and responsibilities
• Encouraging activity
• Maintaining a calendar for events and tasks like taking medications
• Addressing legal and financial concerns 

Support for Family and Caregivers

Caring for a loved one with dementia can be difficult, both physically and emotionally. Caregivers, friends, and family should learn about the condition and practice coping behaviors to help adjust to the progression of symptoms. It's important to ensure you have all the support you need to better handle the many challenges you and your loved ones will face.

• Ask questions during any visits with your loved one's care team
• Join a support group.
• Participate in caregiver education programs in the community or online
• Find out about available support services in the community
• Take care of yourself so you can care for your loved one