Dementia

Dementia is a broad term used to define a group of diseases that significantly impact and degrade memory, thinking and the ability to perform daily tasks. Different types of dementia are all caused by abnormal changes within the brain.

Currently, there’s no cure for dementia unless the underlying cause is reversible. Research is focused on finding treatments for diseases that cause damage to brain cells. The most common type of dementia is Alzheimer’s disease, accounting for 60-80% of diagnosed cases.

Dementia is not an expected part of aging, even though it impacts more than 7 million adults aged 65 and older. Recognizing the difference between memory problems that come with age and dementia-related cognitive decline is key to managing symptoms and slowing the disease progression.

What is dementia?

Dementia isn’t a specific disease, but rather an umbrella term that covers a wide range of neurodegenerative disorders that damage the cells and blood vessels that make up the tissue in your brain. Your brain cells include neurons, which send and receive signals to other parts of your body that help you move, interpret senses and control your behavior. Brain cells also include glia, which provides structure in the brain.

When your brain is damaged by a disease, it prevents your brain from functioning normally. The disease will progress in stages, depending on varying factors – including your age, type of dementia and other health conditions.

What is the main cause of dementia?

Alzheimer’s disease is the most common cause of dementia. There are several other underlying causes and risk factors of dementia, including:

• Brain injury
• Multiple sclerosis (MS)
• Parkinson’s disease
• Huntington’s disease
• Mild cognitive impairment (MCI)
• Heart disease
• Stroke
• High blood pressure (hypertension)
• Infections, like Lyme disease or herpes
• Depression
• Smoking & excessive alcohol use
• Family history of dementia

What makes dementia worse?

Untreated vascular risk factors, like high blood pressure, and head injuries from falls or accidents may speed up the loss of cognitive function. Other factors such as malnutrition, dehydration and infections like pneumonia can also make dementia symptoms worse.

Symptoms of dementia

Each type of dementia affects everyone differently. However, there are hallmark symptoms of cognitive decline that disrupt daily life more than typical age-related changes. It’s common for a friend, family member or caregiver to notice mild dementia symptoms first.

Common symptoms of dementia include:

• Confusion
• Concentration issues
• Language and processing trouble
• Loss of muscle function
• Memory loss
• Mood changes
• Psychological changes

Stages of dementia

Typically, there are three stages of dementia: early (mild), middle (moderate) and late-stage (severe) dementia. However, some of the symptoms and signs of these stages may not appear at all or may appear out of order. In some, mild cognitive impairment is considered the first stage of dementia.

Early-stage dementia symptoms include:

• Difficulty planning or organizing
• Trouble following a conversation
• Forgetting recently learned information
• Losing or misplacing items
• Coming up with the right words

Middle-stage dementia symptoms include:

• Confusion about place and time
• Sudden change in mood
• Forgetting important personal information
• Trouble expressing thoughts
• Withdrawn in social settings
• Needing help with personal care
• Wandering or becoming lost
• Difficulty expressing emotions

Sundowning syndrome (also called sundowning dementia) may also appear in middle-stage dementia. Sundowning is a set of symptoms that increase from late afternoon into the night. It includes confusion, agitation, pacing, disorientation and trouble sleeping.

Late-stage dementia symptoms include:

• Needing 24/7 help with personal care
• Loss of awareness
• Limited speech and difficulty communicating
• Inability to walk or sit
• Trouble eating and swallowing

Each dementia stage can last for several years, with middle-stage dementia usually being the longest stage. As the disease progresses into the middle and end stages, support through caregivers, supportive services that offer dementia care or hospice care will be needed to ensure a safe and comfortable environment.

Diagnosing dementia

Different forms of dementia and other neurological disorders have many overlapping symptoms, which makes a dementia diagnosis difficult to confirm. If you’re experiencing any symptoms of cognitive decline or recognize signs in a loved one, it’s vital to speak with a doctor. Early evaluation may identify other causes of memory loss and help initiate dementia treatments and support.

To diagnose dementia, your doctor will first discuss your medical history and review your current medications. They’ll discuss your symptoms and may order a series of tests. If a loved one noticed your symptoms first, it may help to bring them to the appointment.

There’s no established test for dementia. Dementia tests may include laboratory tests, imaging tests and neurocognitive tests. Specialists including neurologists, neuropsychologists and geriatricians often help with dementia diagnosis.

Testing for dementia includes:

• Cognitive testing: Includes verbal and written testing that evaluates your mental abilities.
• Neurological exam: Tests your eye movements, reflexes and balance.
• Spinal tap (lumbar puncture): Checks your cerebrospinal fluid (CSF) for neurodegenerative diseases.
• Blood or urine tests: Looks for vitamin deficiencies and checks your thyroid levels.
• Imaging tests: A CT or MRI scan looks for signs of stroke or bleeding in the brain.

Dementia treatment

If a dementia diagnosis is confirmed, our multidisciplinary team with meet with you and your family to develop a comprehensive treatment plan. Social workers are also available to provide support, counseling, dementia education and resources.

Medications for dementia

Depending on the type and stage of dementia, it may be possible to improve your quality of life while delaying dementia progression and alleviating symptoms.

Dementia medications may include cholinesterase inhibitors approved by the FDA to treat Alzheimer’s disease symptoms. Cholinesterase inhibits the breakdown of acetylcholine, a chemical messenger critical for learning and memory.

The most common prescribed cholinesterase inhibitors include:

• Donepezil (Aricept): Approved for all stages of Alzheimer’s disease.
• Galantamine (Razadyne): Approved to treat mild to moderate Alzheimer’s disease.
• Rivastigmine (Exelon): Approved to treat mild to moderate Alzheimer’s disease.

Other dementia medications include:

• Memantine (Namenda): Helps with cognitive decline symptoms by controlling the level of glutamate, a chemical in the brain involved in learning and memory.
• Suvorexant (Belsomra): Helps insomnia in mild to moderate Alzheimer’s disease.
• Brexpiprazole (Rexulti): Helps treat agitation associated with dementia due to Alzheimer’s disease.

Researchers are studying new ways to treat dementia. Learn more about research opportunities through the Advocate Memory Center.

Dementia therapies

Cognitive behavioral therapies (CBT) – including memory training and reality orientation therapy – can help you remain cognitively active. These dementia therapies focus on maintaining cognitive function and promoting independence for as long as possible.

Another key aspect of treatment for dementia is adapting the home environment to make it supportive, safe and comfortable. This often involves measures like installing safety locks, removing tripping hazards and using devices that help memory such as labels and reminders.

Treating reversible forms of dementia

It may be possible to reverse your symptoms if certain underlying causes are found. This is especially true if your dementia is caused by things like:

• Infections such as Lyme disease
• Alcoholism
• Brain tumors
• Reactions to medication
• Heart and lung issues

Preventing dementia

There’s no proven way to prevent dementia. If you’re concerned about developing dementia, you can take steps that may help delay the disease progression.

Healthy lifestyle steps you can take include:

• Maintain a healthy diet and weight
• Stay physically and mentally active
• Manage blood sugar and high blood pressure
• Avoid smoking and alcohol