Dementia

Dementia is not a single disease, but rather a group of symptoms affecting memory, thinking, and the ability to perform daily activities that worsens over time. It is caused by changes in the brain and is more common as people grow older, though it is not a normal part of aging.

Table of contents

• What is dementia?
• Signs and symptoms
• What causes dementia?
• Types of dementia
• Who gets dementia?
• How is dementia diagnosed?
• Treatment options
• Risk factors and prevention
• Living with dementia
• Support for caregivers

What is dementia?

Dementia is a general term that describes a group of symptoms affecting how the brain works. It is not one specific disease, but rather a collection of symptoms that occur when certain brain diseases or injuries damage nerve cells and affect different areas of the brain^[1][2].

The main feature of dementia is the loss of cognitive functioning (the ability to think, remember, and reason) to such an extent that it interferes with a person’s daily life and activities^[2]. A person with dementia has two or more difficulties, including problems with memory, reasoning, language, coordination, mood, or behavior^[5].

Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living^[2].

It is important to understand that dementia is not a normal part of aging. While everyone loses some brain cells as they age, people with dementia experience far greater loss^[2]. Many people live into their 90s and beyond without any signs of dementia^[2].

Signs and symptoms

Signs and symptoms of dementia occur when once-healthy neurons (nerve cells) in the brain stop working properly, lose connections with other brain cells, and die^[2]. The symptoms can vary depending on the type of dementia and which parts of the brain are affected.

Common symptoms include^[2][3]:

• Memory loss, which is usually noticed by someone else
• Problems communicating or finding words
• Difficulty speaking, understanding and expressing thoughts, or reading and writing
• Trouble with visual and spatial abilities, such as getting lost while driving
• Problems with reasoning or problem-solving
• Trouble performing complex tasks
• Trouble with planning and organizing
• Poor coordination and control of movements
• Confusion and disorientation
• Wandering and getting lost in familiar places
• Repeating questions
• Using unusual words to refer to familiar objects
• Taking longer to complete normal daily tasks

Dementia also causes psychological changes that may include^[3][4]:

• Personality changes
• Depression
• Anxiety
• Agitation
• Behavior that doesn’t fit the situation
• Being suspicious, known as paranoia
• Seeing things that aren’t there, known as hallucinations
• Losing interest in normal daily activities or events
• Not caring about other people’s feelings

Changes in mood and behavior sometimes happen even before memory problems occur, and symptoms get worse over time^[4].

What causes dementia?

Dementia is the result of changes in certain brain regions that cause neurons and their connections to stop working properly^[8]. These changes are caused by diseases and injuries that affect the brain^[1].

For most cases, researchers have connected specific changes in the brain to certain forms of dementia, but the underlying causes are often unknown^[8]. For a small number of people, rare genetic variants that cause dementia have been identified^[8].

Things that increase the risk of developing dementia include^[4]:

• Age (more common in those 65 or older)
• High blood pressure (hypertension)
• High blood sugar (diabetes)
• Being overweight or obese
• Smoking
• Drinking too much alcohol
• Being physically inactive
• Being socially isolated
• Depression

Not all conditions that cause dementia symptoms are permanent. Some conditions that can cause symptoms similar to dementia are reversible, such as thyroid problems and vitamin deficiencies^[1][5].

Types of dementia

There are several different types of dementia. The most common include^[1][5][8]:

Alzheimer’s disease is the most common cause of dementia, accounting for 60-80% of cases^[1]. It is typically associated with abnormal buildups of proteins in the brain, known as amyloid plaques and tau tangles, along with a loss of connection among nerve cells^[8].

Vascular dementia is the second most common cause of dementia. It occurs because of microscopic bleeding and blood vessel blockage in the brain^[1][8]. People with vascular dementia may have changes in the brain’s white matter, which are the connecting “wires” of the brain that relay messages between regions^[8].

Lewy body dementia involves problems with thinking, movement, behavior, and mood. People with this type have abnormal deposits of a protein called alpha-synuclein in the brain, also called Lewy bodies^[8].

Frontotemporal dementia is rare and tends to occur in people younger than 60. It is named for the areas of the brain affected. Changes in the frontal lobe lead to behavioral symptoms, while changes in the temporal lobe lead to problems with language and emotions^[8].

Mixed dementia refers to a diagnosis where a person shows changes in the brain from multiple types of dementia at the same time^[1][8]. For example, a person might have evidence of changes typical of both Alzheimer’s disease and vascular dementia.

Other causes of dementia include Parkinson’s disease, Huntington’s disease, normal pressure hydrocephalus, and Creutzfeldt-Jakob disease^[5].

Who gets dementia?

Dementia affects millions of people worldwide. In 2021, 57 million people had dementia globally, with over 60% living in low- and middle-income countries^[4]. Every year, there are nearly 10 million new cases^[4].

Dementia is more common as people grow older. About one-third of all people age 85 or older may have some form of dementia^[2][8]. About 5% to 8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age^[5]. It’s estimated that as many as half of people 85 years of age and older have dementia^[5].

Women are disproportionately affected by dementia, both directly and indirectly. Women experience higher disability and mortality due to dementia, but also provide 70% of care hours for people living with dementia^[4].

In the United States, the number of people age 65 and older who have Alzheimer’s disease and related dementias varies by race^[5]:

• Blacks: 14%
• Hispanics: 12%
• Non-Hispanic whites: 10%
• American Indian and Alaska Natives: 9%
• Asian and Pacific Islanders: 8%

Dementia is currently the seventh leading cause of death globally and one of the major causes of disability and dependency among older people^[4]. By 2050, the number of people affected is set to rise to 139 million worldwide^[7].

How is dementia diagnosed?

To diagnose dementia, a healthcare professional must recognize the pattern of loss of skills and function and determine what a person is still able to do^[10]. Although definitive diagnosis of various types of dementia is only possible through autopsy, clinical diagnosis can be performed by a specialist^[14].

A healthcare professional reviews your medical history and symptoms and conducts a physical exam. Someone who is close to you may be asked about your symptoms as well. No single test can diagnose dementia^[10].

Several types of tests may be used^[10]:

Cognitive and neuropsychological tests evaluate your thinking ability. These tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention.

Neurological evaluation examines movement, balance, senses, reflexes, and other areas.

Brain scans can check for evidence of stroke, bleeding, tumor, or fluid buildup. Different types include:

• CT or MRI scans can check for structural changes in the brain
• PET scans can show patterns of brain activity and determine whether certain proteins associated with Alzheimer’s disease have been deposited in the brain^[10]

Laboratory tests through simple blood tests look for changes that affect brain function, such as too little vitamin B-12 in the body or a thyroid gland that is less active than typical. Sometimes spinal fluid is examined for infection, inflammation, or markers of some diseases^[10].

Psychiatric examination helps determine whether depression or another mental health condition is part of the symptoms^[10].

More recently, biomarkers have become available to make more accurate diagnosis of Alzheimer’s disease and other forms of dementia^[14].

Treatment options

There is currently no cure for dementia^[4][11][13]. However, there are treatments that may change disease progression, and both drug and non-drug options may help treat symptoms^[13].

Medications for dementia

Most medicines available are used to treat Alzheimer’s disease, as this is the most common form of dementia. They can help temporarily reduce symptoms^[11].

The main medicines include^[11][14]:

Acetylcholinesterase inhibitors prevent an enzyme from breaking down a substance called acetylcholine in the brain, which helps nerve cells communicate with each other. These include:

• Donepezil (also known as Aricept) – used to treat symptoms of mild to moderate Alzheimer’s disease, and also for more severe disease
• Rivastigmine (Exelon) – used to treat mild to moderate Alzheimer’s disease
• Galantamine (Reminyl) – used to treat mild to moderate Alzheimer’s disease

There is evidence that these medicines can also help treat dementia with Lewy bodies and Parkinson’s disease dementia, as well as people who have mixed dementia^[11]. Side effects can include nausea and loss of appetite, which usually improve after two weeks of taking the medicine^[11].

Memantine (also known as Ebixa, Marixino, or Valios) is given to people with moderate or severe Alzheimer’s disease, dementia with Lewy bodies, and those with a combination of Alzheimer’s disease and vascular dementia^[11]. It works by blocking the effects of an excessive amount of a chemical in the brain called glutamate. Side effects can include headaches, dizziness, and constipation, but these are usually temporary^[11].

More recently, new medications have been approved that address the underlying biology of Alzheimer’s disease, including lecanemab (Leqembi) and donanemab (Kisunla), which have received approval for the treatment of early Alzheimer’s disease^[13].

Treatments for related conditions

Some conditions such as heart problems can affect symptoms of dementia, particularly vascular dementia. It’s important that these are diagnosed and treated. These conditions include stroke, heart problems, diabetes, high blood pressure, high cholesterol, chronic kidney disease, and depression^[11].

Treatments for behavioral symptoms

In the later stages of dementia, many people develop behavioral and psychological symptoms such as increased agitation, anxiety, wandering, aggression, delusions, or hallucinations^[11]. These changes can be very distressing.

Coping strategies should be tried first. If they do not work, antipsychotic medicines may be prescribed for those showing persistent aggression or extreme distress, but only at the lowest dose and for the shortest time possible^[11]. Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety^[11].

Non-medication treatments

Medicines are important, but are only one part of care. Other treatments, activities, and support are just as important in helping people live well with dementia^[11].

Cognitive stimulation therapy (CST) involves taking part in group activities and exercises designed to improve memory, problem-solving skills, and language ability. Evidence suggests that CST benefits people with mild to moderate dementia^[11].

Cognitive rehabilitation involves working with a trained professional, such as an occupational therapist, and a relative or friend to achieve personal goals, such as learning to use a mobile phone or other everyday tasks^[11].

Other approaches include creating a predictable routine, providing regular opportunities for rest and activity, arranging the environment to help the person do as much as they can while staying safe, and facilitating enjoyable activities that match the person’s current strengths and interests^[23].

Risk factors and prevention

Although dementia mainly affects older people, it is not a normal part of aging^[4]. Some risk factors for dementia, such as age and genetics, cannot be changed. However, there are steps you can take that may help reduce your risk.

Things you can do to reduce your risk include^[4]:

• Manage high blood pressure
• Control blood sugar levels if you have diabetes
• Maintain a healthy weight
• Stop smoking
• Limit alcohol consumption
• Stay physically active
• Stay socially connected
• Address depression if present

Almost 62% of healthcare practitioners worldwide incorrectly think that dementia is part of normal aging, and 1 in 4 people think that there is nothing we can do to prevent dementia^[7]. However, research shows that certain lifestyle factors can help reduce risk.

Living with dementia

People with dementia face unique challenges, but there are steps that can help with daily life. As the disease progresses, simple everyday activities become more difficult to complete.

Tips for everyday tasks

To help cope with changes in memory and thinking, consider these strategies^[19][21]:

• Write down to-do lists, appointments, and events in a notebook or calendar
• Set up automated bill payments
• Consider having groceries delivered
• Use a weekly pillbox or medication dispenser with reminders
• Follow a regular schedule for activities like bathing, dressing, and eating
• Keep important items in consistent, labeled places

Staying active and healthy

Participating in activities you enjoy and getting exercise may help you feel better, stay social, maintain a healthy weight, and have regular sleep habits^[21]. Try to be physically active for at least 30 minutes on most days, and aim for a mix of exercise types including endurance, strength, balance, and flexibility^[21].

Sleep tips

Dementia often changes sleeping habits. For better sleep^[21]:

• Follow a regular schedule by going to sleep and getting up at the same time each day
• Develop a relaxing bedtime routine with lowered lights and cool temperature
• Avoid caffeine and naps late in the day
• Keep a lamp and phone nearby for safety

Safety considerations

As dementia progresses, safety becomes more important. Keep your home well-lit, remove tripping hazards, install grab bars in the bathroom, and consider emergency alert systems^[21].

Planning for the future

It’s important to plan ahead while you can still make decisions. This includes arranging legal documents such as advance directives and power of attorney, discussing your wishes for future care, and organizing financial matters^[21].

Support for caregivers

Millions of people care for a friend or family member with dementia. Caregiving can be overwhelming at times, but there are strategies and support available^[18].

Tips for daily care

When providing daily care^[18]:

• Try to keep a routine for bathing, dressing, and eating at the same time each day
• Help the person write down appointments and events
• Plan activities the person enjoys at the same time each day
• Allow the person to do as much as possible on their own
• Be gentle and respectful, telling the person what you are going to do step by step
• Serve meals in a consistent place and give enough time to eat

Communication tips

Improving communication skills will help make caregiving less stressful^[22]:

• Set a positive mood with pleasant tone and body language
• Get the person’s attention before speaking
• Use simple words and sentences
• Speak slowly and clearly
• Ask one question at a time
• Be patient and give time to respond
• Listen with your eyes, ears, and heart

Managing behavioral changes

People with dementia may experience behavior changes such as wandering, agitation, repetitive actions, paranoia, or sleep problems. Understanding that these behaviors are caused by the disease, not intentional, can help. Try to identify triggers, maintain routines, and redirect attention when needed^[22].

Taking care of yourself

Over 50% of carers globally say their health has suffered as a result of their caring responsibilities^[7]. It’s essential to:

• Ask for help from family and friends
• Take breaks and use respite care when needed
• Join support groups to connect with others in similar situations
• Take care of your own health needs
• Seek professional support if feeling overwhelmed

Finding support

Many resources are available including support groups, adult day centers, respite care, and professional caregiving services. National organizations provide helplines, online resources, and local support^[18].