Definition

Dementia is a general loss of mental abilities. It can include a loss of ability to think, reason, learn, and understand. To be considered dementia, these mental losses must be severe enough to interfere with day-to-day activities. Dementia must also have:

• Memory problems
• Mental loss that is severe enough to cause problems with one or more of the following:
  • Language
  • Visuospatial function
  • Executive function—foresight, planning, anticipation, and insight
  • Praxis—learned motor skills

Causes

Causes of dementia include:

• Alzheimer’s dementia (most common)
• Brain damage after multiple small strokes—also called vascular dementia
• Lewy body disease
• Alcohol use disorder
• AIDS
• Multiple sclerosis
• Huntington’s disease
• Parkinson’s disease
• Creutzfeldt-Jakob disease and other prion disorders
• Front-temporal dementia, including Pick’s disease
• Normal pressure hydrocephalus
• Untreated syphilis
• Toxic levels of metals, such as aluminum, which can sometimes occur in people who have dialysis treatment
• Vitamin B12 deficiency
• Thiamine deficiency
• Thyroid dysfunction

Risk Factors

Increasing age is the most common factor that increases your chance of developing dementia. Other factors include:

• Family members with dementia
• Down syndrome
• Apolipoprotein E status—a genetic risk
• Elevated cholesterol
• Multiple strokes
• High blood pressure
• Diabetes
• High cholesterol
• Obesity
• Lack of physical activity
• Vitamin deficiency
• Chronic drug use
• Long-term use of hormone replacement therapy
• Repetitive head trauma—may occur with contact sports
• Overweight or obese

Symptoms

Symptoms often begin mildly and get more severe over time. Symptoms vary according to the cause of the dementia, but often include:

• Increasing trouble remembering things, such as:
  • How to get to familiar locations
  • What the names of family and friends are
  • Where common objects are usually kept
  • How to do simple math
  • How to do usual tasks, such as cooking, dressing, or bathing
  • How to drive
  • How to pay bills
• Having difficulty concentrating on tasks
• Having difficulty completing sentences due to lost/forgotten words—may continue to a complete inability to speak
• Forgetting the date, time of day, season
• Getting lost in familiar surroundings
• Being withdrawn, losing interest in usual activities
• Having mood swings
• Having personality changes
• Walking in a slow, shuffling way
• Having poor coordination
• Losing purposeful movement

Diagnosis

Your doctor may diagnose dementia through:

• An extensive medical history from you and your family
• Observing your behavior
• A physical exam
• Tests for your nervous system
• Mental status and psychological tests

Imaging tests take pictures of internal body structures. These may include:

• CT scan
• MRI scan
• PET scan
• SPECT scan

Cerebrospinal fluid that protects the brain and spinal cord can be analyzed with a lumbar puncture.

Treatment

Currently, there are no treatments to cure many types of dementia. Some medication may help to decrease the symptoms of dementia or slow its course.

Prevention

While the exact cause of dementia is not known, these steps may help to reduce your risk:

• Eat a healthful diet. This will help you to maintain good levels of vitamin B12 and cholesterol.
• Exercise regularly. This can also enhance cardiovascular health, which may delay the onset of vascular dementia.
• Alcohol may have some benefits if you use it in moderation. This means no more than two drinks per day for a man, and one drink per day for a woman. Moderate amounts of alcohol may decrease your risk of dementia. Higher amounts of alcohol however, can increase your risk of dementia.
• Engage in mentally stimulating activity. This may also reduce the risk of Alzheimer’s disease.

American Academy of Neurology http://www.aan.com

Toronto Dementia Network http://www.dementiatoronto.org

Alzheimer’s disease medications fact sheet. National Institute on Aging website. Available at: https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-medications-fact-sheet. Updated August 12, 2015. Accessed August 28, 2015.

Alzheimer’s disease and non-Alzheimer’s dementia. EBSCO Natural and Alternative Treatments website. Available at:
http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments
Updated May 4, 2015. Accessed August 28, 2015.

DeKosky S, Jeff D, Williamson A, et al. Ginkgo biloba for prevention of dementia: A randomized controlled trial. JAMA. 2008;300(19):2253-2262.

Dementia evaluation. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated December 29, 2014. Accessed August 28, 2015.

Gidoni R, Benussi L, Paterlini A, Albertini V, Binetti G, Emanuele E. Cerebrospinal fluid biomarkers for Alzheimer’s disease: The present and the future. Neurodegen Dis. 2011;8(6):413-20.

Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt HP, van den Bussche H. Cholinesterase inhibitors for patients with Alzheimer’s disease: Systematic review of randomized clinical trials. BMJ. 2005;331(7512):321-327.

Ledger AJ, Baker FA. An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer’s disease. Aging Ment Health. 2007;11(3):330-338.

Marjoribanks J, Farquhar C, Roberts H, Lethaby A. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2012;7:CD004143.

Middleton LE, Yaffe K. Promising strategies for the prevention of dementia. Arch Neurol. 2009;66(10):1210-1215.

O’Brien JT, Colloby S, Fenwick J, et al. Dopamine transporter loss visualized with FP-CIT SPECT in the differential diagnosis of dementia with Lewy bodies. Arch Neurol. 2004;61(6):919-925.

Schneider L, Dagerman K, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: Meta-analysis of randomized placebo-controlled trials. JAMA. 2005;294(15):1934-1943.

2/24/2009 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev. 2009;1:CD003120.

9/18/2009 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Anstey KJ, Mack HA, Cherbuin N. Alcohol consumption as a risk factor for dementia and cognitive decline: Meta-analysis of prospective studies. Am J Geriatr Psychiatry. 2009;17(7):542-555.

1/8/2010 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Snitz BE, O’Meara ES, Carlson MC, et al. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA. 2009;302(24):2663-2670.