Alzheimer’s disease is the
most common cause of dementia. This topic focuses on other conditions that
cause dementia. For more information on Alzheimer’s, see the topic
Alzheimer's Disease.
What is dementia?
We all forget things as we get
older. Many older people have a slight loss of memory that does not affect
their daily lives. But memory loss that gets worse may mean that you have
dementia.
Dementia is a loss of mental skills that affects your
daily life. It can cause problems with your memory and how well you can think
and plan. Usually dementia gets worse over time. How long this takes is
different for each person. Some people stay the same for years. Others lose
skills quickly.
Your chances of having dementia rise as you get
older. But this does not mean that everyone will get it. People rarely have
dementia before age 60. But, after age 85, up to half of all adults have
it.
If you or a loved one has memory loss that is getting worse,
see your doctor. It may be nothing to worry about. If it is dementia, treatment
may help.
What causes dementia?
Dementia is caused by damage
to or changes in the brain. Things that can cause dementia include:
In a few cases, dementia is caused by a problem that can
be treated. Examples include having an underactive thyroid gland (hypothyroidism), not getting enough vitamin B12, and
fluid buildup in the brain (normal-pressure hydrocephalus). In
these cases, treating the problem may cure the dementia.
In some
people, depression can cause memory loss that seems like dementia. Depression
can be treated.
As you age, medicines may affect you more. Taking
some medicines together may cause symptoms that look like dementia. Be sure
your doctor knows about all of the medicines you take. This means all
prescription medicines and all
over-the-counter medicines, herbs, vitamins, and
supplements.
What are the symptoms?
Usually the first symptom
is memory loss. Often the person who has a memory problem does not notice it,
but family and friends do. As dementia gets worse:
You may have more trouble doing things that
take planning, like making a list and going shopping.
You may have
trouble using or understanding words.
You may get lost in places
you know well.
Over time, people with dementia may begin to act very
different. They may become scared and strike out at others, or they may become
clingy and childlike. They may stop brushing their teeth or bathing.
Later, they cannot take care of themselves. They may not know where they
are. They may not know their loved ones when they see them.
How is dementia diagnosed?
There is no single test
for dementia. To diagnose it, your doctor will:
Do a physical exam.
Ask questions
about recent and past illnesses and life events. The doctor will want to talk
to a close family member to check details.
Ask you to do some
simple things that test your memory and other mental skills. Your doctor may
ask you to tell what day and year it is, repeat a series of words, or draw a
clock face.
The doctor may do tests to look for a cause that can be
treated. For example, you might have blood tests to check your thyroid or to
look for an infection. You might also have a test that shows a picture of your
brain, like an
MRI and a
CT scan. These tests can help your doctor find a tumor
or brain injury. They can also show if there has been shrinking in parts of the
brain. This can be a sign of dementia.
How is it treated?
There are medicines you can
take for dementia. They cannot cure it, but they can slow it down for a while
and make it easier to live with.
As dementia gets worse, a person
may get depressed or angry and upset. Treatment, such as medicines and
counseling, may help. So can getting out more and having an active social
life.
If a stroke caused the dementia, there are things you can
do to reduce the chance of another stroke. Stay at a healthy weight, exercise,
and keep your blood pressure and cholesterol at normal levels. If you have
diabetes, keep your blood sugar in your target range.
Keeping
both your mind and your body active is a good idea for anyone. So is not
smoking.
How can I help my loved one with dementia?
There
are many things you can do to help your loved one be safe at home. For example,
get rid of throw rugs, and put handrails in bathrooms to help prevent falls.
Post reminder notes around the house. Put a list of important phone numbers by
the telephone. You also can help your loved one stay active. Play cards or
board games, and take walks.
Work with your loved one to make
decisions about the future before dementia gets worse. It is important to write
a
living will and a
durable power of attorney. A living will states the
types of medical care your loved one wants. A durable power of attorney lets
your loved one pick someone to be the
health care agent. This person makes care decisions
after your loved one cannot.
Watching a loved one slip away can
be sad and scary. Caring for someone with dementia can leave you feeling
drained. Be sure to take care of yourself and to give yourself breaks. Ask
family members to share the load, or get other help.
Your loved
one will need more and more care as dementia gets worse. In time, he or she may
need help to eat, get dressed, or use the bathroom. You may be able to give
this care at home, or you may want to think about using a nursing home. A
nursing home can give this kind of care 24 hours a day. The time may come when
a nursing home is the best choice.
You are not alone. Many
people have loved ones with dementia. Ask your doctor about local support
groups, or search the Internet for online support groups, such as the
Alzheimer's Association. Help is available.
After
Alzheimer's disease, dementia caused by strokes (vascular dementia) is the most common type of
dementia. Many people have mixed types of dementia. Mental function lost to
vascular dementia cannot be restored, but future damage may be prevented by
reducing the risk for stroke.
Some causes of dementia can be
reversed with treatment, but most cannot. Common causes of dementia that cannot
be reversed are:
Parkinson's disease, which is a
movement disorder. Dementia is common in people with this
condition.
Dementia with Lewy bodies, which causes
protein deposits (Lewy bodies) in brain cells. It can cause short-term memory
loss like some other brain diseases, but it can also cause the person to fall
often and to see things that aren't there (hallucinations).
Frontotemporal dementia, a group of diseases that
includes Pick's disease. These diseases can cause changes in personality,
behavior, or language.
Severe head injury that caused a loss of
consciousness.
Less common causes of dementia that cannot be reversed
include:
Multiple-system atrophy (a group of degenerative brain
diseases affecting speech, movement, and
autonomic functions).
Infections such as
mad cow disease and late-stage
syphilis. Antibiotics can effectively treat syphilis
at any stage, but they cannot reverse the brain damage already done.
Doctors can treat some causes of dementia and restore
mental function. These include:
Some disorders that cause dementia can run in families.
Doctors often suspect an inherited cause if someone younger than 50 has
symptoms of dementia. For more information, see the topic
Alzheimer's Disease.
It is important to
know that memory loss can be caused by conditions other than dementia, such as
depression, and that those conditions can be treated. Also, occasional trouble
with memory (such as briefly forgetting someone's name) can be a normal part of
aging. But if you are worried about memory loss or if a loved one has memory
loss that is getting worse, see your doctor.
Symptoms
Symptoms of
dementia vary depending on the cause and the
area of the brain that is affected. Memory loss is usually the earliest and most
noticeable symptom. Other key symptoms of dementia include:
Having difficulty recalling recent
events.
Not recognizing familiar people and
places.
Having trouble finding the right words to express thoughts
or name objects.
Having difficulty performing
calculations.
Having problems planning and carrying out tasks, such
as balancing a checkbook, following a recipe, or writing a
letter.
Having trouble exercising judgment, such as knowing what to
do in an emergency.
Having difficulty controlling moods or
behaviors.
Depression is common, and agitation or aggression may
occur.
Not keeping up personal care such as grooming or
bathing.
Some types of dementia cause key symptoms:
People who have
dementia with Lewy bodies often have highly detailed
visual hallucinations. They may fall frequently.
The first symptoms
of
frontotemporal dementia may be personality changes or
unusual behavior. People with this condition may not express any caring for
others, or they may say rude things, expose themselves, or make sexually
explicit comments.
Symptoms of dementia that come on suddenly suggest
vascular dementia or possibly
delirium—short-term confusion caused by a new or
worsening illness.
What Happens
How quickly
dementia progresses depends on what is causing it and
the area of the brain that is affected. Some types of dementia progress slowly
over several years. Other types may progress more rapidly. If
vascular dementia is caused by a series of small
strokes, the loss of mental skills may be gradual. If
it is caused by a single stroke in a large blood vessel, loss of function may
occur suddenly.
The course of dementia varies greatly from one
person to another. Early diagnosis and treatment with medicines used for
Alzheimer's (cholinesterase inhibitors such as
donepezil [Aricept]) may help preserve mental functioning for a while in people
with vascular dementia,
dementia with Lewy bodies, or
Parkinson's disease.1 Even
without these medicines, some people remain stable for months or years, while
others decline rapidly.
Many people with dementia are not aware
of their mental decline. They may deny their condition and blame others for the
problems they experience. Those who are aware may mourn their loss of abilities
and become hopeless and depressed.
Depending on the type of
dementia, the person's behavior may eventually become out of control. The
person may become angry, agitated, and combative or clingy and childlike. He or
she may wander and become lost. These problems can make it difficult for family
members or others to continue providing care at home.
Even with
the best care, people with dementia tend to have a shorter life span than the
average person their age. Death usually results from lung or kidney infections
caused by being bedridden.
What to think about
Many older people have a
slight loss of mental skills (usually recent memory) that doesn't affect their
daily functioning. This is called
mild cognitive impairment by some. People who have mild impairment may be in
the early stage of dementia, or they may stay at their present level of ability
for a long time.
Other factors that may increase your risk of dementia
include:
Having ongoing low blood pressure if you are
older than 75. Researchers think this risk may be the result of the brain not
getting enough blood. More studies are needed to determine the best blood
pressure for older adults, one that lowers their risk for heart disease but
provides enough blood flow to keep the brain healthy.2
Having a high level of
homocysteine. Homocysteine is an amino acid normally
found in small amounts in the blood. High levels of homocysteine are thought to
cause
plaque to build up in the blood vessels. Over time,
this can lead to serious problems such as stroke, heart attack, and
pulmonary embolism. It may also lead to mental
declines. Homocysteine levels are generally stable until age 40 but then begin
to increase naturally, especially after age 70.3
Using hormone therapy after the age of 65.
Hormone replacement therapy (HRT)—a combination of
estrogen and progesterone—was once believed to provide protection from dementia
or cognitive impairment. However, the
Women's Health Initiative found that HRT actually
increased the risk for Alzheimer's disease and other dementias in women age 65
and older who took it for more than 4 years.4 Estrogen
alone (estrogen replacement therapy) had similar
effects.5 Whether either of these therapies might help
reduce the risk of later dementia when used around the age of menopause is not
known.6
Numbness, weakness, or inability to move the
face, arm, or leg, especially on one side of the body.
Vision
problems in one or both eyes, such as dimness, blurring, double vision, loss of
vision, or a sensation that a shade is being pulled down over your
eyes.
Confusion; trouble speaking or understanding.
Trouble walking; dizziness; loss of balance or coordination.
Severe headache with no known cause.
Call a doctor immediately if a
person suddenly becomes confused, emotionally upset, or doesn't seem to know
who or where he or she is. These are signs of
delirium, which can be caused by a reaction to
medications or a new or worsening medical condition.
Call a doctor
if you or a person you are close to has new and troubling memory loss that is
more than an occasional bout of forgetfulness. This may be an early sign of
dementia.
Watchful Waiting
Occasional forgetfulness or memory loss can be a
normal part of aging. But any new or increasing memory loss or problems with
daily living should be reported to a doctor. Learn the
warning signs of dementia, and talk to a doctor if you
or a family member shows any of these signs. They include increased trouble
finding the right words when speaking, getting lost going to familiar places,
and acting more irritable or suspicious than usual.
Who To See
The following health professionals can evaluate
symptoms of memory loss or confusion:
Doctors diagnose the cause of
dementia by asking questions about the person's
medical history and doing a physical exam, a
mental status exam, and lab and imaging tests.
Tests can help the doctor learn whether dementia is caused by a treatable
condition. Even for those dementias that cannot be reversed, knowing the type
of dementia a person has can help the doctor prescribe medicines or other
treatments that may improve mood and behavior and help the family.
Medical history
During a
medical history and physical exam, the doctor will ask
the affected person and a close relative or partner about recent illnesses or
other life events that could cause memory loss or other symptoms such as
behavioral problems. The doctor may ask the person to bring in all medicines he
or she takes. This can help the doctor determine whether the problem might be
caused by the person being overmedicated or having a drug interaction.
Although a person may have more than one illness causing dementia,
symptoms sometimes can distinguish one form from another. For example, early in
the course of
frontotemporal dementia people may display a lack of
social awareness and develop obsessions with eating, neither of which occurs
early in other dementias.
Mental status exam
A doctor or other health
professional will conduct a
mental status exam. This test usually involves such
activities as having the person tell what day and year it is, repeat a series
of words, draw a clock face, and count back from 100 by 7s.
Other
tests have been developed to diagnose dementia. Doctors can use one such test,
Addenbrooke's Cognitive Examination, to distinguish
Alzheimer's disease from frontotemporal dementia.
Orientation, attention, and memory are worse in Alzheimer's, while language
skills and ability to name objects are worse in frontotemporal dementia.
Lab tests
Numerous medical conditions can cause
mental impairment. During a physical exam, the doctor will look for signs of
other medical conditions and have lab tests done to find any treatable
condition. Routine tests include:
MRI can show shrinkage in
parts of the brain that occurs in some types of dementia. MRI and CT scan also
can show evidence of strokes from
vascular dementia.
Two other forms of
imaging—single photon emission CT (SPECT) and
PET scan—are not used routinely to diagnose dementia.
But they may be useful if the symptoms are confusing or odd. These tests can
help identify several forms of dementia, including vascular dementia and
frontotemporal dementia.
In some cases, electrical activity in the brain may be
measured using an
electroencephalogram (EEG). Doctors seldom use this
test to diagnose dementia, but they may use it to distinguish dementia from
delirium and to look for unusual brain activity found
in Creutzfeldt-Jakob disease, a rare cause of dementia.
In rare
cases, a brain
biopsy may be done if a treatable cause of dementia is
suspected.
After death, an
autopsy may be done to find out for sure what caused
dementia. This information may be helpful to family members concerned about
genetic causes. For more information, see the topic
Alzheimer's Disease.
Treatment Overview
Some cases of
dementia are caused by medical conditions that can be
treated, fully or partly restoring mental function. When dementia cannot be
reversed, the goal of treatment is to make life as easy as possible for the
person and the caregivers.
Initial treatment
If the cause of
dementia can be reversed, the doctor will prescribe
treatment. For example, the person might:
Get treatment for reversible
conditions caused by
AIDS.
After treatment for reversible conditions, the person
will continue to see his or her doctor to make sure the symptoms do not return.
For people with
vascular dementia, doctors may prescribe medicines to
lower high blood pressure and medicines for high cholesterol (statins). These drugs cannot reverse existing
dementia, but they may prevent future strokes and heart disease that can lead
to further brain damage.
If the cause of dementia cannot be
treated, the doctor will work with the person and caregivers to develop a plan
to make life easier and more comfortable. Care plans may include tips to help
the person be independent and manage daily life as long as possible. Education
of the family and other caregivers is critical to successfully caring for a
person with dementia. If you are or will be a caregiver, start learning what
you can expect and what you can do to manage problems as they arise. For more
information, see the Home Treatment section of this topic.
While
medicines cannot cure dementia, they may help improve mental function, mood, or
behavior. Medicines that your doctor may prescribe include:
Cholinesterase inhibitors such as donepezil (Aricept),
galantamine (Reminyl), or rivastigmine (Exelon), to improve or maintain mental
function. These drugs were developed to treat
Alzheimer's disease, but they may be tried in other
dementias. Studies indicate that they hold promise for the treatment of people
with vascular dementia. Both donepezil and galantamine have been shown to
improve mental function with few side effects.7
Rivastigmine may help people with
dementia with Lewy bodies and
Parkinson's disease, but side effects such as nausea,
vomiting, and weight loss are common.8 Exelon patches
cause fewer side effects. At present, medicines can slow but not stop the
progress of dementia.
Memantine (Namenda). This type of medicine can slow
the late stages of Alzheimer's disease. It may also benefit those with mild to
moderate vascular dementia.8 More studies are under
way.
Antidepressants to treat depression. They must be used
carefully because they can cause
delirium in people with dementia. Antidepressants that
have the fewest side effects in people with dementia are
SSRIs, such as fluoxetine (Prozac, for example) and
citalopram (Celexa).9
Medicines to ease anxiety, agitation, aggression, and
hallucinations. Some of these medicines, called antipsychotic drugs, are not
approved by the FDA for the treatment of dementia. Studies of people with
psychosis due to dementia who were treated with these medicines, including
Zyprexa and Risperdal, found an increased risk of death.10, 11 Discuss this risk with your doctor
before using these medicines.
People who are recently diagnosed and their families
should begin to make plans for the future. If possible, make decisions while
the person is able to participate in the decision making. These are difficult
but important conversations. Questions include:
What kind of care does the person need right
now?
Who will take care of the person in the future?
What can the family expect as the disease progresses?
What kind of planning needs to be done?
As soon as possible after dementia is diagnosed, family
members should discuss what
financial and legal planning will be needed. Along
with a will, the person should write a
living will and assign a
durable power of attorney for health care. These
documents will ensure that the person's wishes for medical care, especially
life-sustaining treatment, are recorded. For more information, see
Writing an Advance Directive.
Ongoing treatment
The goal of ongoing treatment
for
dementia is to keep the person safely at home for as
long as possible and to provide support and guidance to the caregivers.
Health professionals will work with the person and his or her family or
other caregivers to improve mental function as much as possible. Adjustments to
the home can make the person's life easier and safer. You can install handrails
in showers and remove rugs to improve safety. Calendars and lists can aid
memory; you can place sticky notes or signs with pictures on them around the
house to help the person remember where objects are stored and to guide the
person to the bathroom or kitchen. For more information, see the Home Treatment
section of this topic.
The person may also take medicines such as:
Cholinesterase inhibitors such as donepezil (Aricept),
galantamine (Reminyl), or rivastigmine (Exelon). These drugs were developed to
treat
Alzheimer's disease, but they may be tried in other
dementias to improve or maintain mental function. Studies indicate that this
class of drugs holds promise for the treatment of people with
vascular dementia. Both donepezil and galantamine have
been shown to improve mental function with few side effects.7 Rivastigmine may help people with
dementia with Lewy bodies, but side effects such as
nausea, vomiting, and weight loss are common.8 At
present, cholinesterase inhibitors can slow but not stop the progress of
dementia. It is not clear how long these medicines will work. They may only
stop the progress of dementia for a short time.
Memantine (Namenda). This new type of medicine can
slow the late stages of Alzheimer's disease. It may also benefit those with
mild to moderate vascular dementia.8 More studies are
under way.
Antidepressants to treat depression. They must be used
carefully because they can cause
delirium in people with dementia. Antidepressants that
have the fewest side effects in people with dementia are
SSRIs, such as fluoxetine (Prozac, for example) and
citalopram (Celexa).9
Medicines to ease anxiety, agitation, aggression, and
hallucinations, which can become worse as dementia progresses. Some of these
medicines, called antipsychotic drugs, are not approved by the FDA for the
treatment of dementia. Studies of people with psychosis due to dementia who
were treated with these medicines, including Zyprexa and Risperdal, found an
increased risk of death.10, 11
Discuss this risk with your doctor before using these medicines.
Routine follow-up visits to a health professional (every
3 to 6 months) are necessary to monitor medications and the person's level of
functioning.
If the person's condition is getting worse, decisions
need to be made while he or she is able to participate in the decision making.
Issues include preparing documents such as a
living will and a
durable power of attorney. These documents ensure that
the person's wishes for medical care, especially life-sustaining treatment, are
in writing. For more information, see
Writing an Advance Directive.
Taking
care of a person with dementia is stressful. If you are a caregiver,
seek support from family members or friends. Take care
of your own health by getting breaks from caregiving. Counseling, a support
group, and adult day care or respite care can help you through stressful times
and bouts of burnout.
Treatment if the condition gets worse
As
dementia progresses, memory, judgment, and the ability
to make and carry out plans (executive function) decline. Depending on the type
of dementia, the person's behavior may become out of control; the person may
become angry, agitated, or combative. The person may wander and become lost.
These problems can make it difficult for family members or others to continue
providing care at home. The family may have to consider whether to place the
person in a care facility that has a dementia unit.
For more
information on making the decision about nursing care, see:
Even with the best care, people with dementia tend to
have a shorter life span than the average person their age. The progression
varies depending on the disease causing dementia and whether the person has
other illnesses such as diabetes or heart disease. For more information on
decisions you may face as your loved one's condition progresses, see the topic
Care at the End of Life.
Prevention
Dementia is
difficult to prevent because what causes it often is not known. However, people
who have
vascular dementia may be able to prevent future
declines by lowering their risk of heart disease and
stroke. Even if you don't have these known risks, your
overall health can benefit from these strategies:
Treat or prevent high blood pressure. To do
this, you may need to take medicines or you may be able to get results from
lifestyle changes such as losing excess weight, exercising, limiting alcohol,
cutting back on salt, quitting smoking, and eating a low-fat and
low-saturated-fat diet. For more information, see the topic
High Blood Pressure (Hypertension).
Do not
smoke.
Stay at a healthy weight. This also reduces your risk of
diabetes, another risk factor for
dementia.
Keep your
cholesterol in the normal range. Total cholesterol
should be less than 200 mg/dL. For more information, see the topic
High Cholesterol.
Get plenty of exercise.
Try to do at least 2½ hours a week of
moderate exercise. One way to do this is to be active
30 minutes a day, at least 5 days a week. It's fine to be active in blocks of
10 minutes or more throughout your day and week.12
Stay mentally alert by learning new hobbies,
reading, or solving crossword puzzles.
Stay involved socially.
Attend community activities, church, or support groups.
In people who already have had a
stroke, treating high blood pressure reduces the risk
of another stroke by 20%. Taking aspirin to prevent blood clots lowers the risk
of another stroke by 17%.13 For more information on how
to reduce your risk for stroke, see the topic
Stroke.
Some older people develop
symptoms that look like dementia but are the result of taking medicines that
don't work well together. You may be able to avoid this problem by making sure
your doctor knows about all medicines—both prescription and
over-the-counter—and all vitamin, herbal, and dietary
supplements you take.
Research
One study found that older adults who regularly
participated in leisure activities that required mental effort reduced their
risk of dementia. Reading, playing board games, playing a musical instrument,
and dancing were all found to be helpful, but most likely any hobby that keeps
the brain active would be beneficial.14
Some evidence suggests that light to moderate
alcohol use (1 to 6 drinks a week) may reduce the risk of dementia in older
people.15, 16 Since heavier
drinking can cause dementia, alcohol use is a widely debated issue.
One study found that people age 50 or older who took
cholesterol-lowering medicines called statins reduced their risk of developing
dementia.17 More recent studies have not found that
statins reduce the risk of dementia. But these studies were of people age 65
and older.18, 19 Whether taking
statins might help people who start them at a younger age is not known.
Hormone replacement therapy (HRT)—a combination of
estrogen and progesterone—was once believed to provide protection from dementia
or cognitive impairment. But the
Women's Health Initiative found that HRT actually
increased the risk for Alzheimer's disease and other dementias in women age 65
and older who took it for more than 4 years.4 Estrogen
alone (estrogen replacement therapy) had similar
effects.5 Whether either of these therapies might help
reduce the risk of later dementia when used around the age of menopause is not
known.6
Home Treatment
Home treatment for
dementia involves teamwork among health professionals
and caregivers to create a safe and comfortable environment and to make tasks
of daily living as easy as possible.
A diagnosis of dementia can
create feelings of anger, fear, and anxiety. A person in the early stage of the
illness should seek emotional support from family, friends, and perhaps a
counselor experienced in working with people who have dementia. Professional
counseling may help the person accept the diagnosis and develop coping
strategies.
If the condition is diagnosed early, people with mild
dementia can be involved with their doctor and caregivers in planning for the
future and organizing the home and daily tasks. Dementia progresses at
different rates in different people, so a person may have many months, or even
years, of stable functioning. People with dementia may be able to stay mentally
and physically active for years.
People with dementia and their
caregivers face many challenges, such as:
Whether the person should continue
driving. Taking away driving privileges may reduce the
person's sense of independence and increase dependence. But it is extremely
important to prevent the person from driving when it is no longer safe. People
in the very early stages of dementia should have their driving performance
checked to make sure they can drive safely. Their doctor should reassess their
level of functioning every 6 months.
What
financial and legal planning will be needed. As soon
as possible after dementia is diagnosed, the person should write a living will
and assign a durable power of attorney for health care. These documents will
ensure that the person's wishes for medical care, especially life-sustaining
treatment, are recorded. For more information, see the topic
Writing an Advance Directive. Family members should
also locate all documents necessary to assess the legal and financial affairs
of the person. These include prior tax returns, health and life insurance
policies, pension information, deeds, mortgages, bank accounts, and investment
information.
Other issues for caregivers
Many people who have
dementia are cared for at home by partners or other family members and friends.
Taking care of someone with dementia can be physically and emotionally
draining, but tips and other help can make it easier.
Make sure your home is safe. Keep rooms
uncluttered, with clear walkways. Lock up knives, cleaning supplies, and other
dangerous substances. Remove throw rugs and consider installing carpet to help
prevent slipping. Install handrails, tub mats, and other assistive devices in
the bathroom. Provide good lighting, and put night-lights in bedrooms,
hallways, and bathrooms.
Maintain good nutrition. Offer food
more often, including healthy midmorning and midafternoon snacks. If the person
has trouble using a spoon or a fork, serve finger foods. Serve one food at a
time; choices can be confusing. If the person is losing weight, consider
offering a liquid nutrition drink, such as Ensure.
Manage sleep problems. Keep the person awake and active during the day.
Discourage napping unless doing so causes more problems. Offer warm milk or
caffeine-free herbal tea before bedtime. A warm bath close to bedtime may help
the person relax.
Manage bladder and bowel control problems (incontinence). Encourage the person to use the bathroom on a regular
schedule, such as every 2 hours. Mark the bathroom and toilet clearly with
signs; use pictures when the person can no longer understand words. Consider
using absorbent pads or briefs such as Attends or Depends. If incontinence is a
new problem, make sure it is not caused by another condition, such as a urinary
tract infection.
Some people with dementia develop behavior problems, such
as aggression. These problems can be especially challenging for caregivers. The
following strategies may help.
Make the most of remaining abilities.
It is important to give the person tasks and activities that occupy him or her
without pushing too much. Tailor tasks to the person's abilities. For example,
if cooking is no longer safe, ask for help in setting the table or making
simple dishes such as salad. Reinforce and support the person's efforts to
remain independent, even if tasks take more time or aren't done
perfectly.
Help the person avoid confusion. Label often-used
rooms, such as the bathroom, and objects. Keep regular routines for daily
activities such as meals, baths, and hobbies. Keep furniture, lamps, pictures,
and other objects in the same place.
Understand behavior changes. Strange or disruptive
behaviors can be one of the most difficult problems for caregivers. The person
may do certain things repeatedly or insist on unusual routines or activities.
Think about whether the person's unusual behaviors might be motivated by an
urge to continue past activities or habits. If so, you may be able to find ways
to change the person's environment and set up daily routines that make these
behaviors less of a problem.
Manage agitation. Keep noise levels low and voices
quiet. Develop simple daily routines for bathing, dressing, eating, and other
activities. Tell the person in advance about changes in his or her regular
schedule (trips, doctor visits), and remind the person often of the upcoming
event.
Manage wandering. Try to figure out why the person
wanders. A person who wanders at a certain time of day may always have taken a
walk or gone to work at that time. Lock outside doors, and use alarms and other
devices to alert you when the person wanders. Get a medical ID bracelet for the
person so that you can be contacted if he or she wanders
away.
Communicate successfully. Use short, simple, familiar
words and sentences. Explain your actions. Be calm and supportive. Use eye
contact and use touch to reassure. Don't argue. Offer reassurance and try to
distract the person.
Caregivers should remember to
seek support from other family and friends. Get
counseling, find a support group, and make use of adult day care or other
services to help you through stressful times and bouts of burnout. For more
information, see the topic
Caregiver Tips.
Nursing home placement
Even with the best care,
a person with progressive dementia will decline, perhaps to the point where a
caregiver is no longer physically, emotionally, or financially able to provide
care. The person may develop uncontrollable behavior problems or may have other
medical conditions that the caregiver cannot manage.
Several types
of assisted-living arrangements are available, although many people with
dementia will need full-time care at some point. Making the decision about
nursing home placement is often very difficult. Every family needs to consider
its own financial situation, emotional capacity, and other issues. For more
information, see:
Doctors use medicines to treat
dementia in the following ways:
To correct an underlying condition causing dementia, such as
thyroid replacement for
hypothyroidism, vitamins for lack of vitamin B12, or
antibiotics for infections
To maintain mental functioning for as
long as possible when dementia cannot be reversed
To prevent
worsening of
vascular dementia from future small strokes in people
with high blood pressure and high cholesterol
Doctors may prescribe the following medicines to help
maintain mental function:
Cholinesterase inhibitors such as donepezil (Aricept),
galantamine (Reminyl), and rivastigmine (Exelon). These were developed to treat
Alzheimer's disease, but they may be tried in other
dementias to maintain mental function. Studies indicate that this class of
drugs holds promise for the treatment of people with vascular dementia. Both
donepezil and galantamine have been shown to improve mental function with few
side effects.7 Rivastigmine was also beneficial for
people with
dementia with Lewy bodies or
Parkinson's disease, but side effects such as nausea,
vomiting, and weight loss were common.8 At present,
medicines can only slow, not stop, the progress of dementia. It is not clear
how long these medicines will work. They may only stop the progress of dementia
for a short time.
Memantine (Namenda). This is a type of medicine that
can slow the late stages of Alzheimer's disease. It may also benefit those with
mild to moderate vascular dementia.8 More studies are
under way.
The doctor may prescribe medicines for high blood
pressure and high cholesterol, since these conditions are risk factors for
vascular dementia.20 These drugs cannot reverse
existing dementia, but they may prevent future strokes and heart disease that
can lead to further brain damage. For more information, see the topics
High Blood Pressure (Hypertension),
High Cholesterol, and
Transient Ischemic Attack (TIA).
Medicines that doctors may use to help control mood or behavior problems
include:
Antidepressants to treat depression, which is
common in dementia. They must be used with caution, because they can cause
delirium in people with dementia. Antidepressants that
have the fewest side effects in people with dementia are the
selective serotonin reuptake inhibitors (SSRIs), such
as fluoxetine (Prozac, for example) and citalopram (Celexa).9
Medicines such as risperidone (Risperdal) or
olanzapine (Zyprexa), called antipsychotic drugs. Doctors may use these to
treat symptoms such as anxiety, agitation, aggression, sleep problems, firmly
held false beliefs (delusions), and hallucinations. Antipsychotic drugs are not
approved by the FDA for the treatment of dementia. Studies of people with
psychosis due to dementia who were treated with these medicines found an
increased risk of death. Discuss this risk with your doctor before taking these
medicines.
What To Think About
Rivastigmine (Exelon) can now be
given through a skin patch. Skin patches release medicine into the blood at a
steady level and may reduce side effects. And it’s easier for caregivers to
make sure a person is taking the medicine properly when the person uses a skin
patch.
The medicines risperidone (Risperdal) and olanzapine
(Zyprexa) have been found to reduce behavior problems and
psychosis in people with dementia.8 However, these and similar drugs have some known
risks:
The U.S. Food and Drug Administration (FDA)
issued a public health advisory stating that people with dementia who use
antipsychotics may die sooner than those who don't use these drugs. Examples of
these antipsychotics include haloperidol (Haldol), olanzapine (Zyprexa),
quetiapine (Seroquel), and risperidone (Risperdal).
The makers of
Risperdal have issued a warning that older adults taking this medicine may have
a slightly higher risk of stroke.
Several new medicines have been studied, including
oxiracetam and pentoxifylline. These medicines are experimental and have not
yet been rigorously studied for dementias other than Alzheimer's.
Studies have found daily use of SSRIs may increase the risk of bone
fracture in adults over age 50. Talk to your doctor about this risk before
taking an SSRI.21
FDA advisory about antidepressants. The FDA has issued an advisory to
patients, families, and health professionals to closely monitor for signs of
suicidal behavior in adults and children taking antidepressants. This is
especially important at the beginning of treatment or when doses are
changed.
The FDA also advises that people taking antidepressants
be observed for increases in anxiety, panic attacks, agitation, irritability,
insomnia, impulsivity, hostility, and mania. The FDA has not recommended that
people stop using antidepressants but simply to monitor those taking the
medications and, if concerns arise, to contact a doctor.
Surgery
In rare cases, surgery may be used to remove a
brain tumor or to treat
normal-pressure hydrocephalus, both of which can cause
dementia. Other causes of dementias cannot be treated
with surgery.
Other Treatment
Researchers are investigating
many treatments to learn whether they can prevent or delay the development of
dementia.
Many people take ginkgo biloba to improve or preserve memory. But studies have not shown that ginkgo biloba helps improve memory or prevent dementia.22 Ginkgo biloba is widely used in Europe to treat age-related dementia, including Alzheimer's disease.
People with dementia may
benefit from a structured group program that encourages them to focus on a
variety of topics and to think creatively within their limits. This type of
program, sometimes called reality orientation or cognitive stimulation therapy,
is offered in some day care and residential settings.23Occupational therapists focus on a person's ability to
perform daily tasks and take part in social activities. Studies have shown
occupational therapy can improve the daily functioning of people with
dementia.24
Other Places To Get Help
Organizations
National Institute of Neurological Disorders and
Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424 (301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
Alzheimer's Association
225 North Michigan Avenue, Floor 17
Chicago, IL 60601-7633
Phone:
1-800-272-3900
Fax:
1-866-699-1246 toll-free
TDD:
1-866-403-3073 toll-free
E-mail:
info@alz.org
Web Address:
www.alz.org
The Alzheimer's Association is a national organization that
provides educational materials, support groups, and community services for
people dealing with Alzheimer's disease. It has more than 200 local chapters
throughout the United States. The organization publishes a newsletter as well
as a wide range of brochures and videos. The Web site includes a lot of useful
information for people with Alzheimer's and other dementias, as well as for
their caregivers.
American Geriatrics Society: The AGS Foundation for
Health and Aging
The Empire State Building
350 Fifth Avenue
Suite 801
New York, NY 10118
Phone:
(212) 755-6810
Fax:
(212) 832-8646
E-mail:
info@americangeriatrics.org
Web Address:
www.healthinaging.org
The AGS Foundation for Health and Aging was started by
the American Geriatrics Society (AGS). The foundation works on behalf of older
adults in the areas of wellness and preventive care, self-responsibility and
independence, and connections to family and community.
This Web
site has stories about healthy aging, information on caring for elders at home,
and tips on winter safety, preparing for emergencies, and overcoming the
challenges to healthy aging. The site also has links to many other Internet
resources on aging.
Family Caregiver Alliance
180 Montgomery Street
Suite 1100
San Francisco, CA 94104
Phone:
1-800-445-8106 (415) 434-3388
E-mail:
info@caregiver.org
Web Address:
www.caregiver.org
This organization supports and assists people who are
providing long-term care at home. It also provides education, research,
services, and advocacy.
National Institute on Aging
Building 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD 20892
Phone:
(301) 496-1752 1-800-222-2225, Information Center
Fax:
(301) 496-1072
TDD:
1-800-222-4225 (TTY)
Web Address:
www.nih.gov/nia
The National Institute on Aging (NIA), one of the centers of the
U.S. National Institutes of Health, leads a broad scientific effort to
understand the nature of aging and to extend the healthy, active years of life.
The NIA funds research and provides information about health and research
advances to the public and interested groups.
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Treatment Guidelines From The Medical Letter, 5(54):
9–14.
Verghese J, et al. (2003). Low blood pressure and the
risk of dementia in very old individuals. Neurology,
61(12): 1667–1672.
Garcia A, Zanibbi K (2004). Homocysteine and cognitive
function in elderly people. Canadian Medical Association Journal, 171(8): 897–904.
Shumaker SA, et al. (2003). Estrogen plus progestin
and the incidence of dementia and mild cognitive impairment in postmenopausal
women. The Women's Health Initiative memory study: A randomized controlled
trial. JAMA, 289(20): 2651–2662.
Espeland MA, et al. (2004). Conjugated equine
estrogens and global cognitive function in postmenopausal women: Women's Health
Initiative Memory Study. JAMA, 291(24):
2959–2968.
North American Menopause Society (2008). Estrogen and
progestogen use in postmenopausal women: July 2008 position statement of the
North American Menopause Society. Menopause, 15(4):
584–602. Also available online: www.menopause.org/PSHT08.pdf.
Wilkinson D, et al. (2003). Donepezil in vascular
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Warner J, et al. (2006). Dementia, search date
February 2006. Online version of Clinical Evidence (15):
1–24.
Bird TD, Miller BL (2008). Dementia. Harrison's Principles of Internal Medicine, 17th ed., pp.
2536–2549. New York: McGraw-Hill.
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disorders in elderly patients. FDA Talk Paper T05-13.
Available online: http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01350.html.
Wang PS, et al. (2005). Risk of death in elderly users
of conventional vs. atypical antipsychotic medications. New England Journal of Medicine, 353(22): 2335–2341.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
Roman GC (2002). Vascular dementia revisited:
Diagnosis, pathogenesis, treatment, and prevention. Medical Clinics of North America, 86(3): 477–499.
Verghese J, et al. (2003). Leisure activities and the
risk of dementia in the elderly. New England Journal of Medicine, 348(25): 2508–2516.
Mukamal KJ, et al. (2003). Prospective study of
alcohol consumption and risk of dementia in older adults. JAMA, 289(11): 1405–1413.
Ruitenberg A, et al. (2002). Alcohol consumption and
risk of dementia: The Rotterdam study. Lancet,
359(9303): 281–286.
Jick H, et al. (2000). Statins and the risk of
dementia. Lancet, 356(9242): 1627–1631.
Zandi PP, et al. (2005). Do statins reduce risk of
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217–224.
Li G, et al. (2004). Statin therapy and risk of
dementia in the elderly. Neurology, 63(9):
1624–1628.
Tzourio C, et al. (2003). Effects of blood pressure
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decline in patients with cerebrovascular disease. Archives of Internal Medicine, 163(9): 1069–1075.
Richards JB, et al. (2007). Effect of selective
serotonin reuptake inhibitors on the risk of fracture. Archives of Internal Medicine, 167(2): 188–194.
Birks J, Grimley Evans J (2009). Ginkgo biloba for
cognitive impairment and dementia. Cochrane Database of Systematic Reviews (2).
Spector A, et al. (2003). Efficacy of an
evidence-based cognitive stimulation therapy programme for people with
dementia. British Journal of Psychiatry, 183:
248–254.
Graff MJ, et al. (2006). Community-based occupational
therapy for patients with dementia and their caregivers: Randomised controlled
trial. BMJ, 333(1196). Also available online:
http://www.bmj.com/cgi/content/full/333/7580/1196.
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American Psychiatric Publishing.
Drugs for cognitive loss and dementia (2007).
Treatment Guidelines From The Medical Letter, 5(54):
9–14.
Verghese J, et al. (2003). Low blood pressure and the
risk of dementia in very old individuals. Neurology,
61(12): 1667–1672.
Garcia A, Zanibbi K (2004). Homocysteine and cognitive
function in elderly people. Canadian Medical Association Journal, 171(8): 897–904.
Shumaker SA, et al. (2003). Estrogen plus progestin
and the incidence of dementia and mild cognitive impairment in postmenopausal
women. The Women's Health Initiative memory study: A randomized controlled
trial. JAMA, 289(20): 2651–2662.
Espeland MA, et al. (2004). Conjugated equine
estrogens and global cognitive function in postmenopausal women: Women's Health
Initiative Memory Study. JAMA, 291(24):
2959–2968.
North American Menopause Society (2008). Estrogen and
progestogen use in postmenopausal women: July 2008 position statement of the
North American Menopause Society. Menopause, 15(4):
584–602. Also available online: www.menopause.org/PSHT08.pdf.
Wilkinson D, et al. (2003). Donepezil in vascular
dementia. Neurology, 61(4): 479–486.
Warner J, et al. (2006). Dementia, search date
February 2006. Online version of Clinical Evidence (15):
1–24.
Bird TD, Miller BL (2008). Dementia. Harrison's Principles of Internal Medicine, 17th ed., pp.
2536–2549. New York: McGraw-Hill.
U.S. Food and Drug Administration (2005). FDA issues
public health advisory for antipsychotic drugs used for treatment of behavioral
disorders in elderly patients. FDA Talk Paper T05-13.
Available online: http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01350.html.
Wang PS, et al. (2005). Risk of death in elderly users
of conventional vs. atypical antipsychotic medications. New England Journal of Medicine, 353(22): 2335–2341.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
Roman GC (2002). Vascular dementia revisited:
Diagnosis, pathogenesis, treatment, and prevention. Medical Clinics of North America, 86(3): 477–499.
Verghese J, et al. (2003). Leisure activities and the
risk of dementia in the elderly. New England Journal of Medicine, 348(25): 2508–2516.
Mukamal KJ, et al. (2003). Prospective study of
alcohol consumption and risk of dementia in older adults. JAMA, 289(11): 1405–1413.
Ruitenberg A, et al. (2002). Alcohol consumption and
risk of dementia: The Rotterdam study. Lancet,
359(9303): 281–286.
Jick H, et al. (2000). Statins and the risk of
dementia. Lancet, 356(9242): 1627–1631.
Zandi PP, et al. (2005). Do statins reduce risk of
incident dementia and Alzheimer disease? The Cache County study.
Archives of General Psychiatry, 62(2):
217–224.
Li G, et al. (2004). Statin therapy and risk of
dementia in the elderly. Neurology, 63(9):
1624–1628.
Tzourio C, et al. (2003). Effects of blood pressure
lowering with perindopril and indapamide therapy on dementia and cognitive
decline in patients with cerebrovascular disease. Archives of Internal Medicine, 163(9): 1069–1075.
Richards JB, et al. (2007). Effect of selective
serotonin reuptake inhibitors on the risk of fracture. Archives of Internal Medicine, 167(2): 188–194.
Birks J, Grimley Evans J (2009). Ginkgo biloba for
cognitive impairment and dementia. Cochrane Database of Systematic Reviews (2).
Spector A, et al. (2003). Efficacy of an
evidence-based cognitive stimulation therapy programme for people with
dementia. British Journal of Psychiatry, 183:
248–254.
Graff MJ, et al. (2006). Community-based occupational
therapy for patients with dementia and their caregivers: Randomised controlled
trial. BMJ, 333(1196). Also available online:
http://www.bmj.com/cgi/content/full/333/7580/1196.
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