Dementia

Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person's daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change. 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 living.

Dementia is more common as people grow older (about one-third of all people age 85 or older may have some form of dementia) but it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia.

There are several different forms of dementia, including Alzheimer’s disease. A person’s symptoms can vary depending on the type.

Symptoms

Dementia symptoms vary depending on the cause, but common signs and symptoms include:

Cognitive changes

· Memory loss, which is usually noticed by someone else

· Difficulty communicating or finding words

· Difficulty with visual and spatial abilities, such as getting lost while driving

· Difficulty reasoning or problem-solving

· Difficulty handling complex tasks

· Difficulty with planning and organizing

· Difficulty with coordination and motor functions

· Confusion and disorientation

Psychological changes

· Personality changes

· Depression

· Anxiety

· Inappropriate behavior

· Paranoia

· Agitation

· Hallucinations

Progressive dementias

Types of dementias that progress and aren't reversible include:

· Alzheimer's disease. This is the most common cause of dementia.

Although not all causes of Alzheimer's disease are known, experts do know that a small percentage are related to mutations of three genes, which can be passed down from parent to child. While several genes are probably involved in Alzheimer's disease, one important gene that increases risk is apolipoprotein E4 (APOE).

Alzheimer's disease patients have plaques and tangles in their brains. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein. It's thought that these clumps damage healthy neurons and the fibers connecting them.

· Vascular dementia. This type of dementia is caused by damage to the vessels that supply blood to your brain. Blood vessel problems can cause strokes or affect the brain in other ways, such as by damaging the fibers in the white matter of the brain.

The most common signs of vascular dementia include difficulties with problem-solving, slowed thinking, and loss of focus and organization. These tend to be more noticeable than memory loss.

· Lewy body dementia. Lewy bodies are abnormal balloon like clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer's disease and Parkinson's disease. This is one of the more common types of progressive dementia.

Common signs and symptoms include acting out one's dreams in sleep, seeing things that aren't there (visual hallucinations), and problems with focus and attention. Other signs include uncoordinated or slow movement, tremors, and rigidity (parkinsonism).

· Frontotemporal dementia. This is a group of diseases characterized by the breakdown of nerve cells and their connections in the frontal and temporal lobes of the brain. These are the areas generally associated with personality, behavior and language. Common symptoms affect behavior, personality, thinking, judgment, and language and movement.

· Mixed dementia. Autopsy studies of the brains of people 80 and older who had dementia indicate that many had a combination of several causes, such as Alzheimer's disease, vascular dementia and Lewy body dementia. Studies are ongoing to determine how having mixed dementia affects symptoms and treatments.

Other disorders linked to dementia

· Huntington's disease. Caused by a genetic mutation, this disease causes certain nerve cells in your brain and spinal cord to waste away. Signs and symptoms, including a severe decline in thinking (cognitive) skills, usually appear around age 30 or 40.

· Traumatic brain injury (TBI). This condition is most often caused by repetitive head trauma. Boxers, football players or soldiers might develop TBI.

Depending on the part of the brain that's injured, this condition can cause dementia signs and symptoms such as depression, explosiveness, memory loss and impaired speech. TBI may also cause parkinsonism. Symptoms might not appear until years after the trauma.

· Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without known risk factors. This condition might be due to deposits of infectious proteins called prions. Signs and symptoms of this fatal condition usually appear after age 60.

Creutzfeldt-Jakob disease usually has no known cause but can be inherited. It may also be caused by exposure to diseased brain or nervous system tissue, such as from a cornea transplant.

· Parkinson's disease. Many people with Parkinson's disease eventually develop dementia symptoms (Parkinson's disease dementia).

· Wernicke-Korsakoff Syndrome: Wernicke-Korsakoff syndrome (WKS) is a type of brain disorder caused by a lack of vitamin B-1, or thiamine. The syndrome is actually two separate conditions that can occur at the same time, Wernicke’s disease (WD) and Korsakoff syndrome. Usually, people get the symptoms of WD first. WD is also known as Wernicke’s encephalopathy.

Dementia-like conditions that can be reversed

Some causes of dementia or dementia-like symptoms can be reversed with treatment. They include:

· Infections and immune disorders. Dementia-like symptoms can result from fever or other side effects of your body's attempt to fight off an infection. Multiple sclerosis and other conditions caused by the body's immune system attacking nerve cells also can cause dementia.

· Metabolic problems and endocrine abnormalities. People with thyroid problems, low blood sugar (hypoglycemia), too little or too much sodium or calcium, or problems absorbing vitamin B-12 can develop dementia-like symptoms or other personality changes.

· Nutritional deficiencies. Not drinking enough liquids (dehydration); not getting enough thiamin (vitamin B-1), which is common in people with chronic alcoholism; and not getting enough vitamins B-6 and B-12 in your diet can cause dementia-like symptoms. Copper and vitamin E deficiencies also can cause dementia symptoms.

· Medication side effects. Side effects of medications, a reaction to a medication or an interaction of several medications can cause dementia-like symptoms.

· Subdural hematomas. Bleeding between the surface of the brain and the covering over the brain, which is common in the elderly after a fall, can cause symptoms similar to those of dementia.

· Brain tumors. Rarely, dementia can result from damage caused by a brain tumor.

· Normal-pressure hydrocephalus. This condition, which is caused by enlarged ventricles in the brain, can result in walking problems, urinary difficulty and memory loss.