What is Dementia?

  • Dementia is not a specific disease. It's an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities. Alzheimer's disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies. Dementia is often incorrectly referred to as "senility" or "senile dementia," which reflects the formerly widespread but incorrect belief that serious mental decline is a normal part of aging.

Causes of Dementia

  • Dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other. When brain cells cannot communicate normally, thinking, behavior and feelings can be affected. The brain has many distinct regions, each of which is responsible for different functions (for example, memory, judgment and movement). When cells in a particular region are damaged, that region cannot carry out its functions normally.

    Different types of dementia are associated with particular types of brain cell damage in particular regions of the brain. For example, in Alzheimer's disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That's why memory loss is often one of the earliest symptoms of Alzheimer's.

    While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by the following conditions may improve when the condition is treated or addressed:

    • Depression
    • Medication side effects
    • Excess use of alcohol
    • Thyroid problems
    • Vitamin deficiencies

Symptoms of Dementia

  • While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia:

    • Memory
    • Communication and language
    • Ability to focus and pay attention
    • Reasoning and judgment
    • Visual perception  
    • People with dementia may have problems with short-term memory, keeping track of a purse or wallet, paying bills, planning and preparing meals, remembering appointments or traveling out of the neighborhood.

Treatments for Dementia

  • Treatment of dementia depends on its cause. In the case of most progressive dementias, including Alzheimer's disease, there is no cure and no treatment that slows or stops its progression. But there are drug treatments that may temporarily improve symptoms. The same medications used to treat Alzheimer's are among the drugs sometimes prescribed to help with symptoms of other types of dementiasNon-drug therapies can also alleviate some symptoms of dementia.

    Ultimately, the path to effective new treatments for dementia is through increased research funding and increased participation in clinical studies. Right now, volunteers are urgently needed to participate in more than 180+ actively enrolling clinical studies and trials about Alzheimer's and related dementias.

Types of Dementia

Stages of Dementia

  • The stages of dementia are as follows:
    • No impairment. At this stage, there are no obvious signs of dementia and people are still able to function independently.
    • Very mild. Dementia signs are barely noticeable and simply appear to be the kind of forgetfulness associated with aging — such as misplacing keys but finding them again after some searching.
    • Mild. At this stage, patients are “usually able to do basic activities of daily living,” says Shah — which means they can perform their daily routines, such as getting up, going to the bathroom, getting dressed, and so on, without difficulty. Symptoms of dementia at this stage may include:
      • Some forgetfulness and memory loss
      • Repetition
      • Losing items without being able to retrace steps to find them
      • Slight trouble managing finances, such as balancing a checkbook
      • Confusion while driving
      • Trouble managing medications
      • Loss of concentration
    • Moderate. At this stage patients have “trouble doing routine tasks that they always did, such as cooking, laundry, or using the phone,” explains Shah. Other dementia symptoms during this stage include:
      • Trouble holding urine (incontinence)
      • Increase in memory loss and forgetfulness
      • Inability to use or find the right words and phrases
      • Difficulty doing challenging mental math exercises, such as counting backwards from 100 by 7
      • Increase in social withdrawal
    • Moderately severe. At this stage, dementia patients will need some assistance with their day-to-day activities. Symptoms of moderately-severe dementia include:
      • Increase in memory loss, including inability to remember home address, phone number, or other personal details
      • Confusion about location or chain of events
      • Trouble with less challenging mental math exercises
      • Needing help to select appropriate clothing for the climate, season, or occasion
    • Severe. “Caregivers have to help a lot more with day-to-day activities” at this stage, says Shah. Dementia signs at the severe stage include:
      • Needing help to get dressed
      • Requiring help with toileting, such as wiping and flushing
      • Wandering and becoming lost if not supervised
      • Inability to recall the names of family members or caregivers, but still being able to recognize familiar faces
      • Sleep disturbances
      • Changes in personality or behavior, such as increased paranoia or even hallucinations
    • Very severe. This is the final stage of the disease. Symptoms of dementia during this stage include:
      • Loss of language skills
      • Loss of awareness of surroundings
      • Requiring help to eat
      • Lack of control over urination
      • Loss of muscle control to smile, swallow, or even walk or sit without support
  • In order to determine your loved one’s stage of dementia, your doctor will ask a variety of questions of both the patient and the caregiver. These questions may include some mental tests. One frequently used screening tool is called the Mini-Mental State Examination, an 11-question exam that can help pinpoint cognitive decline on a scale of 0 to 30. In general, Shah says that a score between 14 and 26 points correlates to mild/moderate stage dementia and a score between 4 and 14 correlates with severe dementia.

    It’s important to remember that the stages of dementia are somewhat fluid — use them to help plan for future changes and to work with your doctor to develop a solid treatment plan.

Dementia Diagnosis

  • There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer's and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type. Doctors can determine that a person has dementia with a high level of certainty. But it's harder to determine the exact type of dementia because the symptoms and brain changes of different dementias can overlap. In some cases, a doctor may diagnose "dementia" and not specify a type. If this occurs it may be necessary to see a specialist such as a neurologist or gero-psychologist. Click here for a mental status test.

What to do if diagnosed with Dementia

  • If you or a loved one is experiencing memory difficulties or other changes in thinking skills, don't ignore them. See a doctor soon to determine the cause. Professional evaluation may detect a treatable condition. And even if symptoms suggest dementia, early diagnosis allows a person to get the maximum benefit from available treatments and provides an opportunity to volunteer for clinical trials or studies. It also provides time to plan for the future.