Dementia is characterized by a constellation of symptoms and signs including disturbances in memory, attention, reasoning, behavior, executive function and mood amongst others. About 5 million Americans have dementia. Alzheimer's disease, Vascular dementia and Lewy body dementia are the most common types of dementia seen in clinical practice. Mild cognitive impairment (MCI) often a precursor to dementia can occur in 10%-20% of individuals over the age of 65. There are several risk factors for dementia that can be addressed to delay or prevent the onset of the illness. There are many warning signs of dementia which are often missed by family members leading to a delay in diagnosis and treatment. There are several FDA approved treatments for the memory disturbances in dementia including donepezil, rivastigmine, memantine and galantamine which can be used alone or in combination. Unfortunately there are still many unmet needs in the diagnosis and treatment of this illness.
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What Is Dementia?
Dementia is a disturbance in a group of mental processes including:
Common behavioral disturbances in patients with dementia include:
- Mood Disturbances
- Psychotic Symptoms
Almost 5 million Americans have dementia.
More than 70% of patients with dementia have behavioral disturbances.
Dementia is not a disease but an umbrella term used to describe a constellation of signs and symptoms. It can be due to many different causes.
Mild Cognitive Impairment, a forerunner of dementia occurs in 10%-20% of the population over 65. 5% - 15% of cases of MCI will convert to dementia annually.
Alzheimer’s disease is the sixth leading cause of death in the US.
Every 68 seconds someone in America develops Alzheimer’s.
The number of people with Alzheimer’s disease doubles with every five year interval beyond the age of 65.
10 Early Warning Signs of Dementia:
1. Memory difficulties affecting daily life.
2. Difficulty planning or solving problems.
3. Confusion with places and time.
4. Difficulty with familiar tasks at home.
5. Misplacing things.
6. Difficulty recalling words or following a conversation.
7. Problems with vision or perception.
8. Problems with judgment.
9. Changes in personality.
10. Social and work withdrawal.
Types of dementia include the Following, and Some Patients Can Have More Than One Type:
Alzheimer’s Disease (50%-70% of all cases)
Difficulty remembering names and recent events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.
Vascular Dementia (20% of all cases)
Vascular dementia is a decline in thinking skills caused by conditions that block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients. This often results from a stroke or mini strokes.
Lewy Body Dementia (15%-20% of all cases)
People with dementia with Lewy bodies often have memory loss and thinking problems common in Alzheimer’s, but are more likely than people with Alzheimer’s to have initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and muscle rigidity or other parkinsonian movement features.
Parkinson’s Disease Dementia (5% of all cases)
Problems with movement are a common symptom early in the disease. If dementia develops, symptoms are often similar to dementia with Lewy bodies.
Frontotemporal Dementia (5% of all cases
Typical symptoms include changes in personality and behavior and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected.
In 60% of people with early Alzheimer’s disease the condition is not recognized by their family or not evaluated by a doctor. By the time family members notice signs of dementia it is usually in the moderate stage.
In 2012 more than 15 million family members and unpaid caregivers provided care for patients with dementia, a contribution valued at $216 billion dollars. An estimated 2.3 million caregivers of people with AD and other dementias live at least 1 hour away from the care recipient
The National Alzheimer’s Project Act (NAPA) was signed into law in 2011 by President Obama to create a national plan to overcome Alzheimer’s disease.
A useful resource for patients and caregivers is the Alzheimer’s Association at www.alz.org or 800.272.3900.
What Are the Main Changes in DSM-5 For the Diagnosis of Dementia?
- Replace the term Dementia with the term Major Neurocognitive Disorders
- Etiologies of Major Neurocognitive Disorders specified like Alzheimer’s disease, Vascular disease, Lewy body disease, Frontotemporal lobar degeneration, Parkinson’s disease etc.
How Is a Person Diagnosed With Dementia?
The diagnosis of dementia is made by obtaining a thorough medical and psychiatric history, and a medical, neurologic and mental status examination. Biomarkers being studied for the early diagnosis of dementia and MCI include elevated levels of tau protein and decreased levels of beta amyloid in the cerebrospinal fluid, decreased glucose uptake on PET scans and brain atrophy on MRI scans. Did you know that nanomedicine is being used as a promising approach for the diagnosis and treatment of Alzheimer’s disease?
Neuropsychological testing may sometimes be necessary. The Mini Mental State Exam (MMSE) is one of the commonest screening instruments for dementia in clinical practice. Assessment of driving ability in patients with dementia is important. The MMSE does not correlate with ability to drive.
Laboratory testing may include blood chemistry, thyroid function, folate and B12 levels, and a CT scan or a MRI scan.
How Can Dementia Be Treated?
Lifestyle modifications that may help delay or prevent dementia in some people include avoiding smoking or excessive alcohol intake, aggressive treatment of hypertension, diabetes, high lipids and late life depression, physical exercise, mental and social activity, and cognitive training. The evidence for the use of antioxidants, homocysteine, certain diets, and omega 3 fatty acids is inconsistent.
Treatments for dementia include medications like donepezil, rivastigmine, galantamine and memantine (alone or in combination) which may improve mental processes like memory and sometimes slow the progression of the Alzheimer’s disease, medications for Parkinson’s disease like carbidopa-levodopa which may help dementia due to Parkinson’s disease or Lewy body dementia.
The FDA has not approved any new drugs for Alzheimer’s disease in the last 10 years.
The use of antipsychotics in patients with dementia should be used as a last resort and not first line treatment.
Antidepressants like SSRI’s, antipsychotics or psychostimulants may help treat the behavioral disturbances of dementia.
“What is good for the heart is good for the brain”
Risk Factors For Dementia
- Advancing Age
- Family History
- Head Trauma
- Diabetes Mellitus
- Late Life Depression
Arm bracelets with name and telephone number and shoes with GPS may are a good idea for patients with dementia.
Myths About Dementia
1. Severe memory loss is a natural part of aging.
2. Alzheimer’s disease is not fatal.
3. Aluminum intake can cause Alzheimer’s dementia.
4. Only old people can get dementia
5. Artificial sweeteners like aspartame can cause dementia.