DEMENTIA
The word dementia describes a group of symptoms that includes short-term memory loss, confusion, the inability to problem-solve, the inability to complete multi-step activities such as preparing a meal or balancing a checkbook, and, sometimes, personality changes or unusual behavior.
Certain conditions can cause reversible dementias. These include medication interactions, depression, vitamin deficiencies or thyroid abnormalities. It is important that these conditions be identified early and treated appropriately so that symptoms can be improved.
The irreversible dementias are known as degenerative dementias, and Alzheimer’s disease is the most common. There are a number of other degenerative dementias, however, that may look like Alzheimer’s, but have distinct or different features which need special attention and different treatment. Reversible and irreversible dementias are described in more detail below. An accurate diagnosis is important before decided to label a person with “dementia.”
The process of diagnosing dementia has become more accurate in recent years, and specialists are able to analyze the large amount of data collected and determine if there is a problem, the severity, and, often, the cause of the dementia. Occasionally, there may be a combination of causes or it may take time to monitor the individual to be sure of a diagnosis. Determining whether the cause is a reversible or irreversible condition guides the treatment and care for the affected person and family.
Reversible Dementias
Deteriorating intellectual capacity may be caused by a variety of diseases and disorders in older persons. An illness and/or a reaction to medication may cause a change in mental status. These are sometimes called “pseudodementias.” Detecting the underlying cause of changes through medical evaluation may lead to a determination that the cause is reversible or treatable. Examples of conditions that can cause reversible symptoms of dementia include:
- Reactions to medications. Adverse drug reactions are one of the most common reasons older persons experience symptoms that mimic dementia. All medications, prescriptions, over-the-counter pills and herbal remedies should be monitored by a physician to reduce the possibility of side effects.
- Endocrine abnormalities. The conditions of low or high thyroid levels, parathyroid disturbances or adrenal abnormalities can cause confusion that mimics dementia.
- Metabolic disturbances. Confusion or appetite, sleep and emotional changes can be caused by medical conditions including renal and liver failure, electrolyte imbalances (blood chemistry levels), hypoglycemia (low blood sugar), hypercalcemia (high calcium), and diseases of the liver and pancreas.
- Emotional Distress. Depression or major life changes such retirement, divorce or loss of a loved one can affect one’s physical and mental health. A physician should be informed about major stressful life events.
- Vision and Hearing. Undetected problems of vision or hearing may result in inappropriate responses and be misinterpreted. Hearing and eye exams should be performed.
- Infections. Confusion can be a symptom of an infection and needs to be brought to the attention of the physician.
- Nutritional Deficiencies. Deficiencies of B vitamins (folate, niacin, riboflavin and thiamine) can produce cognitive impairment.
Degenerative (Irreversible) Dementias
If reversible dementias are ruled out and it is determined that the person has a degenerative or irreversible dementia, it is important that families and medical personnel seek the cause of the problem. This will help ensure that the person affected receives proper medical care, and families can plan their caregiving and find appropriate support and resources.
The following are the most common ‘Irreversible’ or ‘degenerative’ dementias:
- Alzheimer’s Disease. Alzheimer’s Disease is the most common cause of dementia in people over 65, although the disease also occurs in people much younger. Alzheimer’s affects approximately 50 percent of those over 85. Presently, researchers cannot definitely say what causes the disease, and there is no cure. Symptoms differ from person to person, but declines in memory, thinking and ability to function gradually progress over of a period of years, ending in a severe loss of function.
- Ischemic Vascular Dementia (IVD). IVD is the second most common dementia, characterized by an abrupt loss of function or general slowing of cognitive abilities that interferes with what are called “executive functions” such as planning and completing tasks. When symptoms appear suddenly, the person has usually experienced a stroke. For others, the condition develops slowly with a gradual loss of function and/or thinking.
- Dementia with Lewy Bodies (DLB). Dementia with Lewy Bodies is a progressive degenerative disease that shares symptoms with Alzheimer’s and Parkinson’s. People affected by this disease have behavioral and memory symptoms which can fluctuate, as well as motor problems which are commonly seen with Parkinson’s disease.
- Frontotemporal Dementia (FTD). FTD is a degenerative condition of the front (anterior) part of the brain, which can sometimes be seen on brain scans. The frontal and anterior temporal lobes of the brain control reasoning, personality, movement, speech, language, social graces and some aspects of memory. Symptoms may lead to misdiagnosis as a psychological or emotionally-based problem. FTD frequently occurs after age 40 and usually before age 65. Symptoms appear in two seemingly opposite ways: some individuals are overactive, restless, distracted and disinhibited (showing poor social judgment), while others are apathetic, inert and emotionally blunted.
- Creutzfeldt-Jakob Disease. Creutzfeldt-Jakob Disease (CJD or Jakob-Creutzfeldt Disease) is a rapidly progressive, fatal brain disease. It is part of a family of diseases, called transmissible spongiform encephalopathies, that are caused by an agent known as a prion (“pree-on”). This condition can be very difficult to diagnose as it has many different symptoms, including behavioral changes, movement changes, cognitive changes and general changes in well-being such as sleep problems, loss of appetite and headaches.
- Parkinson’s Dementia. Parkinsonism is the name given to a collection of symptoms and signs consisting of tremor, stiffness, slowness of movement, unsteady gait. Many neurological disorders have features of parkinsonism, including many of the dementias. When parkinsonism occurs without any other neurological abnormalities, and there is no recognizable cause, the disorder is termed Parkinson’s disease after the English physician who first described it fully in 1817.
- Progressive Supranuclear Palsy (PSP). People with PSP usually show a group of three symptoms, including the gradual loss of balance and trouble walking, loss of control of voluntary eye movements, and dementia. Although these three features are considered to be the hallmarks of PSP, patients with this disorder also experience other symptoms common to degenerative diseases of the brain, including difficulties with movement, changes in behavior and difficulty with speech and swallowing. In part because it is relatively rare, PSP is frequently misdiagnosed as Parkinson’s Disease. However, its treatment response and clinical symptoms are different, making an accurate diagnosis very important.
- Normal Pressure Hydrocephalus (NPH). Gait instability, urinary incontinence and dementia are the signs and symptoms typically found in patients who have NPH. Considered a rare cause of dementia, it primarily affects persons older than 60 years. The precise incidence of NPH is hard to determine because the condition does not have a formal, agreed-upon definition. Some physicians base the diagnosis strongly on radiographic evidence; another group of health care professionals relies more on clinical indications. Still others use a combination of signs and symptoms that they have found to be reliable. Traditionally, treatment is surgical implantation of a shunt to reduce the pressure caused by the build up of cerebrospinal fluid.
- Huntington’s disease (HD). Huntington’s disease is a fatal disease typically characterized by involuntary movements (chorea) and cognitive decline (dementia). It is caused by a genetic mutation that can be passed down from generation to generation. HD is an illness with profound neurological and psychiatric features affecting certain structures deep within the brain, particularly the basal ganglia, responsible for such important functions as movement and coordination. Structures responsible for thought, perception and memory are also affected, likely due to connections from the basal ganglia to the frontal lobe of the brain. As a result, patients may experience uncontrolled movements (such as twisting and turning), loss of intellectual abilities, and emotional and behavior disturbances.
- Mixed Dementias. At times, two of these conditions can overlap. This is commonly seen in Alzheimer’s disease and vascular dementia, and also in Alzheimer’s disease and Lewy Body dementia.
(Sources: National Library of Medicine 2008; Family Caregiver Alliance 2008, Family Caregiver Alliance©, Fact Sheets and Publications)
