Some people, when asked to define the word “dementia” use words such as “confused, forgetful, senile, Alzheimer’s,” and so forth. And that’s partially true. People with dementia are often confused and forgetful, and have at times in the past been described as being senile. Some people with dementia also have Alzheimer’s disease. But there’s a lot more to it than that.
Dementia is not actually a disease, but instead is a syndrome or a cluster (group) of symptoms. It is a characteristic of a number of different diseases including Alzheimer’s disease, Lewy Body Disease, Vascular Dementia, Huntington’s disease, and several others. Most common in the geriatric population, it can also be found in persons much younger than might be expected – and even in children. It can occur as the primary feature of disorders (such as Alzheimer’s disease), or as a secondary feature of others (Parkinson’s disease, for example).
One of the main features of dementia is decreased intellectual functioning that interferes with day-to-day life. There must be a disruption (a loss or impairment) in two or more areas such as memory, language, perception, judgment, and reasoning. There may also be effects on emotions, behavior, personality, and problem solving skills. Common signs of dementia include, but are not limited to:
- Memory loss
- Difficulty with communication
- Difficulty remembering new information
- Difficulty with planning and organizing
- Difficulty with coordination and motor functions
- Personality changes
- Difficulty reasoning
- Inappropriate behavior
To be diagnosed as having one of the dementias, a person should be displaying symptoms for at least six months. This is because some of the same characteristics can be found in delirium, which is usually caused by more short-term illnesses such as infections, dehydration, reactions to medications, injuries, post-surgical reactions, to name a few. In the case of delirium, the symptoms will almost always improve with treatment, whereas dementia is largely irreversible and progressive. Another disorder that can mimic dementia, and is often mistaken for it, is depression.
Dementia is due to the development of a variety of processes in those parts of the brain that control learning, memory, decision-making, and language. Some of these processes include:
- Degenerative diseases that affect parts of the brain (Alzheimer’s, Parkinson’s, Huntington’s, etc.)
- Diseases that affect the blood vessels, such as a stroke (multi-infarct, or vascular dementia)
- Toxic reactions due to poisoning or medication reactions, or illicit drug use (including alcohol)
- Nutritional and metabolic deficiencies
- Infections involving the brain and spinal cord
- Some kinds of hydrocephalus, or an abnormal accumulation of fluid in the brain
- Head injury
- Disease processes in other parts of the body, including the kidneys and liver
- Tumors in the brain
- Anoxia, or a lack of sufficient oxygen to the brain
Recent scientific advances have enabled us to radically improve our ability to diagnose dementia. However, it still holds true that the only way to completely and definitely diagnose many of the diseases causing dementia is after death, at autopsy. But doctors can now confidently determine that there is a strong likelihood that a person has Alzheimer’s disease (for example), as opposed to one of the other possibilities.
Only a short time ago, many professionals were of the opinion that it wasn’t really important to differentiate between the different dementias. After all, the treatment for them all was basically the same. But that just isn’t true nowadays. We are learning that there are sometimes very definite differences in the way the different dementias are treated. For instance, some of the drugs used for Alzheimer’s and some other dementias, when given to someone with Lewy Body Disease, will produce a very negative and possibly catastrophic reaction. And some of the dementias are only temporary, if treated quickly enough.
So, how do we diagnose dementia? First of all, it’s a diagnosis that must be done by a team of professionals. A complete health history will be taken, including a list of medications and when problems were first noticed. This will include a family history. A thorough physical examination can help rule out any medical conditions that can cause similar symptoms. A cognitive and neuropsychological evaluation will look at how the brain functions, and help determine how far along the dementia is. A neurological evaluation will look at balance, sensory functions, and reflexes, among other things. A brain scan may be ordered, as well as various laboratory tests. A psychiatric evaluation may be ordered, to rule out depression or other psychiatric disorders.
Once a determination is made as to whether the person actually does have dementia, and hopefully a diagnosis as to what kind of dementia, then an appropriate treatment can be initiated. Some forms of treatment are fairly generalized, while others will be specific to the particular disease process involved. These might include medications. In some cases (for example, a brain tumor), surgery might be recommended. In others, various lifestyle changes will be recommended, such as quitting smoking or dietary modifications. Physical, occupational, or speech therapy may be appropriate, as well as counseling. And alterations to the home environment may be indicated, as the disease progresses. Your doctor and other medical professionals can advise you on which treatments are best.
The most important thing to remember is that a dementia diagnosis does not mean the end of life as we know it. There are some things that will have to change, and usually the disorder is a progressive one. But many persons with dementia go on to live fruitful and rewarding lives for a number of years after their initial diagnosis, with the right kind of support. It is important, however, to identify the problem as early as possible, to treat the underlying conditions that can be present, and to slow down the progression of symptoms as much as is possible. Most of all, remember that there are a lot of mechanisms for support in the community. Make use of as many of these as you can, and don’t try to do it by yourself.