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Alternative names Return to top
Chronic brain syndromeDefinition Return to top
Dementia refers to a group of symptoms involving progressive impairment of brain function.
Causes, incidence, and risk factors Return to top
Disorders that cause dementia include conditions that impair the vascular (blood vessels) or neurologic (nerve) structures of the brain. Some causes of dementia are treatable. These include normal pressure hydrocephalus, brain tumors, and dementia due to metabolic causes and infections. Unfortunately, most disorders associated with dementia are progressive, irreversible, and degenerative.
The two major degenerative causes of dementia are Alzheimer's disease and vascular dementia (loss of brain function due to a series of small strokes). The two conditions often occur together, and vascular dementia may speed the progression of Alzheimer's disease. Neither condition can be diagnosed definitively until autopsy.
Dementia may be diagnosed when two or more brain functions are impaired. These functions include language, memory, visual-spatial perception, emotional behavior or personality, and cognitive skills (such as calculation, abstract thinking, or judgment). Dementia usually appears first as forgetfulness. Other symptoms may be apparent only with neurologic examination or cognitive testing.
Dementia progresses slowly from decreased problem solving and language skills to difficulty with ordinary daily activities to severe memory loss and complete disorientation with withdrawal from social interaction.
Symptoms Return to top
Signs and tests Return to top
A neurologic examination may reveal abnormalities. Early signs of dementia include mild problems with memory or attention. Over time, the following cognitive difficulties may appear:
The extent of damage and cause of dementia may be indicated by tests and procedures that include, but are not limited to, the following:
Treatment Return to top
The goal of treatment is to control the symptoms of dementia. Treatment varies with the specific disorder. Hospitalization may be needed for a short time. The underlying causes should be identified and treated, this includes treating reversible organic lesions such as tumors.Sensory function should be evaluated regularly and hearing aids, glasses, or cataract surgery should be provided as needed.
Formal psychiatric treatment such as psychotherapy or group therapy is seldom helpful because it may overload the limited cognitive resources in the person with dementia.
LONG-TERM TREATMENT:
Providing a safe environment, controlling aggressive or agitated behavior, and meeting the physiologic needs of a person with dementia may require monitoring and assistance in the home or in an institutionalized setting. Possible options include in-home care, boarding homes, adult day care, and convalescent homes.
Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may help in caring for the person with dementia. In some communities, support groups may be available (see elder care - support group), and family counseling can help family members cope with home care.
In any care setting, there should be familiar objects and people. Lights can be left on at night to reduce disorientation. The activity schedule should be simple. Behavior modification may help some people to control unacceptable or dangerous behavior. This consists of rewarding appropriate behaviors and ignoring inappropriate ones (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may also help reduce disorientation.
Legal advice may be appropriate early in the course of the disorder, before the person with dementia becomes too incapacitated to make decisions. Advance directives, power of attorney, and other legal actions may make it easier to decide about the care of the person with dementia.
Expectations (prognosis) Return to top
The outcome varies. Acute disorders that cause delirium may coexist with chronic disorders causing dementia. Chronic brain syndromes are often progressive and usually result in decreased quality of life and decreased life span.Complications Return to top
Complications depend on the cause of the dementia, but they may include the following:Calling your health care provider Return to top
Prevention Return to top
Most causes of dementia are not preventable. The risk of vascular dementia, which is caused by a series of small strokes, can be reduced by quitting smoking and controlling high blood pressure and diabetes. Eating a low-fat diet and exercising regularly may also reduce the risk of vascular dementia. Vascular dementia may also play a role in the progression of Alzheimer's disease. Update Date: 4/22/2004 Updated by: Joseph V. Campellone, M.D., Division of Neurology, Cooper Hospital/University Medical Center, Camden, NJ. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |