Dementia - What is it?

Learn the different causes of dementia and how they can be treated and prevented. Community Living can benefit a person with dementia and improve their quality of life through socialization, exercise, and lifestyle management.

Dementia is NOT a normal part of aging.

The myth that dementia develops as you age is still what most people believe. However, dementia is not a normal condition that relates to aging. The degree of memory loss during the aging process varies greatly in older adults.  While some individuals will have short-term memory loss, they often will have excellent recall of significant life events. Short-term memory problems commonly are details of recent activity, such as remembering to take a high blood pressure medication. While they may not be able to retrieve that information accurately or recall what they had for lunch, they can accurately describe the details of their first job.

What does it mean to have a Dementia Diagnosis?

Dementia is a word that refers to several conditions. It is a symptom of the brain that can affect memory loss, speech, movement, or difficulty completing everyday tasks. There are multiple types of dementia.

How is Dementia diagnosed?

Dementia can be diagnosed through a physical exam and a series of tests from your primary care physician and/or a specialist. Brain scans, blood tests, and cognitive and neurological tests can be conducted to help reach a definitive diagnosis. It is important to include any family history regarding dementia symptoms, memory problems,  or other neurological disorders. There is no single test that is used to diagnose dementia.

There are different types of Dementia

Dementia is not one specific disease but a term used to describe a group of symptoms.  There are different causes of dementia, such as Alzheimer's disease and other related dementias. In addition to  Alzheimer’s disease, there are other types of dementia, including vascular dementia, Lewy body dementia, frontotemporal dementia, and Creutzfeldt-Jakob disease (CJD), a rare brain disorder. Dementia can stem from multiple sources. These types of dementia can include but are not limited to alcohol or drug abuse, strokes, traumatic brain injury, urinary tract infections (UTIs), and mismanagement of medication.

Another rare but significant brain disorder is chronic traumatic encephalopathy, or CTE, affecting the brain and nervous system.  This can occur in persons who have played contact sports such as football or boxing.  These symptoms of dementia can also be found in military personnel who have been exposed to explosive blasts. The dementia signs and symptoms occur years after periods of post-concussive events and are, unfortunately, a definitive diagnosis that can only be determined through autopsy.
Not everyone who has dementia has Alzheimer’s disease, but rather Alzheimer’s disease is one of the forms of dementia.  People tend to think of Alzheimer's disease as the most common dementia diagnosis.   Alzheimer's disease accounts for 60-70% of all dementias.

Does dementia affect more women and the less fortunate?

Women appear to be living longer than men, which is why a higher percentage of women are being diagnosed with Alzheimer's disease and other related dementias. Studies have also shown that the less fortunate may have a greater risk factor for dementia because of a lack of resources and education on preventing, diagnosing, or slowing the progression of the disease.
The early signs and symptoms of dementia may go undiagnosed in older adults who already have diagnoses of intellectual and developmental disabilities. There is a correlation between persons with Down Syndrome and Alzheimer's disease because of proteins associated with the 21st chromosome.  Statistics from the Centers for Disease Control show that 30 percent of those in their 50s will have Alzheimer's, and 50 percent will be diagnosed in their 60s (CDC).

MCI (Mild Cognitive Impairment) is not Dementia

MCI is part of normal aging and is not considered dementia. MCI is the stage between normal forgetfulness as we age and the development of full-blown dementia. Individuals with MCI have noticeable symptoms affecting memory but are still able to carry out their normal activities. You may notice cognitive decline affecting everyday tasks when using familiar objects such as a cell phone or a computer. There are no specific tests for MCI, but your doctor can go through your health and medical history to determine what may be contributing to memory or other brain-related issues. Early testing is beneficial even in the absence of symptoms as it provides a baseline for future testing. When dementia-like symptoms present, an early diagnosis can help in finding local resources and education through organizations like the Alzheimer's Association, the National Institute on Aging, and your region's Area Agency on Aging.

Is Dementia Inevitable?

MCI may move to a stage of dementia, but it is not inevitable in most cases. Symptoms that MCI is progressing may be noticeable when there is an increased difficulty in completing daily tasks, staying focused, balancing a checkbook, preparing food, using the bathroom, or getting dressed. You may see behavioral symptoms such as anxiety, irritability, mood swings, and other dementia symptoms. This would be the time to schedule an appointment with a physician, who may order a series of brain scans (Healthline).

Early Stage Alzheimer's Disease versus Early Onset Alzheimer's Disease

These two terms are sometimes confusing and thought mistakenly to be interchangeable.  Early-stage Alzheimer's Disease is when symptoms are just beginning to affect some activities of daily living, but the person with the diagnosis functions and copes well in social situations.

Early Onset Alzheimer's or Young Onset Alzheimer's disease is when a person develops symptoms of dementia at a younger age, before age 65. Early onset Alzheimer's can be more severe than the early stage and can cause changes in personality and relationships. When this devastating diagnosis occurs,  it often affects a family financially as well as emotionally.  It is not uncommon for a diagnosis to be uncovered because the person with the diagnosis is faltering in the workplace, resulting in a loss of income, identity, and dignity.  If the spouse is also employed, their job status can be adversely affected.  Factors include time away from medical appointments, counseling, and legal preparations. As dementia symptoms increase, the spouse may have to forego employment to become a full-time caregiver (Mayo Clinic).

Risk Factors for Dementia

Various risk factors can increase one's chances of developing a dementia diagnosis. Some risk factors, such as one's age or family history, cannot be changed. However, risk factors in one's daily life, such as one's diet, exercise habits, and level of socialization, can be changed.
Some factors that increase the risk of dementia include:

• Age – The likelihood of being diagnosed with dementia increases as you get older.
• Family history – If you have a relative who has had dementia, your risk is increased.
• Genetics – Some diseases or conditions can increase your chances of developing dementia. These include Down syndrome, Huntington's disease, Creutzfeldt-Jakob disease (CJD), and other brain disorders.
• Head injury – A head injury can increase your risk of developing dementia later in life.
• Stroke – A stroke can damage the brain and increase the risk of dementia.
• Poor nutrition - studies have shown that poor nutrition can be a dementia risk.
• Age: The risk of dementia increases as you get older.
• Gender: Women are more likely to develop dementia than men.
• Family History: Dementia can run in families. If you have a close relative with dementia, you are more likely to develop the disease yourself.
• Lifestyle Choices: Smoking and drinking alcohol can increase your risk for dementia. So can being inactive and having an unhealthy diet.
• Medical Conditions: Some medical conditions, such as diabetes and high blood pressure, can increase your risk for dementia.
• Brain Diseases: Dementia can be a result of certain brain diseases, such as Alzheimer's disease or vascular dementia, resulting in nerve cell death and brain changes.
• Head Injury: A head injury can increase your risk for dementia later in life.
• Medications: Some medications may increase your risk for dementia.
• Brain Structure and Function: Some people are simply born with a higher risk for dementia. This may be due to the structure of their brain or how well their brain functions.
• Stroke: A stroke can increase your risk for dementia.
• Mild Cognitive Impairment (MCI): People with MCI are more likely to develop dementia.
• Traumatic Brain Injury (TBI): A TBI can increase your risk for dementia, depending on the area of the brain affected.
• Parkinson's Disease: Parkinson's disease increases the risk of dementia.
• Normal Pressure Hydrocephalus: This is an excessive accumulation of cerebrospinal fluid in the brain but can be treated surgically with the placement of a shunt.
• Isolation: Social interaction and loneliness can have an effect.

What is Mixed Dementia?

The term “mixed” Dementia is used when a person has more than one disease of the brain. The most common are Alzheimer’s disease and Vascular Dementia.

Vascular Dementia

Vascular dementia is caused by a series of small strokes where brain cells die. Alzheimer’s disease is the most common type of dementia, accounting for 60 to 80 percent of cases. It is a progressive disease, which means it gets worse over time. Early symptoms of dementia include difficulty with planning and organizing, memory loss, and decreased ability to think or reason.

Lewy Body Dementia

Alzheimer's and Lewy body dementia are also considered to be mixed dementia. Lewy body disease (LBD) is a type of dementia that shares features of both Alzheimer's and Parkinson's disease. Lewy bodies are deposits of protein that may form in the brain, affecting nerve cells and causing cognitive degeneration. It is the second most common form of progressive dementia after Alzheimer's, accounting for up to 20 percent of all cases.

Exercise and Activities Benefit Those Living with Dementia and Dementia Symptoms

Exercise is a positive and productive way to expend energy with those living with dementia. Many benefits include better sleep, a decrease in depression, increased appetite, and reduced episodes of anxiety and wandering.

Participation in meaningful activities, such as painting, singing, dancing, and socializing with friends and family, also provides cognitive and emotional stimulation.
Activities provide a sense of purpose and can help to improve mood, reduce stress and anxiety, promote communication, and stimulate the senses.

Many activities are beneficial for those living with dementia. Some examples include:

• Arts and crafts
• Gardening
• Cooking
• Singing or listening to music
• Playing games (cards, puzzles, board games)
• Watching movies or television

Numerous books and website links can give you ideas for what you can do with and for your loved one.

Some Dementias are temporary and reversible

In some instances, dementia-like symptoms may have a medical cause or indicate an underlying disease. Blood tests and urine tests are useful in determining the cause in cases such as this. Dementia caused by a urinary tract infection (UTI), lung infection, insomnia, electrolyte imbalance, vitamin deficiency, or side effects from medication are all reversible forms of dementia that a physician can treat. These dementia-like symptoms may present as a sudden onset of confusion in a person who is not usually confused. Reversible dementias include those that are caused by treatable medical conditions such as hyperthyroidism (overactive thyroid gland), vitamin B12 deficiency, or low levels of sodium in the blood. In many cases, dementia caused by normal pressure hydrocephalus can be treated and reversed with the surgical placement of a shunt in the brain.

A person with Dementia can benefit from Community Living

A person with dementia can lead an active and fulfilling life. However, as dementia symptoms increase, over time, your loved one may require more assistance. Dementia Care in a senior living community that has a memory care component should be considered for helping your loved one and your family. The proper environment can have a positive impact and their daily life. These communities provide tools for their caregivers to create a positive environment for their residents.  Memory care staff are specially equipped to understand the process and stages of dementia as well as manage behavioral symptoms. Many of these approaches include recognizing signs and symptoms as dementia progresses, helping to redirect, learning how to understand non-verbal behaviors, implementing exercise, brain games, a healthy diet, and creative and practical avenues for socialization.

The Treatment for Dementia and a Future Cure

At present, there is no specific cure for dementia, but it can be managed with a combination of treatments and strategies tailored specifically for each individual. This may include medication, therapies, diet changes, memory aids, and social activities.

What Does Research Show?

Many new dementia therapies are being researched and tested. Some of these possible treatments include:

• Regulating the immune system
• Stimulating nerve growth factors
• Preventing or reversing damage to the brain through diet or supplements
• Drugs that block enzymes that destroy neurons
• Preventing memory loss with lifestyle changes

The National Institute on Aging has information on recent research that can be found on their website.

Recent research and development have provided multiple medications that are beneficial in reducing and, in some cases, eliminating many symptoms.  There is no cure for dementia. However, there are treatments available that can help improve the quality of life for people with dementia and their caregivers. Some medications may help slow down the progression of the disease. There are also a variety of support services available that can help caregivers and people with dementia. As stated earlier, depending on the cause, some cases of dementia can be reversed.  Several drugs have been approved and are being used for treatment and researchers continue to be hopeful for a future cure.

Conclusion: Let's Remember

It is important to remember that dementia is not a normal part of aging, and there are treatments and strategies available to help those living with dementia lead fulfilling lives. For more information on dementia and its treatment, please visit the Alzheimer’s Association website and The Centers for Disease Control and Prevention website.