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Understanding
Dementia
The Basics
Dementia is a medical term used to describe a reduction in mental ability that is severe enough to disrupt a person’s normal activities and relationships. There are certain treatable medical conditions that can cause dementia. For example, the condition can result from a deficiency in folic acid, vitamin B12, or thiamine, which can usually be reversed with the proper treatment.
Memory loss is the most common symptom of dementia. The condition can also cause people to have difficulty in using or understanding words or to get lost in a familiar place. It causes some people to have difficulty performing tasks that require organization, such as balancing a chequebook or making a list to go grocery shopping. Dementia can also cause depression, irritability, or other personality and behaviour changes. |
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Among the common forms of dementia that cannot be cured are Alzheimer’s disease, dementia with Lewy bodies, and vascular dementia.
Alzheimer’s disease: This condition starts in one part of the brain and gradually spreads to other regions. As it progresses, Alzheimer’s destroys nerve cells within the brain and the connections between them, leaving behind clumps of proteins (called plaques) and twisted fibres. Over time, this damage reduces abilities in the areas of language, learning, memory, and reason. Personality and behaviour are also dramatically affected by Alzheimer’s disease.
The first symptom of Alzheimer’s disease is usually forgetfulness. As the condition progresses, it affects language, reasoning, and understanding. Eventually, a person with Alzheimer’s may become withdrawn, anxious, or aggressive.
Alzheimer’s disease affects more than one in 20 Canadians over age 65 and one in four over age 85. It may affect people as young as 40, though this is considered rare. In addition to age, genetics plays a role in determining who is most likely to develop this condition.
Dementia with Lewy bodies: This form of dementia causes protein deposits called Lewy bodies to form deep inside brain cells. These tiny deposits cause tremors and rigid muscles similar to those caused by Parkinson’s disease.
Some of the symptoms are similar to Alzheimer’s disease, but this form of dementia also has distinctive symptoms like visual hallucinations. Unlike Alzheimer’s, Lewy body dementia may affect the speed of thinking, attention span, ability to concentrate, and ability to judge distance more severely than it affects memory and language skills.
Lewy bodies often are found in the brains of people who have Parkinson's or Alzheimer's, suggesting that the three conditions are related or that Lewy body dementia and Alzheimer's or Parkinson's disease sometimes co-exist in the same person.
Vascular dementia: Vascular dementia is caused by the narrowing and blocking of the arteries that supply blood to the brain or by strokes that result from an interruption of blood flow to the brain. Although damage caused by vascular dementia cannot be restored, future damage can be prevented by reducing the risk for heart and blood vessel disease.
The symptoms of vascular dementia usually come on suddenly. However, after they first appear, the disease sometimes progresses slowly, making it difficult to distinguish from Alzheimer’s disease. Vascular dementia causes problems with thinking, language, walking, bladder control, and vision.
Diagnosing the Problem
A doctor may conduct several tests and examinations to be certain that the diagnosis of dementia is correct. These diagnostic tools include:
- Medical history: A doctor may ask about recent illnesses or other life events that could cause memory loss and about other symptoms such as behavioural changes.
- Mental status examination: A doctor may conduct a mental status examination that often includes asking questions such as what day and year it is. The patient may also be asked to do things such as repeating a series of words, drawing a clock face, or counting backward from 100 by 7s.
- Laboratory tests and physical examination: A doctor may look for signs of other medical conditions that can cause the symptoms of dementia and may follow up with laboratory tests to look for treatable conditions. Routine tests may uncover an underactive thyroid, a lack of vitamin B12 or folic acid, an infection, impaired liver function, or unusual levels of glucose in the blood.
- Imaging tests: A doctor may recommend a brain imaging test such as magnetic resonance imaging (MRI) or computed tomography (CT). These tests can rule out brain tumours, strokes, or other conditions that cause dementia-like symptoms. MRI can show shrinkage in parts of the brain that occurs in some forms of dementia. Both MRI and CT can also show evidence of strokes that could cause vascular dementia.
Another interesting diagnostic tool that is under development is the aroma test. Researchers are currently studying a simple scratch and sniff test that may help doctors identify patients with Alzheimer’s disease. This tool started to be developed after scientists discovered that people with early Alzheimer’s disease may be unable to smell certain odours including strawberry, smoke, soap, and cloves.
Treating Dementia
Some cases of dementia may be caused by medical conditions that can be treated, leading to full or partial return of mental function. In cases where dementia cannot be reversed, the goal of treatment is to make life as easy as possible for both the patient and the caregiver. This treatment may include providing tips on making the home safe, coping with memory loss, and trying to maintain activities of daily living.
There are also certain medications that can help with mood or behavioural problems, including:
- Cholinesterase inhibitors, which are used to treat early Alzheimer’s disease, may also be given to people who have dementia with Lewy bodies to slow mental decline.
- Antidepressants can help relieve the depression that often accompanies dementia. However, they must be used carefully, because they can cause delirium in people with dementia.
- Tranquilizers may be given to reduce anxiety, agitation, aggression, and hallucinations.
- NMDA-receptor antagonists are a new class of drugs that may slow the progress of moderate to severe Alzheimer’s. The first drug developed in this class is memantine, and it works by blocking excess amounts of a chemical that causes damage to brain cells.
Helping Yourself
If you have been diagnosed with dementia, you may want to modify your home and daily routine to meet your changing needs. The following tips can help:
- Become familiar with local resources such as support groups, in-home health care aides, and adult activity centres.
- Educate yourself about the disease so that you can fully understand your condition and find creative ways to cope with its symptoms.
- Talk openly with family and friends. Discuss plans for future living arrangements and your preferences for medical care and treatment.
- Use memory aids to help you remember how to perform simple tasks, like making a cup of tea or using the telephone. Having these little reminders around your home will help you remain more independent.
- Check around the house to see what changes you can make now that will make life easier later on. For example, learning to use a microwave can simplify meal preparation. Establish routines that reduce the demands on your memory. Always keep your purse or wallet in the same spot, and get into the habit of filling and using a weekly pill organizer.
- Don’t give up your current lifestyle. Stay involved in your hobbies and interests. If you stop working, try a new hobby or do volunteer work.
- Exercise regularly. Exercise can improve your energy, sleep, circulation, stamina, and mood. Other benefits include helping to retain motor skills, reducing stress, and maintaining strength, flexibility, and balance, which will lower the risk of injury from a fall.
Even though a diagnosis of dementia may seem frightening, keep in mind that you are not alone. About 25% of all Canadians have a family member with this condition. Talk to other people who are dealing with the situation. Join a support group to find practical information, solve problems, share stories, and discover new ways to cope with these changes.
If you have any questions about dementia or its treatment, your pharmacist will be happy to answer them for you.
The material in this pamphlet has been supplied by a professional medical writer. It is intended for information purposes only and should not be used in place of consultation with a health care professional. Axis Pharmacy is not responsible for errors, omissions, or inconsistencies with respect to the information contained in this pamphlet and does not accept any liability whatsoever for reliance by the reader on the information contained herein.
© Promo-Ad & Associates Inc., 2005
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