Dementia

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Dementia

Topic Overview

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Alzheimer’s disease is the most common cause of dementia. This topic focuses on other conditions that cause dementia. For more information on Alzheimer’s, see the topic Alzheimer's Disease.

What is dementia?

We all forget things as we get older. Many older people have a slight loss of memory that does not affect their daily lives. But memory loss that gets worse may mean that you have dementia.

Dementia is a loss of mental skills that affects your daily life. It can cause problems with your memory and how well you can think and plan. Usually dementia gets worse over time. How long this takes is different for each person. Some people stay the same for years. Others lose skills quickly.

Your chances of having dementia rise as you get older. But this doesn't mean that everyone will get it. By age 85, about 35 out of 100 people have some form of dementia. That means that 65 out of 100 don't have it. Dementia is rare before age 60.1

If you or a loved one has memory loss that is getting worse, see your doctor. It may be nothing to worry about. If it is dementia, treatment may help.

What causes dementia?

Dementia is caused by damage to or changes in the brain. Things that can cause dementia include:

In a few cases, dementia is caused by a problem that can be treated. Examples include having an underactive thyroid gland (hypothyroidism), not getting enough vitamin B12, and fluid buildup in the brain (normal-pressure hydrocephalus). In these cases, treating the problem may cure the dementia.

In some people, depression can cause memory loss that seems like dementia. Depression can be treated.

As you age, medicines may affect you more. Taking some medicines together may cause symptoms that look like dementia. Be sure your doctor knows about all of the medicines you take. This means all prescription medicines and all over-the-counter medicines, herbs, vitamins, and supplements.

What are the symptoms?

Usually the first symptom is memory loss. Often the person who has a memory problem doesn't notice it, but family and friends do. As dementia gets worse:

  • You may have more trouble doing things that take planning, like making a list and going shopping.
  • You may have trouble using or understanding words.
  • You may get lost in places you know well.

Over time, people with dementia may begin to act very differently. They may become scared and strike out at others, or they may become clingy and childlike. They may stop brushing their teeth or bathing.

Later, they cannot take care of themselves. They may not know where they are. They may not know their loved ones when they see them.

How is dementia diagnosed?

There is no single test for dementia. To diagnose it, your doctor will:

  • Do a physical examination.
  • Ask questions about recent and past illnesses and life events. The doctor will want to talk to a close family member to check details.
  • Ask you to do some simple things that test your memory and other mental skills. Your doctor may ask you to tell what day and year it is, repeat a series of words, or draw a clock face.

The doctor may do tests to look for a cause that can be treated. For example, you might have blood tests to check your thyroid or to look for an infection. You might also have a test that shows a picture of your brain, like an MRI or a CT scan. These tests can help your doctor find a tumour or brain injury. They can also show if there has been shrinking in parts of the brain. This can be a sign of dementia.

How is it treated?

There are medicines you can take for dementia. They cannot cure it, but they can slow it down for a while and make it easier to live with.

As dementia gets worse, a person may get depressed or angry and upset. Treatment, such as medicines and counselling, may help. So can getting out more and having an active social life.

If a stroke caused the dementia, there are things you can do to reduce the chance of another stroke. Stay at a healthy weight, exercise, and keep your blood pressure and cholesterol at normal levels. If you have diabetes, keep your blood sugar in your target range.

Keeping both your mind and your body active is a good idea for anyone. So is not smoking.

How can you help a loved one who has dementia?

There are many things you can do to help your loved one be safe at home. For example, get rid of throw rugs, and put handrails in bathrooms to help prevent falls. Post reminder notes around the house. Put a list of important phone numbers by the telephone. You also can help your loved one stay active. Play cards or board games, and take walks.

Work with your loved one to make decisions about the future before dementia gets worse. It is important for your loved one to write down decisions and name a person who will make decisions if he or she is no longer able to make them.

Watching a loved one slip away can be sad and scary. Caring for someone with dementia can leave you feeling drained. Be sure to take care of yourself and to give yourself breaks. Ask family members to share the load, or get other help.

Your loved one will need more and more care as dementia gets worse. In time, he or she may need help to eat, get dressed, or use the bathroom. You may be able to give this care at home, or you may want to think about using a nursing home. A nursing home can give this kind of care 24 hours a day. The time may come when a nursing home is the best choice.

You are not alone. Many people have loved ones with dementia. Ask your doctor about local support groups, or search the Internet for online support groups, such as the Alzheimer Society of Canada. Help is available.

Frequently Asked Questions

Learning about dementia:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with dementia:

End-of-life issues:

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  Alzheimer's or Other Dementia: Should I Move My Relative Into Long-Term Care?

Cause

Dementia is caused by damage to or changes in the brain. After Alzheimer's disease, stroke is the most common cause of dementia. Dementia caused by stroke is called vascular dementia.

Some causes of dementia can be reversed with treatment, but most cannot.

Causes that cannot be reversed

Common causes of dementia that cannot be reversed are:

  • Parkinson's disease. Dementia is common in people with this condition.
  • Dementia with Lewy bodies. It can cause short-term memory loss.
  • Frontotemporal dementia, a group of diseases that includes Pick's disease.
  • Severe head injury that caused a loss of consciousness.
  • Vascular dementia that may occur in people who have a stroke, long-term high blood pressure, or severe hardening of the arteries (atherosclerosis).

Less common causes of dementia that cannot be reversed include:

  • Huntington's disease.
  • Leukoencephalopathies, which are diseases that affect the deeper, white-matter brain tissue.
  • Creutzfeldt-Jakob disease, a rare and fatal condition that destroys brain tissue.
  • Brain injuries from accidents or boxing.
  • Some cases of multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS).
  • Multiple-system atrophy (a group of degenerative brain diseases affecting speech, movement, and autonomic functions).
  • Infections such as late-stage syphilis. Antibiotics can effectively treat syphilis at any stage, but they cannot reverse the brain damage already done.

Causes that may be reversible

When dementia is caused by certain treatable problems, the treatment may also help the dementia. These treatable problems include:

Inherited dementia

Some disorders that cause dementia can run in families. Doctors often suspect an inherited cause if someone younger than 50 has symptoms of dementia. For more information, see the topic Alzheimer's Disease.

Symptoms

Symptoms of dementia vary depending on the cause and the area of the brain that is affected. Symptoms include:

  • Memory loss. This is usually the earliest and most noticeable symptom.
  • Trouble recalling recent events or recognizing people and places.
  • Trouble finding the right words.
  • Problems planning and carrying out tasks, such as balancing a checkbook, following a recipe, or writing a letter.
  • Trouble exercising judgment, such as knowing what to do in an emergency.
  • Trouble controlling moods or behaviours. Depression is common, and agitation or aggression may occur.
  • Not keeping up personal care such as grooming or bathing.

Some types of dementia cause particular symptoms:

  • People who have dementia with Lewy bodies often have highly detailed visual hallucinations. And they may fall frequently.
  • The first symptoms of frontotemporal dementia may be personality changes or unusual behaviour. People with this condition may not express any caring for others, or they may say rude things, expose themselves, or make sexually explicit comments.

Symptoms of dementia that come on suddenly suggest vascular dementia or possibly delirium—short-term confusion caused by a new or worsening illness.

It is important to know that memory loss can be caused by conditions other than dementia, such as depression, and that those conditions can be treated. Also, occasional trouble with memory (such as briefly forgetting someone's name) can be a normal part of aging. But if you are worried about memory loss or if a loved one has memory loss that is getting worse, see your doctor.

What Happens

How quickly dementia progresses depends on what is causing it and the area of the brain that is affected. Some types of dementia progress slowly over several years. Other types may progress more rapidly. If vascular dementia is caused by a series of small strokes, the loss of mental skills may be gradual. If it is caused by a single stroke in a large blood vessel, loss of function may occur suddenly.

The course of dementia varies greatly from one person to another. Early diagnosis and treatment with medicines used for Alzheimer's (cholinesterase inhibitors such as donepezil [Aricept]) may help preserve mental functioning for a while in people who have vascular dementia, dementia with Lewy bodies, or Parkinson's disease.2 Even without these medicines, some people remain stable for months or years, while others decline rapidly.

Many people with dementia are not aware of their mental decline. They may deny their condition and blame others for their problems. Those who are aware may mourn their loss of abilities and become hopeless and depressed.

Depending on the type of dementia, the person's behaviour may eventually become out of control. The person may become angry, agitated, and combative or clingy and child-like. He or she may wander and become lost. These problems can make it difficult for family members or others to continue providing care at home.

Even with the best care, people with dementia tend to have a shorter lifespan than the average person their age. The progression varies depending on the disease causing the dementia and whether the person has other illnesses such as diabetes or heart disease. Death usually results from lung or kidney infections caused by being bedridden.

For more information on decisions you may face as your loved one's condition progresses, see the topic Care at the End of Life.

What to think about

Many older people have a slight loss of mental skills (usually recent memory) that doesn't affect their daily functioning. This is called mild cognitive impairment by some. People who have mild impairment may be in the early stage of dementia, or they may stay at their present level of ability for a long time.

What Increases Your Risk

Aging is the main risk factor for all types of dementia. Some diseases that cause dementia (such as early-onset Alzheimer's disease and some frontotemporal dementias) may run in families.

You have a greater chance of developing vascular dementia if you:

When To Call a Doctor

Call 911 or other emergency services immediately if signs of a stroke or transient ischemic attack (TIA) develop suddenly. These may include:

  • Numbness, weakness, or inability to move the face, arm, or leg, especially on one side of the body.
  • Vision problems in one or both eyes, such as dimness, blurring, double vision, loss of vision, or a sensation that a shade is being pulled down over your eyes.
  • Confusion, or trouble speaking or understanding.
  • Trouble walking, dizziness, or loss of balance or coordination.
  • Severe headache with no known cause.

Call a doctor immediately if a person suddenly becomes confused or emotionally upset or doesn't seem to know who or where he or she is. These are signs of delirium, which can be caused by a reaction to medicines or a new or worsening medical condition.

Call a doctor if you or a person you are close to has new and troubling memory loss that is more than an occasional bout of forgetfulness. This may be an early sign of dementia.

Watchful waiting

Occasional forgetfulness or memory loss can be a normal part of aging. But any new or increasing memory loss or problems with daily living should be reported to a doctor. Learn the warning signs of dementia, and talk to a doctor if you or a family member shows any of these signs. They include increased trouble finding the right words when speaking, getting lost going to familiar places, and acting more irritable or suspicious than usual.

Who to see

Your family doctor or general practitioner can evaluate symptoms of memory loss or confusion. You may be referred to a specialist, such as a:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

Doctors diagnose the cause of dementia by asking questions about the person's medical history and doing a physical examination, a mental status examination, and lab and imaging tests.

Tests can help the doctor learn whether dementia is caused by a treatable condition. Even for those dementia that cannot be reversed, knowing the type of dementia a person has can help the doctor prescribe medicines or other treatments that may improve mood and behaviour and help the family.

Medical history

During a medical history and physical examination, the doctor will ask the affected person and a close relative or partner about recent illnesses or other life events that could cause memory loss or other symptoms such as behavioural problems. The doctor may ask the person to bring in all medicines he or she takes. This can help the doctor find out if the problem might be caused by the person being overmedicated or having a drug interaction.

Although a person may have more than one illness causing dementia, symptoms sometimes can distinguish one form from another. For example, early in the course of frontotemporal dementia, people may display a lack of social awareness and develop obsessions with eating, neither of which occurs early in other dementias.

Mental status examination

A doctor or other health professional will conduct a mental status examination. This test usually involves such activities as having the person tell what day and year it is, repeat a series of words, draw a clock face, and count back from 100 by 7s.

Other tests have been developed to diagnose dementia. Doctors can use one such test, Addenbrooke's Cognitive Examination, to distinguish Alzheimer's disease from frontotemporal dementia. Orientation, attention, and memory are worse in Alzheimer's, while language skills and ability to name objects are worse in frontotemporal dementia.

Lab tests

Many medical conditions can cause mental impairment. During a physical examination, the doctor will look for signs of other medical conditions and have lab tests done to find any treatable condition. Routine tests include:

Other lab tests that may be done include:

Imaging tests

Brain imaging tests such as CT scans and MRI may also be done to make sure another problem isn't causing the symptoms. These tests may rule out brain tumours, strokes, normal-pressure hydrocephalus, or other conditions that could cause dementia symptoms.

MRI can show shrinkage in parts of the brain that occurs in some types of dementia. MRI and CT scan also can show evidence of strokes from vascular dementia.

Two other forms of imaging—single photon emission CT (SPECT) and PET scan—are not used routinely to diagnose dementia. But they may be useful if the symptoms are confusing or odd. These tests can help identify several forms of dementia, including vascular dementia and frontotemporal dementia.

In some cases, electrical activity in the brain may be measured using an electroencephalogram (EEG). Doctors seldom use this test to diagnose dementia, but they may use it to distinguish dementia from delirium and to look for unusual brain activity found in Creutzfeldt-Jakob disease, a rare cause of dementia.

In rare cases, a brain biopsy may be done if a treatable cause of dementia is suspected.

After death, an autopsy may be done to find out for sure what caused dementia. This information may be helpful to family members concerned about genetic causes. For more information, see the topic Alzheimer's Disease.

Treatment Overview

Some cases of dementia are caused by medical conditions that can be treated, and treatment can restore some or all mental function. But most of the time, dementia cannot be reversed.

Treatment when dementia can be reversed

Sometimes treating the cause of dementia helps the dementia. For example, the person might:

  • Take vitamins for a deficiency of vitamin B12.
  • Take thyroid hormones for hypothyroidism.
  • Have surgery to remove a brain tumour or to reduce pressure on the brain.
  • Stop or change medicines that are causing memory loss or confusion.
  • Take medicines to treat an infection, such as encephalitis.
  • Take medicine to treat depression.
  • Get treatment for reversible conditions caused by AIDS.

Treatment when dementia can't be reversed

If the cause of dementia cannot be treated, the doctor will work with the person and caregivers to develop a plan to make life easier and more comfortable. Care plans may include:

  • Tips to help the person be independent and manage daily life as long as possible. For more information, see Home Treatment.
  • Medicine. While medicines cannot cure dementia, they may help improve mental function, mood, or behaviour. For more information, see Medications.
  • Support and counselling. A diagnosis of dementia can create feelings of anger, fear, and anxiety. A person in the early stage of the illness should seek emotional support from family, friends, and perhaps a counsellor experienced in working with people who have dementia.

Planning for the future

If possible, make decisions while your loved one is able to take part in the decision making. These are difficult but important conversations. Questions include:

  • What kind of care does he or she need right now?
  • Who will take care of him or her in the future?
  • What can the family expect as the disease progresses?
  • What kind of financial and legal planning needs to be done?

Education of the family and other caregivers is critical to successfully caring for someone who has dementia. If you are or will be a caregiver, start learning what you can expect and what you can do to manage problems as they arise. For more information, see Home Treatment.

Treatment as dementia gets worse

The goal of ongoing treatment for dementia is to keep the person safely at home for as long as possible and to provide support and guidance to the caregivers.

Routine follow-up visits to a health professional (every 3 to 6 months) are necessary to monitor medicines and the person's level of functioning.

Eventually, the family may have to consider whether to place the person in a care facility that has a dementia unit. For more information on making the decision about nursing care, see:

Click here to view a Decision Point. Alzheimer's or Other Dementia: Should I Move My Relative Into Long-Term Care?

Taking care of a person with dementia is stressful. If you are a caregiver, seek support from family members or friends. Take care of your own health by getting breaks from caregiving. Counselling, a support group, and adult daycare or respite care can help you through stressful times and bouts of burnout.

Prevention

Dementia is hard to prevent, because what causes it often is not known. But people who have dementia caused by stroke may be able to prevent future declines by lowering their risk of heart disease and stroke. Even if you don't have these known risks, your overall health can benefit from these strategies:

  • Treat or prevent high blood pressure. For more information, see the topic High Blood Pressure.
  • Don't smoke. For more information, see the topic Quitting Smoking.
  • Stay at a healthy weight. This also reduces your risk of diabetes, another risk factor for dementia. For more information, see the topic Weight Management.
  • Keep your cholesterol in the normal range. For more information, see the topic High Cholesterol.
  • Get plenty of exercise. For more information, see the topic Fitness.
  • Stay mentally alert by learning new hobbies, reading, or solving crossword puzzles.
  • Stay involved socially. Attend community activities, church, or support groups.
  • If your doctor recommends it, take ASA. For more information on how to reduce your risk for stroke, see the topic Stroke.

Home Treatment

Home treatment for dementia involves teamwork among health professionals and caregivers to create a safe and comfortable environment and to make tasks of daily living as easy as possible. People who have mild dementia can be involved in planning for the future and organizing the home and daily tasks.

Tips for caregivers

Caregivers should remember to seek support from other family and friends. For more information, see the topic Caregiver Tips.

Nursing home placement

Even with the best care, a person with progressive dementia will decline, perhaps to the point where the caregiver is no longer physically, emotionally, or financially able to provide care.

Making the decision about nursing home placement is often very difficult. Every family needs to consider its own financial situation, emotional capacity, and other issues. For more information, see:

Click here to view a Decision Point. Alzheimer's or Other Dementia: Should I Move My Relative Into Long-Term Care?

Medications

Doctors use medicines to treat dementia in the following ways:

  • To correct a condition that's causing dementia, such as thyroid replacement for hypothyroidism, vitamins for lack of vitamin B12, or antibiotics for infections
  • To maintain mental functioning for as long as possible when dementia cannot be reversed
  • To prevent further strokes in people who have dementia caused by stroke (vascular dementia)
  • To manage mood or behaviour problems, such as depression, insomnia, hallucinations, and agitation

Medication Choices

Medicines to help maintain mental function:

  • Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon).  
    • These drugs were developed to treat Alzheimer's disease, but they may be tried in other dementias, especially vascular dementia.2
    • It is not clear how long these medicines will work.
    • Side effects include nausea, vomiting, diarrhea, and weight loss.3
  • Memantine (Ebixa). This medicine is used to treat symptoms of Alzheimer's disease, but may also help with mild to moderate vascular dementia.3

Medicines to help control mood or behaviour problems:

Medicines to prevent future strokes:

  • The doctor may prescribe medicines for high blood pressure and high cholesterol, since these conditions are risk factors for vascular dementia.4 These drugs can't reverse existing dementia, but they may prevent future strokes and heart disease that can lead to further brain damage.

For more information, see the topics:

Other Treatment

  • Ginkgo biloba. Many people take ginkgo biloba to improve or preserve memory. But studies have not shown that ginkgo biloba helps improve memory or prevent dementia.5
  • Other medicines. Research is ongoing to look at the usefulness of non-steroidal anti-inflammatory drugs (NSAIDS), cholesterol-lowering drugs (statins), and other antioxidants.
  • Reality orientation. People who have dementia may benefit from a structured group program that encourages them to focus on a variety of topics and to think creatively within their limits. This type of program, sometimes called reality orientation or cognitive stimulation therapy, is offered in some daycare and residential settings.6 
  • Occupational therapy. Studies have shown occupational therapy can improve the daily functioning of people with dementia.7 Occupational therapists focus on a person's ability to perform daily tasks and take part in social activities.

Other Places To Get Help

Organization

Alzheimer Society of Canada
20 Eglinton Avenue West
Suite 1600
Toronto, ON  M4R 1K8
Phone: 1-800-616-8816
(416) 488-8772
Fax: (416) 322-6656
Email: info@alzheimer.ca
Web Address: www.alzheimer.ca
 

The Alzheimer Society of Canada provides information, education, and support services to individuals with Alzheimer's disease and their caregivers. There are provincial and local affiliates located throughout Canada.


References

Citations

  1. Beers MH, et al., eds. (2004). Merck Manual of Health and Aging. Whitehouse Station, NJ: Merck Research Laboratories.
  2. Drugs for cognitive loss and dementia (2010). Medical Letter on Drugs and Therapeutics: Drugs of Choice, 8(91): 19–24.
  3. Warner J, et al. (2010). Dementia, search date April 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  4. Tzourio C, et al. (2003). Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Archives of Internal Medicine, 163(9): 1069–1075.
  5. Birks J, Grimley Evans J (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).
  6. Spector A, et al. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia. British Journal of Psychiatry, 183: 248–254.
  7. Graff MJ, et al. (2006). Community-based occupational therapy for patients with dementia and their caregivers: Randomised controlled trial. BMJ, 333(1196). Also available online: http://www.bmj.com/cgi/content/full/333/7580/1196.

Other Works Consulted

  • Bourgeois JA, et al. (2008). Dementia section of Delirium, dementia, and amnestic and other cognitive disorders. In RE Hales et al., eds., American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 304–363. Washington DC: American Psychiatric Publishing.
  • Knopman DS (2009). Alzheimer disease and other dementing illnesses. In EG Nabel, ed., ACP Medicine, section 11, chap. 11. Hamilton, ON: BC Decker.
  • Knopman DS, et al. (2001, reaffirmed 2004). Practice parameter: Diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 56: 1143–1153.
  • Langa KM, et al. (2004). Mixed dementia: Emerging concepts and therapeutic implications. JAMA, 292(23): 2901–2908.
  • U.S. Preventive Services Task Force (2003). Screening for dementia: Recommendation and rationale. Annals of Internal Medicine, 139(11): 925–926.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Primary Medical Reviewer Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Peter J. Whitehouse, MD - Neurology
Last Revised August 5, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.