Dementia: Symptoms, Causes, Diagnosis, Treatment, and Prevention

Dementia is not a disease. Instead, it is a syndrome — a set of symptoms — that occurs when neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. Eventually, this leads to a loss of cognitive ability that is significant enough to disrupt a person’s daily life — the definition of dementia, according to the National Institute on Aging. Dementia ranges in severity from mild to severe. In the final stages, people become completely incapable of caring for themselves and require around-the-clock help with the most basic aspects of daily living. Up to half of all men and women ages 85 and older (sometimes called the oldest old) have some form of dementia, yet experts do not consider it a normal part of aging. Many people live into their nineties with their cognitive abilities intact. Some people with dementia may be unable to control their emotions, or they may exhibit personality changes. They may also grapple with hallucinations (seeing or experiencing things that don’t exist) or delusions (convictions not grounded in reality).e60dc2a1-f33c-4a05-9b50-8e3e8e59762967c373fc-b92d-4ae9-ae82-383386042dd7
Are Dementia and Alzheimer’s the Same? Dementia and Alzheimer’s disease are not the same thing. Alzheimer’s accounts for 60 to 80 percent of all dementia cases. It is a slowly progressing brain disease marked by the accumulation of fragments of the protein beta-amyloid (plaques) outside neurons in the brain and twisted strands of the protein tau (tangles) inside neurons. Early in the course of the disease, people with Alzheimer’s may have difficulty remembering recent conversations, names, or events, and they may experience apathy and depression. While Alzheimer’s is the most common type of dementia, it is not the only kind. The second most common form of dementia is vascular dementia, which is caused by brain damage over time when small blood vessels in the brain become blocked, depriving brain cells of the oxygen and nutrients they need to function. While memory loss is one of the first signs of Alzheimer’s, people with vascular dementia may initially have impaired judgment or unusual difficulty with planning, organizing, and making decisions. In the past, doctors used a diagnosis of Alzheimer’s to rule out vascular dementia and vice versa. But now experts believe that the two types of dementia often coexist, an example of what’s known as mixed dementia. Autopsy studies of people with Alzheimer’s reveal that over half of deceased participants also show signs of other forms of dementia, most commonly vascular dementia.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c5de0b9e-8370-4272-bf6e-de07cb576148
Signs and Symptoms of Dementia Symptoms Dementia involves impairment of core cognitive functions — such as memory, language skills, visual perception, the ability to focus and pay attention, and the ability to reason and solve problems — that is severe enough to affect a person’s ability to do normal everyday tasks. While short-term memory loss can be an early sign of dementia, particularly Alzheimer’s, different types of dementia may have different symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c4e2e183-84c2-4838-8040-5dec2d6afa1b When vascular dementia develops after multiple small strokes, for instance, people may have difficulty with judgment and planning or may become increasingly unable to focus mentally.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290e758892-ddba-409b-9a2b-deb592be7514 With Lewy body dementia , people may experience visual hallucinations — imagining they see things that aren’t there — or they may alternate between periods of alertness and confusion (day to day, or even hour to hour). Movement problems are also common, such as muscle rigidity, shaking or tremor, and loss of coordination.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d2c2e842-93dd-4f08-8408-92671ade5c7f Some people with frontotemporal dementia exhibit extreme changes in behavior and personality. They may begin making wildly inappropriate comments in social situations, for instance, or show a startling lack of inhibition.e60dc2a1-f33c-4a05-9b50-8e3e8e59762967837004-afbd-49da-8f93-f583df6bc7f6 In a form of frontotemporal dementia called primary progressive aphasia, people have difficulty expressing their thoughts or finding words.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d1263f9c-ba9e-48eb-9d75-c0a3415718ec An accurate diagnosis is the first step toward getting the right kind of treatment and support for your dementia.
Stages of Dementia Stages People with dementia will always see their symptoms worsen over time, but not every person with the same type of dementia will decline at the same rate or experience the same symptoms at the same stage. Certain symptoms may never appear, stages may overlap, and symptoms may appear then disappear — each person is unique.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cfee4941-8458-4f0b-b0f2-6fddc21dc587 Outlining the stages of dementia , however, can be useful for people considering their future caregiving needs, hoping to enlist in clinical trials, or otherwise planning ahead . Understanding the earliest stages of dementia can also help people make sense of puzzling brain glitches. In fact, researchers now identify a condition called mild cognitive impairment as a precursor to dementia for some people. This condition — which involves lapses in memory, language, thinking, and judgment that are noticeable to the person affected but not severe enough to impact everyday functioning — affects 12 to 18 percent of people ages 60 and over, according to the Alzheimer’s Association.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e33ac56a-6c87-4412-90d7-80518060a2ed Each of the four most common types of dementia — Alzheimer’s, vascular dementia, Lewy body dementia, and frontotemporal disorders — has early symptoms that can be telling. Unlike the short-term memory loss of Alzheimer’s, for instance, vascular dementia may reveal itself as difficulty making plans or decisions. In their advanced stages, though, symptoms of different dementia types all tend to become more like Alzheimer’s — with short-term memory loss, loss of awareness of surroundings, and difficulty communicating.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ed78733d-12fc-4b8d-bfb5-2d52caf1d089
Dementia Causes and Risk Factors Causes Dementia occurs when neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. Researchers are still working to understand why this happens and are investigating the role that genetics, lifestyle, and environment all play as dementia risk factors . Genes, which are passed down from parents to their offspring, are believed to play a role in almost every type of dementia. Yet except in rare cases of a single-gene mutation, people don’t inherit dementia directly. Instead, their odds depend on some combination of genetic, environmental, and lifestyle factors.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f80ad6ad-82d3-460f-a7ae-a15e2fa56494 Certain kinds of dementia, though, appear to be more seriously affected by genetics. About 10 to 15 percent of people with a form of dementia called frontotemporal disorders (also known as frontotemporal dementia ) have a strong family history.e60dc2a1-f33c-4a05-9b50-8e3e8e597629255900bf-01ea-4a38-9d5b-d2cee4ac8106 Scientists have observed an association between certain kinds of dementia and high levels of proteins in the brain, as with the protein beta-amyloid (plaques) in Alzheimer’s disease. Lewy body dementia, the third most common form of dementia, is associated with abnormal deposits of a protein called alpha-synuclein. In a healthy brain, alpha-synuclein helps neurons communicate. But when alpha-synuclein begins to clump inside neurons, forming so-called Lewy bodies, brain function is impaired, impacting thinking, movement, behavior, and mood. Risk factors for Lewy body dementia include a family history of the condition, older age, having Parkinson’s disease , and having a condition called REM (rapid eye movement) sleep behavior disorder , which causes people to physically act out vivid, sometimes violent, dreams in their sleep.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297986a53c-65e5-48e8-8507-da3f1fcb3890 Vascular dementia has been linked to damaged arteries that block the flow of blood to areas of the brain, depriving brain cells of the oxygen and nutrients they need to function. Sometimes, small blockages in blood vessels don’t cause any immediate symptoms, but can lead to dementia as more and more of the brain becomes damaged. Risk factors include atherosclerosis (buildup of fatty deposits in arteries), high cholesterol, high blood pressure, diabetes, and smoking.e60dc2a1-f33c-4a05-9b50-8e3e8e59762901959e17-500f-47f9-ad26-d34f64cdf6fb At this point in time, the main risk factor that scientists have been able to identify for frontotemporal disorders is family history. But researchers have found genetic similarities between the underlying brain condition, frontotemporal degeneration, and amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease). Exploring those similarities may help scientists better understand and treat both illnesses.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ab8d148c-6233-471e-9404-a2cb534d073c
Prevention of Dementia Prevention While your genetic makeup is known to play a role in dementia risk, in most cases, it’s just one piece of the puzzle. Researchers are actively investigating lifestyle and environmental factors that may increase or decrease your risk of developing dementia . To prevent vascular dementia, for instance, the best way to protect your brain may be to protect your heart. This means not smoking, getting enough physical activity, and keeping your blood pressure and cholesterol in check.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293e341f55-01c3-48d9-8fe1-1dce423e7e88 Scientists are actively investigating other lifestyle factors that can affect dementia risk. There is ongoing research on social engagement that analyzes factors like marital status and emotional connectedness. Some evidence supports an association between higher levels of social engagement and a lower dementia risk.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c66d045c-a158-4193-aa07-b998ce94938d Another area of study is the link between sleep and dementia. One study found that compared with older adults who reported typically getting 6 to 8 hours of sleep, those who got less than 5 hours of sleep were about twice as likely to develop dementia after five years.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293019ed8e-aeab-48d6-9a23-e7ffda3df95e
Diagnosis of Dementia Diagnosis In general terms, diagnosis of dementia — identifying cognitive impairment — is typically much easier than identifying the underlying brain disorder. Symptoms of different types of dementia may overlap, and people can have more than one type of dementia at the same time.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296f44ef48-86e9-471d-a6dc-b6a8a3718e35 The right diagnosis, though, is critical to getting the best treatment. Typically, this process starts with your primary care doctor, although specialists like a neurologist, neuropsychologist, or geriatrician may play a role. The first task is ruling out treatable or reversible conditions with symptoms that can mimic dementia, such as depression or a thyroid problem. Your doctor will take a detailed medical history, conduct a physical exam and a neuropsychological assessment, and order lab tests. Neuropsychological assessments help doctors see cognitive patterns that may indicate the presence of a particular brain disorder. These tests look at cognitive skills like memory, problem solving, language abilities, and focus. Your doctor may also use imaging scans like MRI, CT, or PET to look at your brain.e60dc2a1-f33c-4a05-9b50-8e3e8e597629528fb540-adfa-4857-95af-2064c966b71d
How Long Does Dementia Last? Duration Dementia is an ongoing condition that becomes more severe over time. How quickly your dementia progresses will depend on many factors, including the type of dementia you have, and varies from person to person. For Alzheimer’s disease, the average length of time from diagnosis to death is 4 to 8 years, but some people live as long as 20 years, according to the Alzheimer’s Association. A diagnosis at an older age typically means a shorter time before death.e60dc2a1-f33c-4a05-9b50-8e3e8e597629475007a7-43c4-41d6-94cd-2617b7150893 People with vascular dementia typically live for about 5 years, and are more likely to die from a stroke or heart attack than from their dementia. People with Lewy body dementia typically live for about 6 years. For people with frontotemporal dementia, the typical length of time from diagnosis to death is 6 to 8 years. But those with motor neuron disease linked to this form of dementia typically live for only 2 to 3 years after diagnosis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f7496f04-23ef-4191-8b50-8188868af0b1
Treatment and Medication Options for Dementia Treatment There is currently no cure for any of the progressive brain diseases that cause dementia. But there are several potential ways to treat dementia , depending on your underlying condition. Some newer drugs may slow down the process of cognitive decline in the early stages of Alzheimer’s disease. These drugs — lecanemab (Leqembi) and donanemab (Kisunla) — work by preventing plaques from clumping in the brain. But there is no evidence that these drugs restore cognitive function that has already been lost, or prevent Alzheimer’s from progressing further. They have only been studied in people with mild cognitive impairment or early-stage Alzheimer’s — not in people with more advanced Alzheimer’s, or with other forms of dementia.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297f20531a-5061-40f1-86f0-3cc2e3c24942 This group of drugs remains controversial, with many experts raising concerns about their effectiveness, safety, and cost.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e0b75f66-fc6d-4c29-ba51-6039172bbb3b Other medications may reduce or stabilize some of the symptoms of dementia, at least for a while. Many have been approved by the U.S. Food and Drug Administration (FDA) to treat Alzheimer’s disease , with clinical evidence that they can also help people with other forms of dementia.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e1fd1850-2cec-438d-aef6-becdcf421314 People with Lewy body dementia, for instance, may take a group of drugs approved for Alzheimer’s called cholinesterase inhibitors. These medications may help with memory loss and confusion, as well as behavioral problems and hallucinations.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b17b0f9c-4675-49f0-aed6-451494233e46 Treatment for vascular dementia typically focuses on addressing underlying issues with your heart and blood vessels, potentially slowing the rate of cognitive decline. Depending on your needs, you may be prescribed drugs to reduce your blood pressure, lower your cholesterol, prevent blood clots, or control your blood sugar if you have diabetes.e60dc2a1-f33c-4a05-9b50-8e3e8e59762907979253-4b18-4537-912f-39cc9f59e6d2 Frontotemporal disorders are particularly difficult to treat with drugs because people can have adverse and even dangerous reactions to some medications. Certain antidepressants, though, may help curb social disinhibitions or impulsivity.e60dc2a1-f33c-4a05-9b50-8e3e8e597629da2bd946-40ac-4df7-a5a7-a983c1148f28 Drug treatments aren’t the only way to address dementia. You may benefit from individual sessions with a mental health counselor to deal with feelings of stress or grief, or enlist the services of an occupational therapist to help make your home simpler and safer. Support group meetings with other people coping with dementia may also be an option.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d720190e-fa56-43e8-ae40-1b9c6c96077f There are hundreds of clinical trials in the United States looking at dementia. Investigators working with people online and at centers around the country are studying both pharmaceutical and nonpharmaceutical interventions. Participants in these clinical trials, including people with dementia and those at risk, can gain access to potential treatments before they are in widespread use while also helping find a cure for future generations.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294cf9db21-62c6-4f7c-b5ca-0ffa80d58b86
Lifestyle Changes for Dementia Lifestyle People with dementia may improve their quality of life by focusing on their overall well-being and taking steps to reduce stress, simplify tasks, and reduce clutter at home. You can enhance your physical health by being physically active, eating well, and taking part in activities that involve social interaction or stimulate your brain. To boost psychological health, relationships are key. Having close friends who can provide emotional support can lift your feelings of well-being and self-worth. People with dementia can also nourish their spiritual health by taking part in meaningful activities — whether that means outings with family and friends or quiet, meditative moments alone pursuing a hobby like yoga. Caregivers can help improve quality of life for people with dementia by knowing the best ways to communicate and having strategies to overcome cognitive or behavioral challenges. For instance, presenting complex tasks a step at a time can lead to a greater chance of success and foster feelings of confidence. Since many people with dementia tend to have worse symptoms in the evening, a calming routine before bed can help — meaning no noise from family members’ conversations or television, and no chores like meal cleanup. Plenty of night lights can also help with disorientation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629edcf3aac-66af-46e1-8408-d5f2e0da2b44
Research and Statistics: How Many People Have Dementia? Research and Statistics More than 55 million people around the world have dementia, according to the World Health Organization. Alzheimer’s disease accounts for 60 to 70 percent of all dementia cases. Worldwide, the total costs of dementia are in excess of one trillion dollars each year — including the uncompensated costs of providing care and supervision informally, which average about 5 hours a day.e60dc2a1-f33c-4a05-9b50-8e3e8e597629994198f1-d1d3-4b9c-9d9a-c7df5ad8fb49 In the United States, an estimated 10 percent of adults ages 65 and older have dementia, and another 22 percent have mild cognitive impairment. The risk for dementia increases with older age — while just 3 percent of people ages 65 to 69 have dementia, that number rises to 35 percent for people ages 90 and older. The total yearly costs of dementia in the United States — including unpaid caregiving — are estimated at $257 billion.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c1468878-68d8-4e32-8637-ff1357a4b929 While more women than men have Alzheimer’s and other types of dementia, it’s not clear that the risk for dementia is different for men and women. Instead, women tend to live longer, and older age contributes to a greater dementia risk for women. When it comes to race and ethnicity, the numbers tell a different story in the United States. One study showed that 19 percent of Black and 14 percent of Hispanic adults ages 65 and older had dementia, compared with 10 percent for white older adults. These numbers are believed to reflect disparities in wealth, education, healthcare, and more.e60dc2a1-f33c-4a05-9b50-8e3e8e59762914778461-d9b1-40e5-9f3a-3a281e5d5963
The Takeaway Dementia is cognitive impairment that significantly affects your daily life, and can be caused by several different patterns or processes in your brain. While dementia can’t be cured, it can be treated or managed through medications, changes in your home and daily routine, and a healthy lifestyle with social connections. Don’t hesitate to seek cognitive screening if you notice any concerning changes in thinking or behavior.
Resources We Trust Mayo Clinic: Alzheimer’s and Dementia: What’s the Difference?National Institute on Aging: How Biomarkers Help Diagnose DementiaHarvard Medical School: Dementia: Coping With Common, Sometimes Distressing BehaviorsAlzheimer’s Association: Tips for Daily LifeAlzheimers.gov: Tips for Caregivers and Families of People With Dementia