Dementia is a syndrome associated with many separate disease processes. It is characterized by memory loss along with language, judgment, problem solving, and comprehension deficits. Dementia is an incurable progressive disease that leads to dependence and death.

Many of the pathologic features of dementia are known. Having an understanding of these features helps you understand the disease.

• A starch like produced called amyloid is abnormally deposited in the brain and disrupts the normal functioning of the brain.
• Acetylcholine is a neurotransmitter in the brain that is reduced in Alzheimer’s disease.
• Neurofibrillary tangles are an abnormal growth of nerves that kill the normal function of cells.

It is not possible to determine the type of dementia without a brain biopsy. Most of the time a doctor makes the diagnosis after an interview and exam. Alzheimer’s disease is the most common type of dementia but there are many other types of dementia including: vascular dementia, Lewy body dementia, mixed dementia, normal pressure hydrocephalus and frontal lobe dementia

Risk factors for dementia include:

• Age. Age is not synonymous with dementia, but the incidence of dementia is significantly higher as one ages.
• Female gender
• Family history of dementia in a parent or sibling
• Different races have different risk of dementia with African Americans being at increased risk for the development of vascular dementia while white Americans are more at risk of Alzheimer’s disease.
• Head injury
• Poor control of many chronic diseases, including congestive heart failure, hypertension, diabetes and lung disease can make dementia worse.
• Risk factors for vascular disease - high blood pressure, diabetes, smoking and high cholesterol
• Low blood pressure is also associated with the development of dementia. Specifically low diastolic pressure is linked to a higher incidence of dementia in patients over 75.

Dementia, a disease with a gradual but continual decline, rarely has a uniform presentation. Patients usually experience a steady decline in mental functioning over a number of years, which is frequently complicated by many other medical problems.

The different types of dementia progress differently. Most dementias start with the loss of short-term memory as evidence by forgetting recent events. People in the early stages of dementia often misplace items, forget appointments, ask questions repeatedly and have trouble learning new information. Demented people often use words incorrectly; have difficulty finding the right word or use general words to describe a specific item. A demented person uses the word "thing" to describe many items. Personality changes, making poor decisions and mood swings are common symptoms of early dementia.

Patients with early dementia are able to make up for their deficits when they are in familiar environments, such as the home. When getting out of the home environment, such as a hospital admission, is when the dementia is often first noticed.

Activities of daily living such as bathing, handling finances, grooming, dressing and preparing meals becomes more challenging as the disease progresses. This is a major reason that many people with dementia are unable to live by themselves.

The memory impairment is very distressing for both family and the individual who is afflicted. The memory may be so bad that those with advanced dementia do not know the name of his or her spouse or children.

Dementia often leads to a point where they forget how to swallow. Inability to swallow increases the risk for pneumonia, malnutrition and dehydration.

Individuals with advance dementia have a myriad of behavioral problems. This may include:

• Mood swings
• Personality changes such as irritability, suspiciousness and fearfulness
• Hallucinations include seeing things that are not there such as dead relatives or hearing non-existent voices
• Delusions or false beliefs may include thinking people are out to get them, thinking that someone is trying to poison them or believing they are God.

Dementia is diagnosed by an examination from a doctor. The first step typically involves performing a mental status examination. Standardized tests – such as the mini-mental state exam (MMSE) – are often used to document mental decline, watch decline and help make the diagnosis. Mental status examinations evaluate memory and intellectual function, language, ability to perform purposeful movements, and ability to recognize objects.

If after an evaluation by a doctor a diagnosis is not known than more extensive testing may be employed. A neurologist or psychiatrist commonly performs neuropsychological testing. This is more extensive testing that looks at the mental state and can help in the diagnosis of dementia.

The diagnosis of dementia is established by physical and mental exam. The mental status exam needs to show a decline in mental function, a progressive decline of memory and one of the following: a decreased capacity to recall words, inability to execute purposeful movement, and a decreased ability to perform tasks of daily living.

The work up of dementia rules out other causes of mental decline and consists of imaging, blood and urine tests. Common laboratory testing includes a complete blood count to rule out infection or anemia, kidney function testing, electrolyte testing, liver function testing, testing for vitamin deficiencies and diabetes. Less common tests run include tests for syphilis, Lyme disease, HIV and genetic defects. A lumbar puncture is sometimes performed if an infection in the central nervous system is suspected.

The doctor needs to look for depression. Depression can present with memory loss and memory loss can reverse with treatment of depression. Additionally, depression obscures the course of dementia if they co-exist.

Many patients with dementia undergo imaging examination to rule out physical causes of disease. Common tests include a CAT scan or MRI of the brain. The chance of finding a cause of the supposed dementia on these tests is low so these tests are not run on everyone who presents with dementia.

These tests are run more commonly on someone who a doctor strongly suspects has an underlying cause of the memory loss that is not Alzheimer’s disease. Reasons a doctor may order an imaging test include: having a very young person present with dementia, those who have a very rapid onset of symptoms, people with a history of cancer and those who have an exam finding that is suggestive of a problem with the brain. Imaging can rule out brain tumors, stroke or normal-pressure hydrocephalus. The only way to confirm the diagnosis is to perform a brain biopsy, which is rarely done or necessary.

More advanced testing includes PET scans or single photon emission computed tomography (SPECT) scans. These tests are rarely used except in research settings.

No treatment is able to reserve dementia, but treatments are available that can help improve quality of life, slow disease progression and improve behaviors.

Support groups improve the ability to cope with this progressive and disabling disease. The health care system should provide guidance about what is to be expected with this disease and provide techniques to improve coping. This is often best accomplished in the setting of a support group.

Non-drug treatments can help the patient with dementia. Orienting the demented individual to his or her surrounding is helpful. This includes telling the person the date and time. Reminiscing with pictures provides a link to the past. Providing sensory stimulation including tough/massage and aromatherapy is helpful in providing a calming environment. Maintaining an active social life is an important step in preventing and treating Alzheimer’s disease.

Maintain a familiar environment. Provide consistency and structure; keep a routine schedule; keep items such as clothes, shoes, medications and furniture, in the same place; maintain a large calendar in the home with important dates such as birthdays and doctor appointments; list Important phone numbers in plain view; and label drawers and cabinets. This will help the demented person function more effectively.

Safety is a key consideration as the disease progresses. Some tips to maintain safety include:

• Provide simple instructions by keeping instructions to less than five words.
• Maintain lighting to reduce the risk of falls. Use night-lights.
• Remove sharp objects from the home or place them in a locked area.
• Get an occupational therapists to do a home evaluation to assure safety.
• Hire a cleaning service to reduce clutter in the home.
• Place identification tags, available in many pharmacies, on the patient in case he or she gets lost.
• Place alarms at the exits of the home to prevent the patient from wandering off.

Behavior analysis determines triggers that agitate or make the demented individual more confused. Controlling things that agitate the patient or increase confusion can go a long way into making the disease more manageable. The behavior chart in the appendix can be used by to help determine what triggers the behavior problems. Recording activities, medications, the people present and the corresponding behaviors identifies patterns to help loved ones understand what agitates the individual. The behavior chart should be filled out if there is a change in behavior, a few days before a doctor’s appointment, or after a medication change.

The behavior chart is made up of six columns.