Dementia

Dementia involves a decline in the mental abilities you need for daily living. It develops when there’s damage to the parts of your brain involved with learning, memory, decision-making and language.

It’s not a specific disease. It’s a clinical description of a set of symptoms caused by underlying brain diseases. The most common cause is Alzheimer’s disease.

If you have it, you might forget the name of a close friend or loved one. Or you might get lost in the neighborhood where you’ve lived for many years.

It isn’t part of normal aging. And it can shorten your lifespan, but how much varies.

An estimated 6.7 million U.S. adults age 65 or older have dementia.

Types of dementia

There are three types. They differ based on the cause:

• Primary: A brain disease is the main cause of dementia. There aren’t any other causes. Examples include: Alzheimer’s disease, frontotemporal dementia, Lewy body dementia, vascular dementia and mixed dementia (two or more types combined).
• Secondary: This type happens from another medical condition that causes changes in your body. The brain dysfunction is a secondary consequence. Examples include infections or alcohol related.
• Reversible: Some secondary causes of dementia could be reversible from treatable issues like vitamin deficiency or medication side effects.

Symptoms of dementia

Symptoms can vary based on the type and the area of your brain that has the most damage.

Cognitive symptoms

Cognitive symptoms are changes to your thinking and understanding. These may include:

• Difficulty sharing thoughts: Having trouble saying what you want to say
• Memory loss: Forgetting names, past events or things you just learned
• Problems following directions: Not understanding or remembering steps
• Trouble with language: Finding it hard to read, write or understand words

Behavioral and psychological symptoms

These are changes in how you feel or relate to others. They can affect your mood, interests and personality. These may include:

• Agitation: Feeling restless or upset
• Anxiety: Feeling nervous or worried
• Depression: Losing interest or feeling sad
• Disorientation: Not knowing where you are or what time it is
• Irritability: Feeling frustrated or upset by tasks that used to be easy
• Hallucinations: Seeing or hearing things that aren’t really there
• Paranoia: Thinking others are trying to hurt or trick you
• Fidgeting or repeating movements: Pacing or finger tapping
• Sleep problems: Waking up often at night or sleeping during the day

Dementia stages

Doctors may describe dementia in stages, based on how symptoms get worse over time. The three main stages are:

• Early-stage dementia (mild)
• Middle-stage dementia (moderate)
• Late-stage dementia (severe)

In the early stage, it affects your daily life, but not severely. You may notice some memory or thinking problems, but you can still do most self-care tasks at home, like dressing, bathing and making simple meals.

In the middle stage, thinking and daily tasks become harder. You may need reminders or prompts to complete them.

In the late stage, you need daily help and may require full-time care. Most thinking skills are lost, and you need support with basic activities, like eating, bathing and getting dressed.

Dementia causes

Damaged brain cells cause dementia. In most cases, this damage comes from a neurodegenerative disease (a disease that slowly harms brain cells over time). These changes affect the parts of your brain that control memory, learning, language and decision-making.

Brain cells need to “talk” to each other by sending electrical signals. These signals help your brain work. When something blocks the signals or damages the cells, your brain can’t work properly.

Researchers are still studying why dementia develops in some people and not in others. In rare cases, a gene change can cause it.

Secondary dementia causes

Common disorders and conditions that cause secondary dementia include:

• Alcohol-related
• Creutzfeldt-Jakob disease
• Encephalitis
• Meningitis
• Multiple sclerosis
• Traumatic brain injury
• Wilson disease

Reversible dementia causes

With reversible dementia, symptoms may go away once your provider treats what’s causing them. Some common causes include:

• Bleeding in the brain (subdural hematomas)
• Brain tumors
• Diseases of other body organs (liver cirrhosis, renal failure)
• Fluid buildup in your brain (normal pressure hydrocephalus)
• Hormone-related disorders (Addison’s disease, Cushing’s disease, thyroid disorders)
• Infections (like HIV, syphilis)
• Medicine side effects (from certain drugs, like anticholinergics or benzodiazepines)
• Vitamin deficiencies (not enough vitamins, like B1, B6, B12, copper or vitamin E)

Risk factors

Certain factors may raise your chances of developing dementia. These include:

• Age: You can’t avoid it, but getting older is the biggest risk. Most diagnoses happen after age 65.
• Family history: If a biological parent or sibling has it, you may be more likely to get it, too.
• Down syndrome: This condition increases your risk of getting symptoms, especially at an earlier age.
• Heart and blood vessel problems: Conditions like high blood pressure, high cholesterol, diabetes and smoking can damage blood vessels. Poor blood flow and strokes can increase your risk as well.
• Race and ethnicity: Black adults are about twice as likely, and Hispanic adults are about 1.5 times more likely than white adults to develop dementia.
• Serious brain injury: A severe head injury and loss of consciousness during your life can raise your risk.

Complications

Your brain controls everything your body does. When it stops working properly, it can affect your overall health. Dementia can lead to serious problems, including:

• Bedsores
• Dehydration and poor nutrition
• Trouble managing your pee or poop
• Falls, injuries or broken bones
• Pneumonia
• Sepsis

Some of these problems can be life-threatening if not treated quickly. Unmanaged symptoms may lead to early death.

How doctors diagnose dementia

To find out if you have dementia, a provider will:

• Ask about your symptoms, like when they started and how often they happen
• Review your personal and family medical history
• Look at the medications you’re currently taking
• Order tests

Diagnosing dementia can take time. That’s because many other disorders can cause similar symptoms. Your care team may need to rule out other problems first. While they work on getting the right diagnosis, they’ll help you manage symptoms.

Dementia testing

Your provider may use one or more of the following tests to confirm a diagnosis:

• Blood tests
• CT scan
• MRI
• Mental status exam
• PET scan
• Neuropsychiatric evaluation
• Spinal tap (lumbar puncture)

Is there a cure for dementia?

Right now, there’s no cure. Researchers are working to better understand it. But many types of dementia are treatable.

How is dementia treated?

No treatment can completely stop dementia from getting worse. But your provider can help you manage symptoms and reduce how much they affect your daily life.

Treatment can look different for each person because dementia affects everyone in different ways. What works well for one person may not work the same for you. Some treatments may also become less helpful as the disease progresses.

Dementia medications

Medicines are usually the first type of treatment for most kinds of dementia. Common options include:

• Cholinesterase inhibitors (donepezil, rivastigmine, galantamine): These improve memory by changing the chemical balance in your brain.
• NMDA receptor antagonist (memantine): This medicine controls signals in your brain. It may help with memory and make it easier to do everyday activities.
• Anti-amyloid therapies (lecanemab, donanemab): These medications may help in early stages of Alzheimer’s disease. They slow disease progression and are effective by removing the amyloid plaques in your brain.
• Antidepressants and antipsychotics: These may help with mood and behavior changes, anxiety or other symptoms.

Your provider will explain which medicine is best for you and what side effects to watch for before starting treatment.

Non-medication-related dementia treatment

Treatment may include additional ways to support and improve your brain function, including:

• Managing any health conditions that affect your brain, like diabetes and blood pressure
• Balancing your vitamin, calcium, thyroid or blood sugar levels
• Changing your medication type or dose
• Having surgery to remove a tumor or reduce pressure in your brain
• Treating infections with medications
• Eating heart-healthy foods
• Participating in regular physical exercise
• Being socially engaged
• Having hobbies to challenge your thinking skills

When should I see a healthcare provider?

Make an appointment with a provider if you or your loved ones notice changes in your:

• Ability to perform everyday tasks
• Behavior
• Memory
• Mental functioning

What questions should I ask my healthcare provider?

If you or a loved one has dementia, you may want to ask a healthcare provider:

• What symptoms should I look out for?
• What type of treatment do you recommend?
• What is the life expectancy?
• Is living independently possible?
• Is driving safe?

What can I expect if I have dementia?

Dementia gets worse over time. Even with treatment, your memory and thinking skills may continue to decline. This can affect your safety and ability to care for yourself or loved ones.

It’s a good idea to make an advance directive. This is a written plan that tells your providers and family what kind of medical care you want in the future.

As symptoms progress, you may have to make tough decisions to stay safe. This could include:

• Not driving
• Getting help at home
• Moving to a full-time care facility

These choices aren’t easy and can affect your emotions. Talking to a mental health professional or joining a support group may help you cope.

Researchers are still studying ways to cure dementia. New treatments and care options may be available in the future.

What’s the life expectancy of a person with dementia?

Dementia is a serious condition that usually shortens your life. But how long you live with dementia can vary.

One study found that people with Alzheimer’s disease lived for about 5.8 years after getting a dementia diagnosis. But people can live longer if they’re in otherwise good medical health.

Providers look at many things to help estimate life expectancy, including:

• Your overall health
• Any other medical conditions you have
• How advanced symptoms are

Each person’s medical history and life situation is different. Both can affect life expectancy.

Can dementia be prevented?

You can’t prevent all types. But there are ways to lower your risk for some kinds. A healthcare provider can help you stay healthy and keep your brain strong. They may suggest:

• Quit smoking.
• Eat healthy meals with a balance of fruits, vegetables and whole grains.
• Be active for at least 30 minutes most days of the week.
• Keep your brain busy with puzzles, word games, reading or new activities.
• Stay social by talking with friends and family to support your mental and emotional health.
• Get your hearing and vision checked and treated to decrease risk of cognitive impairment.
• Manage your risk factors, like diabetes, high blood pressure and cholesterol carefully.