Dementia is the broad umbrella term used to describe a decline in mental ability severe enough that it affects your daily life. The activities of daily living that may be affected are grooming (dressing), toileting, eating, medication taking, decision making, loss of reasoning skills, reduced visual perception, or personality changes.
These symptoms don't occur all at the same time, or to the same degree of severity. They appear gradually but with increasing frequency as time goes on. Sometimes the person is the most aware of their beginning problems, is frightened, and tries to hide them. Other times it is the co-workers, friends, or family members who notice the signs first. Most commonly it is repetitive gaffes in memory that brings the person to the doctor. Less commonly, a fairly rapid change in personality leads to family strife. At this point the last thing on the family's mind is a diagnosis of dementia. More and more physicians are becoming aware that a personality change can signal a dementia. The doctor begins by taking a good family history as well as a description of the incidences that trouble the patient or family. Then some mental testing should be undertaken before years of therapy is attempted which has no positive outcome. Fronto-temporal dementia is especially known for personality (behavioral) changes, and anger management issues.
There are numerous reasons for dementia to occur:
- Thyroid deficiencies
- B12 deficiency
- Alzheimer's disease 60%
- Vascular dementia (strokes, brain bleeds causing loss of blood to neurons) 15%
- Lewy-body dementia 15%
- Mixed dementias 10%
- Parkinson's disease
- Multiple sclerosis
- Down's syndrome
- Korsakoff's syndrome (alcoholism)
- Posterior cortical atrophy
- Multi-system atrophy
- Huntington's disease
- Creitzfeld Jacob's disease (Mad Cow)
- Primary progressive aphasia
The first three items on the list are reversible with treatment. None of the others are reversible or curable. All occur, however, because the neurons of the brain are damaged in some way such that they can no longer transmit messages. Some have deposits of a specific protein or proteins that clog the area around the neuron leading to neuron death. When there is massive neuron death, symptoms appear as deficits for the parts of the brain that were damaged.
You may reasonably ask, "Why should I get an in-depth diagnosis from a neurologist when there is no cure?" Yes, it is important for the person/family to know what might be wrong. Especially if the dementia were due to one of the first three mentioned, which are reversible with treatment. Wouldn't you feel bad if you could have done something about it and you didn't? The length of each dementia may be quite different as well as the supportive medicine that may be prescribed to manage it's course. Many of these dementias have slightly different outward expressions: problems in motion, speech, memory, or behavior, that make that particular dementia stand out from the rest. It should be the neurologist who periodically meets with the person and care partner, assesses the changes over time, and manages the medicines that would help to make the course less problematic as they progress in the disease, rather than just the general practitioner alone.
The course of the disease can also be improved by the family and person affected getting support and education from the Alzheimer's Association. The Alzheimer's Association gives all sorts of support and learning opportunities for all the dementias not just Alzheimer's. Being a successful caregiver for dementia is quite different than being a caregiver for someone who has other medical problems. It requires changing your way of thinking and acting in order to reduce the anxiety of the person with the dementia. Support groups are the best way to learn those skills.
Generally, the person with memory problems undergoes a quick test called the mini-mental exam that assesses the workings of different parts of the brain. They are given blood tests to check the B12 level and thyroid functioning. They are also given a brain MRI. Then if the neurologist needs further testing of how the brain functions, they will request that. After all the necessary information is gathered, the neurologist will decide what dementia to call it if he can at that point in the progression. The important thing here is to have an idea of what is causing the dementia and providing future care, possible medications to manage symptoms, and guidance for all involved. Unfortunately, the field of dementia is not an exact science, and many times a specific diagnosis may only be verified upon autopsy. The list, however, can be skillfully narrowed down to within 90-95% accuracy as to the actual dementia at play.