What is Dementia?

Dementia encompasses the decline in cognitive abilities, including thinking, remembering, and reasoning, to the extent that it disrupts daily life and activities. Individuals with dementia may experience emotional instability and personality changes. Its severity ranges from mild stages, where functioning begins to be affected, to severe stages, necessitating complete dependence on others for basic tasks like feeding.

Although more prevalent with age (affecting about one-third of those aged 85 or older), dementia is not an inevitable aspect of aging. While millions are affected, many individuals live beyond their 90s without experiencing dementia symptoms. Alzheimer’s disease stands as the most common form among various types of dementia.

Signs and Symptoms

Signs and symptoms of dementia arise from the dysfunction and deterioration of once-healthy neurons in the brain, leading to the loss of connections with other brain cells and eventual cell death. While some neuronal loss is a natural part of aging, individuals with dementia endure significantly greater neuronal decline. The manifestations of dementia can vary depending on the specific type and may encompass a range of symptoms:


  1. **Memory Impairment and Cognitive Decline:** Individuals may experience memory loss, poor judgment, and confusion, making it challenging to retain and recall information accurately.


  1. **Communication Challenges:** Difficulties may arise in speaking, understanding, expressing thoughts, or engaging in activities involving reading and writing. Communication breakdowns can lead to frustration and social withdrawal.


  1. **Disorientation and Wandering:** Those with dementia may exhibit wandering behavior and get lost even in familiar surroundings, posing risks to their safety and well-being.


  1. **Financial Management Issues:** Managing money responsibly and handling financial obligations such as paying bills may become increasingly problematic, leading to financial mismanagement and potential legal consequences.


  1. **Repetitive Behaviors:** Repetitive questioning, actions, or habits may emerge, reflecting cognitive impairment and an inability to retain recent information.


  1. **Language and Speech Abnormalities:** Using unconventional or unfamiliar words to describe common objects or concepts can be indicative of linguistic decline associated with dementia.


  1. **Slowed Processing and Task Completion:** Everyday tasks may take longer to complete as cognitive processing speed decreases, affecting overall efficiency and productivity.


  1. **Loss of Interest and Engagement:** A decline in motivation and enjoyment of previously pleasurable activities or events may occur, resulting in social withdrawal and isolation.


  1. **Psychotic Symptoms:** Hallucinations, delusions, or paranoid thoughts may surface, altering perceptions of reality and exacerbating behavioral disturbances.


  1. **Impulsivity and Lack of Empathy:** Individuals may display impulsive or reckless behaviors and demonstrate reduced concern for the feelings and well-being of others.


Recognizing symptoms of dementia in individuals with intellectual and developmental disabilities presents unique challenges, as baseline cognitive functioning can vary widely among this population. Monitoring for subtle changes in cognitive abilities and behavior over time is crucial for early detection and intervention. Additionally, understanding and accommodating an individual’s current capabilities are essential for providing appropriate support and care as dementia progresses.


What Causes Dementia?

Dementia manifests as a consequence of alterations occurring within specific brain regions, leading to dysfunction in neurons (nerve cells) and their interconnections. Researchers have linked these brain changes to various forms of dementia and are actively exploring the underlying mechanisms contributing to their occurrence, aiming to discern why these changes manifest in certain individuals but not others. While for a minority, dementia can be attributed to rare genetic mutations identified as causative factors.

Different Types of Dementia

Dementia emerges from a range of neurodegenerative conditions and factors, culminating in the gradual and irreversible deterioration of neurons and overall brain function. Regrettably, there exists no cure for any variant of dementia at present. The spectrum of dementia encompasses several distinct types, each presenting its unique set of challenges and manifestations.

Alzheimer’s disease stands as the prevailing diagnosis for dementia among older adults, stemming from cerebral alterations characterized by anomalous accumulations of proteins termed amyloid plaques and tau tangles.

In contrast, frontotemporal dementia, a less common variant, typically afflicts individuals under 60 years old. This form of dementia manifests distinct clinical features and poses unique challenges compared to Alzheimer’s disease. Additionally, Lewy body dementia, attributed to irregular deposits of the protein alpha-synuclein, known as Lewy bodies, represents another significant subtype within the spectrum of dementia.

Vascular dementia, another prevalent form of dementia, arises from various conditions that inflict harm upon blood vessels within the brain or disrupt the circulation of blood and oxygen to cerebral tissues. This subtype underscores the critical role of vascular health in maintaining cognitive function and highlights the interplay between cardiovascular and neurological well-being.

Furthermore, mixed dementia, a complex amalgamation of two or more dementia types, further complicates diagnostic and treatment approaches. Autopsy studies have revealed a significant prevalence of mixed dementia cases among older adults with cognitive impairment, emphasizing the intricate nature of dementia pathology and its multifaceted clinical manifestations.

How is Dementia Diagnosed?

To diagnose dementia comprehensively, physicians initially investigate whether any underlying and potentially treatable conditions could be contributing to the individual’s cognitive impairment. This diagnostic journey typically begins with a thorough physical examination to assess vital signs, including blood pressure, alongside laboratory analyses of blood and other bodily fluids.

These tests aim to evaluate various biochemical markers, hormones, and nutrient levels, aiding in the identification or exclusion of potential causal factors for the observed symptoms. Moreover, a detailed review of the patient’s medical history, encompassing both personal and familial contexts, can offer valuable insights into their predisposition to dementia. Inquiries may delve into the presence of dementia within the family lineage, the onset and progression of symptoms, alterations in behavior and personality, and the usage of medications that could potentially exacerbate cognitive decline. Additionally, specialized diagnostic procedures may be employed to further elucidate the nature and extent of cognitive impairment.

Cognitive and neurological tests serve as fundamental tools in assessing an individual’s cognitive function and neurological status. These evaluations encompass a range of assessments designed to gauge various cognitive domains, including memory, problem-solving abilities, language proficiency, and mathematical aptitude. Additionally, these tests may encompass examinations of physical functioning, such as assessments of balance and sensory perception. By administering these tests, clinicians can obtain comprehensive insights into the individual’s cognitive capabilities and neurological integrity, aiding in the diagnosis and management of cognitive disorders like dementia.

Brain scans
These tests play a crucial role in identifying underlying conditions such as strokes, tumors, and other abnormalities that can contribute to dementia. Through imaging scans, changes in the brain’s structure and function can be detected, aiding in the diagnostic process. Among the most common imaging techniques used are computed tomography (CT), which utilizes X-rays to generate images of the brain and other organs, and magnetic resonance imaging (MRI), which employs magnetic fields and radio waves to produce detailed images of body structures, including tissues, organs, bones, and nerves. Additionally, positron emission tomography (PET) scans utilize radiation to capture images of brain activity, such as energy utilization, or the presence of specific molecules in various brain regions. These imaging modalities provide valuable insights into the physiological and structural aspects of the brain, facilitating the diagnosis and management of dementia-related conditions.

Psychiatric evaluation
If individuals display behavioral or mood changes, a psychiatric evaluation may be suggested to determine if depression or other mental health conditions contribute to their symptoms. This assessment involves evaluating their emotional state, cognitive function, and overall mental health through structured interviews, observation, and possibly psychological testing. Mental health professionals aim to identify any psychiatric disorders exacerbating the observed changes, facilitating appropriate interventions to alleviate symptoms and improve well-being.

Genetic tests
Some forms of dementia are linked to genetics. In rare cases, genetic testing can identify specific gene mutations associated with these conditions. However, it’s essential to consult with a genetic counselor both before and after undergoing such testing, involving family members and healthcare providers in the process. While genetic tests can reveal genetic variations that influence the risk of developing dementia, they aren’t diagnostic tools for dementia itself.

Cerebrospinal fluid (CSF) tests
Cerebrospinal fluid (CSF) is a transparent fluid that envelops the brain and spinal cord, offering protection, insulation, and nourishment. To obtain CSF for analysis, doctors perform a lumbar puncture, commonly known as a spinal tap. By measuring the concentrations of proteins or other substances in CSF, healthcare professionals can aid in the diagnosis of Alzheimer’s disease or other forms of dementia.

Blood tests
Many doctors, subject to state-specific availability reflecting U.S. Food and Drug Administration guidelines, can now order a blood test to measure levels of beta-amyloid, a protein that accumulates abnormally in people with Alzheimer’s. While several other blood tests are in development, current blood test results alone should not be used for dementia diagnosis but may be considered alongside other tests.

Nevertheless, the availability of these diagnostic tests remains limited, and some tests and procedures used for diagnosis may not be covered by health insurance. It’s advisable to consult your insurance provider and discuss with your healthcare team to determine the best options for you. Early detection of symptoms is crucial, as some causes can be effectively treated. However, in many cases, the cause of dementia is unknown and cannot be effectively treated. Nonetheless, obtaining an early diagnosis can assist with managing the condition and planning for the future, particularly in the early stages of dementia.

Many doctors can now order a blood test to measure beta-amyloid levels, a protein abnormality in Alzheimer’s, subject to state-specific availability and FDA guidelines. While other blood tests are in development, current results alone aren’t for diagnosis but may supplement other tests. However, test availability remains limited, and some may not be covered by insurance. Consult your provider and healthcare team for options. Early symptom detection is key as some causes are treatable, although many remain untreatable. Yet, an early diagnosis aids in management and planning, especially in early dementia stages.

Who can Diagnose?

Visiting a primary care doctor is typically the initial step for individuals experiencing cognitive, motor, or behavioral changes indicative of dementia. However, neurologists, specializing in brain and nervous system disorders, are often involved in dementia diagnosis. Geriatric psychiatrists, neuropsychologists, and geriatricians may also provide diagnostic services. If a specialist isn’t available locally, contacting the nearest medical school’s neurology department or hospital could offer referrals or access to dementia clinics. Additionally, the Alzheimer’s Disease Research Centers directory, which lists NIA-funded centers, can assist in finding expert evaluation and medical management resources.