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Alternative namesChronic brain syndrome
Dementia refers to a group of symptoms involving progressive impairment of brain function.
Causes, incidence, and risk factors
Disorders that cause dementia include conditions that impair the vascular (blood vessels) or neurologic (nerve) structures of the brain. Some causes of dementia are treatable. These include normal pressure hydrocephalus , brain tumors, and dementia due to metabolic causes and infections. Unfortunately, most disorders associated with dementia are progressive, irreversible, and degenerative.
The two major degenerative causes of dementia are Alzheimer's disease (the progressive loss of nerve cells without known cause) and vascular dementia (loss of brain function due to a series of small strokes). The two conditions often occur together, and vascular dementia may speed the progression of Alzheimer's disease. Neither condition can be diagnosed definitively until autopsy.
Dementia may be diagnosed when two or more brain functions are impaired. These functions include language, memory, visual-spatial perception, emotional behavior or personality, and cognitive skills (such as calculation, abstract thinking, or judgment). Dementia usually appears first as forgetfulness. Other symptoms may be apparent only with neurologic examination or cognitive testing.
Dementia progresses slowly from decreased problem solving and language skills to difficulty with ordinary daily activities to severe memory loss and complete disorientation with withdrawal from social interaction.
Signs and tests
A neurologic examination may reveal abnormalities. Early signs of dementia include mild problems with memory or attention. Over time, the following cognitive difficulties may appear:
The extent of damage and cause of dementia may be indicated by tests and procedures that include, but are not limited to, the following:
TreatmentThe goal of treatment is to control the symptoms of dementia. Treatment varies with the specific disorder. Hospitalization may be needed for a short time. The underlying causes should be identified and treated, including treatment for reversible organic lesions such as tumors.
Stopping or changing medications that worsen confusion or that are not essential to the care of the person may improve cognitive function. Medications that contribute to confusion include anticholinergics, analgesics , cimetidine, central nervous system depressants, lidocaine, and others.
Disorders that contribute to confusion should also be treated. These include heart failure , decreased oxygen ( hypoxia ), thyroid disorders , anemia , nutritional disorders, infections, and psychiatric conditions such as depression . Correction of coexisting medical and psychiatric disorders often greatly improves mental functioning.
Medications may be needed to control aggressive or agitated behaviors that are dangerous to the person with dementia or to others. These are usually given in very low doses and adjusted as necessary.
Possible medications for this use include the following:
Sensory function should be evaluated regularly and hearing aids, glasses, or cataract surgery should be provided as needed.
Providing a safe environment, controlling aggressive or agitated behavior, and meeting the physiologic needs of a person with dementia may require monitoring and assistance in the home or in an institutionalized setting. Possible options include in-home care, boarding homes, adult day care, and convalescent homes.
Expectations (prognosis)The outcome varies. Acute disorders that cause delirium may coexist with chronic disorders causing dementia. Chronic brain syndromes are often progressive and usually result in decreased quality of life and decreased life span.
ComplicationsComplications depend on the cause of the dementia, but they may include the following:
Calling your health care provider
PreventionMost causes of dementia are not preventable. However, eating a low-fat diet and exercising regularly may reduce the risk of vascular dementia, which is caused by repeated small strokes. Vascular dementia may also play a role in the progression of Alzheimer's disease.
Update Date: 5/21/2002Alberto Espay, M.D., Department of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT