Introduction:

Dementia is a term that describes the loss of cognitive function, usually because of damaged brain cells. It includes memory loss and at least one of the following: difficulty with language, impaired movement, and inability to plan and initiate appropriate behaviors socially or at work. People with dementia may not be able to care for themselves by getting dressed or eating; they may have trouble balancing their checkbook and may get lost in familiar settings.

Signs and Symptoms:

Alzheimer' s disease

• Increasing memory loss
• Difficulty with language (not being able to find the right word)
• Not being able to think abstractly
• Disorientation (getting lost in familiar places)
• Not recognizing friends or family
• Inability to do familiar tasks (such as cooking)
• Loss of judgment and decision making ability
• Personality changes

Vascular dementia

• Mental confusion
• Having trouble walking; falling frequently
• Memory loss
• Difficulty with language
• Becoming agitated
• Urinary frequency or incontinence

What Causes It?:

Dementia usually occurs in elderly people, although it is not considered a normal effect of aging. Some kinds of vascular dementia may be mistaken for Alzheimer' s disease, and the two often occur together.

Other causes of dementia include:

• Vascular disease (blockage of a blood vessel to the brain)
• Traumatic brain injury
• Parkinson's, Huntington's, Creutzfeldt-Jakob, and other diseases
• Brain tumor
• Vitamin B deficiencies
• Drug or alcohol abuse, medications, or exposure to toxic substances
• A history of severe hypoglycemic episodes among people with type 2 diabetes

What to Expect at Your Provider's Office:

Your doctor will go over your symptoms and do a physical examination. However, since there is no test to diagnose dementia, your doctor will rely greatly on interviews with you and your family, especially to discover noticeable declines in mental and physical abilities. Depression is sometimes mistaken for dementia in older people, so your doctor should ask questions to rule that out. If your doctor suspects vascular dementia, your doctor may order an MRI (magnetic resonance imaging) or CT (computed tomography) scan to look at your brain.

Treatment Options:

There is no cure for either vascular dementia or Alzheimer' s disease, but there are some medications that may help slow the progression of the disease. It is important for both the person with dementia and the person' s caregiver to have a strong support system in place to deal with the emotional challenges of the disease.

Treatments are aimed at lessening the symptoms and slowing the progression of the disease. Treatment may include a combination of drug and psychiatric or behavioral therapies. If you are elderly, your doctor may pay close attention to the medications you take, because some drugs may cause confusion or delirium in older people. Exercise, both physical and mental, can slow the progress of dementia.

Drug Therapies

The following drugs have been approved to treat Alzheimer' s disease. They are also often used to treat vascular dementia. However, not everyone responds to these medications. Research is continuing to find better drugs to treat Alzheimer' s and other forms of dementia.

Cholinesterase inhibitors -- These drugs increase the amount of a brain chemical called acetylcholine, a messenger chemical that is involved in memory and judgment. Side effects can include nausea, fatigue, and diarrhea. This class of drugs includes

• Donepezil (Aricept)
• Rivastigmine (Excelon)
• Galantamine (Razadyne)

Memantine (Namenda) -- This drug works by regulating a chemical messenger called glutamate, which is involved in information storage and retrieval in the brain. Side effects can include headache, constipation, confusion, and dizziness.

Complementary and Alternative Therapies

Alternative therapies may help treat dementia. If you are deficient in some nutrients, taking a supplement or getting more of that nutrient in your diet may help slow the progression of the disease. Many of the nutrients and herbs listed are used due to their supposed effects of increasing blood flow to the brain. Not surprisingly, many of them have a blood thinning effect and therefore can interfere or accentuate the effects of blood thinning medications. Dementia therapies, pharmaceutical or natural, should be used under the supervision of a qualified physician.

Nutrition and Supplements

• Phosphatidylserine (100 mg 3 times per day), a substance occurring naturally in the brain, shows promise in several studies. This supplement may increase levels of brain chemicals that deal with memory, according to several studies. Do not take phosphatidylserine if you are taking anticoagulants (blood thinners), and use caution if combining it with ginkgo for the same reason. There are great differences in quality among phosphatidylserine supplements. You should consider spending more for a more expensive brand, as they tend to be better than cheaper brands.
• Antioxidants may protect against the development of dementia. They may even slow the progression of dementia. In some studies, but not all, vitamin E (400 - 800 IU per day) combined with Aricept may slow cognitive decline in people with Alzheimer' s disease. Another antioxidant, coenzyme Q10 (10 - 50 mg 3 times per day), may also help the brain get more oxygen. The skins of dark berries also provide valuable antioxidants. Many naturally-oriented physicians recommend eating half a cup of frozen blueberries daily -- freezing makes the antioxidants in the skin more easily absorbed.
• Vitamins: biotin (300 mcg); B1 (50 - 100 mg), B2 (50 mg), B6 (50 - 100 mg), B12 (100 - 1,000 mcg), folic acid (400 - 1,000 mcg). No scientific evidence shows a direct benefit, but B12 and folic acid lower the levels of an amino acid in the blood that is often elevated in Alzheimer's patients. Injections of B12 may have the best results.
• Zinc (30 - 40 mg per day) is often deficient in elderly people, and may help improve memory.
• Some evidence suggests that L-arginine, an amino acid, may help in vascular dementia by increasing blood flow to the brain. The dose used was 1.6 g each day for 3 months.
• Essential fatty acids, such as those found in alpha linolenic acid (ALA), borage oil, and evening primrose oil, may help reduce the risk of Alzheimer's disease. Dietary changes include eating fewer animal fats and more fish.

Herbs

The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

• Ginkgo (Ginkgo biloba) shows the best evidence for treating early Alzheimer's disease and vascular dementia. It may be taken in a standardized extract of 40 - 50 mg 3 times per day. If you are taking blood thinning medication, use ginkgo only under the supervision of your doctor.
• Huperzine A, a chemical made from the plant Huperzia serrata, may improve memory in both vascular and Alzheimer's dementia, according to several studies in China. However, more studies are needed to know for sure. The usual dose is 200 mcg twice a day. Do not take huperzine A if you have liver disease or if you are about to have anesthesia.
• One study showed that lemon balm (Melissa officinalis) helped improve cognitive function in people with mild to moderate Alzheimer's. The dose used was 60 drops per day.
• Bacopa (Bacopa monnieri) leaf extract, called Brahmi, is used in Ayurvedic or Indian medicine to improve brain function and learning. However, no scientific studies have looked at bacopa to see whether it might help lessen symptoms of dementia. One study found that taking 300 mg of bacopa per day for 12 weeks seemed to improve cognition in healthy people.
• Lavender may be effective in terms of alleviating agitation associated with dementia. Lavender is not used internally but rather as an aromatherapy agent.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies, based on their knowledge and experience, for treating dementia. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Some of the most common remedies used for dementia are listed below.

• Alumina -- for dullness of mind, vagueness, slow answers to questions
• Argentum nitricum -- for dementia with irritability, especially with lack of control over impulses
• Cicuta -- for dementia after head injuries, especially with convulsions
• Helleborus -- for stupefaction, when a person answers questions slowly and stares vacantly
• Silica -- for mental deterioration with anxiety over small details

Following Up:

People with dementia usually require continuous care and monitoring by both a health care provider and family members.

Special Considerations:

Caregiver and patient education focusing on knowledge of the disease, health, and the patient's well being results in better patient care. Caregivers must also closely monitor patients to make sure they are taking medications appropriately.

Alternative Names:

Senile dementia