Dementia Support Group

Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Particularly affected areas may be memory, attention, language and problem solving, although particularly in the later stages of the condition, affected persons may be disoriented in time (not knowing what day of the week, day of the month, what month or even what year it is), place (not knowing where they are) and person (not knowing who they are). Symptoms of dementia can be classified as either reversible or irreversible depending upon the etiology of the disease. Less than 10% of all dementias are reversible. Dementia is a non-specific term that encompasses many disease processes, just as fever is attributable to many etiologies.

Proper differential diagnosis between the types of dementia (see below) will require, at the least, referral to a specialist, e.g. a geriatric internist, geriatric psychiatrist, neurologist, neuropsychologist or geropsychologist. However, there are some brief (5-15 minutes) tests that have good reliability and can be used in the office or other setting to evaluate cognitive status. Examples of such tests include the abbreviated mental test score (AMTS) and the mini mental state examination (MMSE).

An AMTS score of less than six and an MMSE score under 24 suggests a need for further evaluation. Of course, this must be interpreted in the context of the person's educational and other background, and particular circumstances. Routine blood tests are usually performed to rule out treatable causes. These tests include vitamin B12, folic acid, thyroid-stimulating hormone (TSH), C-reactive protein, full blood count, electrolytes, calcium, renal function and liver enzymes. Abnormalities may suggest vitamin deficiency, infection or other problems that commonly cause confusion or disorientation in the elderly. Chronic use of substances such as alcohol can also predispose the patient to cognitive changes suggestive of dementia.

A CT scan or magnetic resonance imaging (MRI scan) is commonly performed. This may suggest normal pressure hydrocephalus, a potentially reversible cause of dementia, and can yield information relevant to other types of dementia, such as infarction (stroke) that would point at a vascular type of dementia. Sometimes neuropsychological testing is helpful as well.

The final diagnosis of dementia is made on the basis of the clinical picture. For research purposes, the diagnosis depends on both a clinical diagnosis and a pathological diagnosis (ie, based on the examination of brain tissue, usually from autopsy).

Most common causes

* Alzheimer's disease
* Vascular dementia (also known as multi-infarct dementia), including Binswanger's disease
* Dementia with Lewy bodies (DLB)
* Alcohol Induced Persisting Dementia
* Frontotemporal lobar degeneration (FTLD), including Pick's disease
* Frontotemporal dementia (or frontal variant FTLD)
* Semantic dementia (or temporal variant FTLD)
* Progressive non-fluent aphasia

Less common causes

It can also be a consequence of:

* Creutzfeldt-Jakob disease
* Huntington's disease
* Parkinson's disease
* HIV infection (leading to AIDS dementia complex)
* Head trauma
* People with Down's syndrome have an increased risk of developing dementia of the Alzheimer's type. This risk increases as the person ages.

Treatable causes

Less than 5% of a sample of dementia cases have a potentially treatable cause. These include:

Hypothyroidism, Vitamin B1 (thiamine) deficiency, Vitamin B12, Vitamin A deficiency, Depressive pseudodementia (note: dementia and depression can coexist in many patients and can be difficult to differentiate.), Normal pressure hydrocephalus, Tumor.

Except for the treatable types listed above, there is no cure to this illness, although scientists are progressing in making a type of medication that will slow down the process. Cognitive and behavioral interventions may also be appropriate. Educating and providing emotional support to the caregiver [or carer] is of importance as well.

A Canadian study found that a lifetime of bilingualism has a marked influence on delaying the onset of dementia by an average of four years when compared to monolingual patients. The researchers determined that the onset of dementia symptoms in the monolingual group occurred at the mean age of 71.4, while the bilingual group was 75.5 years. The difference remained even after considering the possible effect of cultural differences, immigration, formal education, employment and even gender as influences in the results.

Snoezelen rooms that provide patients with a soothing and stimulating environment of light, color, music and scent have been used in the therapy of dementia patients.