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Understanding dementia

Jeffrey M. Kagan, M.D. [June 16 2011]

It's not uncommon for patients and their family members to ask primary care physicians about dementia and Alzheimer's disease, a type of dementia. Frequent questions revolve around the types of dementia, how dementia is diagnosed, available treatments, and if dementia can be prevented.

Dementia is not a disease but rather a syndrome characterized by a group of symptoms with a final outcome. The condition is marked by a decline in cognitive or mental function with memory loss a classic feature. It's common for patients to forget people and places, get lost or disoriented, lose things and have trouble performing executive functions like balancing a check book. Functional declines include activities of daily living like dressing, bathing, preparing food, eating, toileting, speaking and driving. Dementia patients may also exhibit behavioral disturbances including irritability, mood swings, aggressiveness, hostility, depression and paranoia.

Dementia has several causes, with the two primary causes Alzheimer's disease and vascular dementia. Alzheimer's disease is nonreversible, progressive and usually strikes senior citizens, though a rare form strikes earlier in life. The disease course can range from a few years to 20 years.

Vascular dementia results from multiple, usually minor strokes. It's characterized by the same mental deficits of Alzheimer's, but the changes are sudden. Vascular dementia risk factors are atrial fibrillation, an irregular heart rhythm; blocked carotid arteries; high blood pressure; diabetes; and smoking. The patient will be relatively stable and then exhibit a sudden loss of function after a stroke. The best way to prevent this process from getting worse is to prevent another stroke. For many patients, this means taking a blood thinner.

Other triggers to dementia can include Parkinson's disease, Lewy body disease, frontotemporal degeneration, Wernicke-Korsakoff syndrome, brain infections, brain tumors, radiation therapy, multiple sclerosis, supranuclear palsy, hydrocephalus (fluid buildup in the brain), and nutritional causes like vitamin deficiencies of B12 or B1 (thiamine). Metabolic abnormalities like liver and thyroid disease, as well as depression can give the appearance of dementia, but actually cause a delirium, an altered mental state, which may resolve when the underlying problem is corrected.

Dementia evaluation starts with a detailed history from the patient, relatives or coworkers and neighbors. Also included are a physical examination with special attention to cardiac and neurological systems, and the patient's mental status; lab work; and a brain image via CT scan, MRI or PET scan.

Dementias are classified as reversible, potentially reversible, stabilized, or nonreversible. Reversible or potentially reversible syndromes may include those due to vitamin deficiency or certain infections. Many dementias are not reversible; medications have a modest effect on slowing deterioration.
Dementia's final stages are quite similar regardless of cause. The patient loses ability to speak, swallow, walk, smile, or hold his or her head up. Hospice care is appropriate for patients with end-stage dementia.

Strategies to prevent dementia include keeping your mind active such as following current events and doing puzzles; remaining physically active; and eating a Mediterranean diet. Such a diet includes grains, fresh fruits and vegetables, nuts, high-fiber foods, fish/other seafood, and olive oil as main fat source in food preparation.

Dr. Kagan is a member of The Hospital of Central Connecticut (HOCC) medical staff. He is board-certified in both internal medicine and hospice and palliative care, and a certified medical director for long-term care. For referrals to HOCC physicians, please contact our free Need-A-Physician referral service by phone at 1-800-321-6244 or online, www.thocc.org. Need a physician? Visit our free referral service