What Is Dementia: Symptoms, Causes, Types, and More

Dementia is a description of an individual’s mental function and is not a specific disease. It involves a decline in cognitive abilities from a previously higher level, which is severe enough to disrupt daily life. A person with dementia typically experiences two or more of the following specific difficulties:

• Memory.
• Reasoning.
• Language.
• Coordination.
• Mood.
• Behavior.

Dementia occurs when areas of the brain responsible for functions like learning, memory, decision-making, or language are affected by infections or diseases. The most common cause of dementia is Alzheimer’s disease. However, there are other recognized causes of dementia, including:

• Vascular dementia.
• Dementia with Lewy bodies.
• Frontotemporal dementia.
• Mixed dementia.
• Dementia resulting from Parkinson’s disease.
• Dementia-like conditions caused by reversible factors, such as medication side effects or thyroid problems.

Dementia Vs. Alzheimer’s disease – What’s the difference?

Dementia is a term used to characterize an individual’s cognitive function and is not a specific ailment. It serves as an overarching category that describes significant mental decline affecting daily life. Dementia encompasses various forms, symptoms, and causes within the neurodegenerative diseases. Presently, there is no cure for dementia, but ongoing research is focused on developing effective treatments and preventive measures.

Numerous underlying conditions can lead to dementia, with Alzheimer’s disease and Parkinson’s disease being among them. Alzheimer’s disease is the most prevalent underlying cause of dementia.

Who is at risk of developing Dementia?

Dementia is typically associated with late life, as it predominantly manifests in older people. Statistics indicate that approximately 5% to 8% of individuals aged 65 and above experience some form of dementia, with this figure doubling every five years beyond that age. It is estimated that up to half of those aged 85 and older may have dementia.

The prevalence of Alzheimer’s disease and related dementias among people aged 65 and older, broken down by race, is as follows:

• Blacks: 14%
• Hispanics: 12%
• Non-Hispanic whites: 10%
• American Indians and Alaska Natives: 9%
• Asian and Pacific Islanders: 8% 

Is memory loss an early sign of Dementia?

A common misconception regarding memory loss is the assumption that it invariably signifies the presence of dementia in either yourself or a loved one. Memory loss can stem from various causes, and its occurrence alone does not necessarily equate to a dementia diagnosis.

Additionally, it’s important to acknowledge that some memory changes are a natural part of the ageing process, linked to the natural loss of neurons in the brain as we grow older. However, this age-related memory decline is typically not functionally disabling, meaning it doesn’t significantly disrupt daily life.

Dementia, on the other hand, goes beyond ordinary memory lapses like misplacing keys. It impairs an individual’s ability to function and can result in difficulties as profound as forgetting the purpose of keys. It’s crucial to understand that dementia is not a typical aspect of the ageing process.

What Are different types of dementia?

There are several different types of dementia. Dementia is an umbrella term that consists of neurological conditions characterized by a decline in cognitive function.

Dementias can be categorized into three groups:

Primary Dementia: This includes diseases and conditions where dementia is the primary illness, a central symptom, or the main focus.
Secondary Dementia: Refers to cases where dementia results from another underlying disease or condition.
Reversible Dementia-Like Symptoms: These are caused by other illnesses or factors and may mimic dementia, but they are potentially treatable or reversible.

• Primary Dementia

Some of the most common types of primary dementia include:

Alzheimer’s Disease: Alzheimer’s disease is the most prevalent form of dementia. It is characterized by the accumulation of abnormal protein deposits in the brain that disrupt communication between neurons. These proteins disrupt the communication between nerve cells in the brain, leading to the death of nerve cells, which initially occurs in one area and gradually spreads to other regions. Symptoms of Alzheimer’s disease typically include short-term memory loss, confusion, personality and behaviour changes. As the disease progresses, individuals may also experience difficulties with speech, recalling distant memories, and walking. 

Vascular Dementia: This type of dementia results from impaired blood flow to the brain, often due to strokes or other vascular issues. It can occur suddenly or gradually. Symptoms often encompass memory difficulties, confusion, and challenges with concentration and task completion. The onset of decline may occur suddenly, following a major stroke, or progressively, as a result of a series of minor strokes. Risk factors for vascular dementia include high blood pressure, diabetes, and elevated cholesterol levels.  

Lewy Body Dementia: This condition, known as Lewy body dementia, is characterized by the accumulation of protein clusters called Lewy bodies in the nerve cells of the brain, leading to damage. Symptoms encompass issues with movement and balance, alterations in sleep patterns, memory loss, challenges with planning and problem-solving, as well as the presence of visual hallucinations and delusions.  

Frontotemporal Dementia: Frontotemporal dementia (FTD) arises from the damage to the frontal and temporal lobes of the brain due to the accumulation of abnormal proteins in these regions. It leads to alterations in social behavior, personality, and may involve the loss of language skills, such as speaking, understanding, or forgetting the meaning of common words, as well as motor coordination issues. FTD is a frequent cause of early-onset dementia, typically affecting individuals between the ages of 45 and 64.  

Mixed Dementia: This is a condition that involves the presence of two or more types of dementia, with the most frequent combination being Alzheimer’s disease and vascular dementia. It predominantly affects individuals aged 80 and older. Diagnosing mixed dementia can be challenging as symptoms of one form of dementia may be more prominent, and many symptoms overlap between different types. People with mixed dementia tend to experience a more rapid decline compared to those with only one type of dementia.

• Secondary Dementia

Some of the most common types of secondary dementia include:

Parkinson’s Disease Dementia: Some individuals with Parkinson’s disease eventually develop dementia as the disease progresses. In the advanced stages of Parkinson’s disease, many individuals may experience the onset of dementia. This condition is characterized by symptoms that involve cognitive difficulties, such as impaired thinking and memory, as well as the presence of hallucinations and delusions. Additionally, individuals with Parkinson’s disease dementia may contend with depression and speech-related issues.

Creutzfeldt-Jakob Disease: This is a rare and fatal degenerative brain disorder. This rare infectious brain disease afflicts approximately only 1 in 1 million individuals. It is triggered by an abnormal brain protein known as prions, which aggregate and lead to the demise of nerve cells in the brain. Symptoms comprise issues with cognitive functions, such as thinking, memory, communication, planning, and judgment. Additionally, individuals with this condition may experience confusion, behavioural changes, agitation, and depression.

Huntington’s Disease: Huntington’s disease is an inherited disorder that leads to progressive cognitive and motor dysfunction. This brain disorder is instigated by a solitary faulty gene. It leads to the degeneration of nerve cells in the brain, resulting in issues related to the control of body movements, as well as difficulties in thinking, decision-making, memory, and changes in personality.

Wernicke-Korsakoff Syndrome: This is a form of dementia often related to chronic alcohol abuse, resulting in severe memory and cognitive problems. This brain disorder stems from a pronounced deficiency of thiamine, which is vitamin B1. Such a deficiency can lead to bleeding in critical regions associated with memory in the brain. The most prevalent cause is alcohol use disorder, but it can also arise from malnutrition and chronic infection. Symptoms encompass double vision, loss of muscle coordination, and challenges in information processing, learning new skills, and memory retention.

Traumatic brain injury (TBI): This can result from recurrent impacts to the head. It is most frequently observed in individuals such as football players, boxers, soldiers, and those involved in vehicular accidents. Dementia symptoms may surface years later and encompass memory loss, alterations in behaviour or mood, slurred speech, and persistent headaches.

• Reversible Dementia-Like Symptoms

Some of the most common types of reversible dementia-like include:

Normal Pressure Hydrocephalus: This condition occurs when there is an accumulation of cerebrospinal fluid (CSF) within the brain’s ventricles, leading to detrimental effects on the brain. Normal pressure hydrocephalus (NPH) can be triggered by factors such as a brain infection, injury, haemorrhage, or prior brain surgery. Symptoms encompass impaired balance, forgetfulness, difficulties in concentration, mood fluctuations, frequent falls, and loss of bladder control. Healthcare providers can alleviate this condition by surgically placing a shunt (tube) to drain the excess fluid.

Vitamin Deficiency: Inadequate intake of vitamins B1, B6, B12, copper, and vitamin E can lead to symptoms resembling dementia.

Infections: Infections such as HIV, syphilis, and Lyme disease can cause dementia-like symptoms. COVID-19 infection has been associated with “brain fog” and acute delirium due to inflammation and stroke risk. Urinary tract infections (UTIs) and lung infections in the elderly can also manifest as dementia-like symptoms. Central nervous system infections and brain infections caused by fungi, bacteria, and parasites may lead to cognitive issues.

Metabolic and Endocrine Conditions: Conditions that mimic dementia include Addison’s disease, Cushing’s disease, low blood sugar (hypoglycemia), exposure to heavy metals like arsenic or mercury, elevated calcium levels (hypercalcemia, often linked to hyperparathyroidism), liver cirrhosis, and thyroid problems.

Medication Side Effects: Certain medications, in some individuals, can replicate dementia symptoms. These may include sleeping pills, anti-anxiety drugs, antidepressants, anti-seizure drugs, antiparkinson drugs, nonbenzodiazepine sedatives, narcotic pain relievers, statins, and others. If you experience dementia-like symptoms, consult your healthcare provider to assess your medications.

Other Causes: Other factors that can produce dementia-like symptoms encompass brain tumours and subdural hematomas, which are brain bleeds between the brain’s surface and the covering over the brain.

Symptoms and Causes Of Dementia

What are the symptoms of dementia?

Early signs of dementia include:

• Forgetting recent events or information.
• Repetition of comments or questions within a short timeframe.
• Misplacing commonly used items or putting them in unusual locations.
• Difficulty in recognizing the season, year, or month.
• Struggling to find the right words.
• Changes in mood, behaviour, or interests.

As dementia progresses, signs that it is worsening include:

• Further decline in memory and decision-making abilities.
• Increasing difficulty in communication and finding the right words.
• Greater challenges in performing daily complex tasks, such as personal grooming, preparing meals, operating a TV remote, or managing finances.
• Diminished rational thinking, problem-solving skills, and changes in behaviour.
• Altered sleep patterns.
• Heightened levels of anxiety, frustration, confusion, agitation, suspicion, sadness, and/or depression.
• Increased dependence on assistance for activities of daily living, including grooming, toileting, bathing, and eating.
• Occurrence of hallucinations, such as seeing people or objects that do not exist.

These symptoms are common indicators of dementia. Each individual with dementia may exhibit varying symptoms based on the specific areas of their brain that are affected. Different types of dementia may also present additional or distinct symptoms.

What are the causes of dementia?

Dementia arises from brain damage that disrupts the communication between nerve cells in various brain regions. It can also occur due to restricted blood flow, depriving the brain of essential oxygen and nutrients, resulting in the death of brain tissue.

The specific symptoms of dementia depend on the affected area of the brain. Some forms of dementia are irreversible and progress over time, while others are linked to underlying medical conditions that impact the brain. Additionally, certain health issues can produce symptoms resembling dementia. Many of these conditions are treatable, leading to the potential reversal of dementia-like symptoms. 

Diagnosis and Tests Dementia

How is Dementia diagnosed?

Establishing a diagnosis of dementia can be a complex process, as various diseases and conditions can contribute to or trigger dementia. Furthermore, many dementia symptoms overlap with those of numerous other medical conditions.

To confirm a diagnosis, your healthcare provider will typically:

• Inquire about the progression of your symptoms.
• Dig into your medical history.
• Review your present medications.
• Inquire about your family’s history of diseases, including dementia.

Order a range of tests, which may include laboratory assessments, imaging studies, and neurocognitive evaluations.

Neurologists and geriatricians may also play an important role in aiding the diagnostic process for dementia.

Laboratory Tests: These are conducted to eliminate other potential causes of dementia, such as infection, inflammation, underactive thyroid, and vitamin deficiency (particularly B12). In some cases, healthcare providers may request cerebrospinal fluid tests to assess autoimmune conditions and neurodegenerative diseases when deemed necessary.

Imaging Tests: These are used to examine your brain and may encompass the following:

• Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): CT uses X-rays and computer technology to generate detailed brain images, while MRI uses magnets, radio frequencies, and computer technology to produce intricate brain images. These tests are aimed at detecting signs of stroke, bleeding, tumours, and the presence of fluid in the brain.
• FDG-PET Scan: This specialized brain scan assists in assessing brain function and cognitive decline by examining the pattern of glucose absorption in brain tissue. It is occasionally utilized in specific diagnostic scenarios.

Neurocognitive Testing: It involves written and computerized assessments to evaluate various mental faculties, including problem-solving, learning, judgment, memory, planning, reasoning, language, and more. A psychiatric evaluation by a mental health professional may be conducted to identify signs of depression, mood fluctuations, or other mental health issues that could contribute to memory loss.

Management and Treatment of Dementia

Can dementia be treated?

It’s essential to clarify the terms “treatable,” “reversible,” and “curable” in the context of dementia. Nearly all forms of dementia are treatable, meaning that medications and other interventions can help manage symptoms. However, most types of dementia cannot be completely cured or reversed, and treatments typically offer only moderate benefits.

Thankfully, certain types of dementia, specifically those stemming from treatable causes, have the potential for successful reversal. These dementia-like symptoms may result from:

• Adverse effects of medications, illicit drugs, or alcohol.
• Surgically removable tumours.
• Subdural hematoma, which is the accumulation of blood beneath the outer brain covering due to head injury.
• Normal pressure hydrocephalus, characterized by the buildup of cerebrospinal fluid in the brain.
• Metabolic disorders, such as vitamin B12 deficiency.
• Hypothyroidism, a condition arising from insufficient thyroid hormone levels.
• Hypoglycemia, or low blood sugar.
• Depression.

Dementias that are not reversible may still exhibit partial responses to medications designed to address memory loss or behavioural issues. Such dementias include:

• Alzheimer’s disease.
• Multi-infarct (vascular) dementia.
• Dementias linked to Parkinson’s disease and related conditions.
• AIDS dementia complex.
• Creutzfeldt-Jakob disease.

Which drugs are accessible for dementia management?

Approved medications for the most prevalent form of dementia, Alzheimer’s disease are:

• Cholinesterase inhibitors: These include donepezil (Aricept, rivastigmine, and galantamine).
• NMDA receptor antagonist: Memantine (Namenda).
• Anti-amyloid antibody: Aducanumab (Aduhelm).

Healthcare providers may also use these drugs to address various other types of dementia.

Cholinesterase inhibitors and the NMDA receptor antagonist influence distinct chemical processes within the brain. Both drug classes have demonstrated some effectiveness in enhancing or stabilizing memory function in specific individuals with dementia.

Cholinesterase inhibitors regulate the brain chemicals responsible for transmitting messages between brain cells, crucial for proper brain function. (As dementia progresses, connections are lost due to the death of brain cells.) Memantine functions similarly to cholinesterase inhibitors but acts on a different chemical messenger, promoting the survival of nerve cells.

Aducanumab is designed to target amyloid proteins that accumulate into the plaques observed in the brains of individuals with Alzheimer’s disease.

While these drugs do not appear to halt the underlying disease’s progression, they may slow it down. In cases where other medical conditions contribute to or coexist with dementia, healthcare providers prescribe medications specific to those conditions. These additional conditions may encompass sleep disturbances, depression, hallucinations, and agitation.

Prevention of Dementia

Can dementia be prevented?

While dementia cannot be entirely prevented, adopting a health-conscious lifestyle may help reduce risk factors for certain types of dementia. Maintaining clear blood vessels free from cholesterol buildup, keeping blood pressure within normal ranges, managing healthy blood sugar levels, and maintaining a healthy weight are essential for providing your brain with the oxygen and nutrients it requires to function at its optimal capacity. You can take specific health-promoting measures, including:

• Quitting smoking.
• Embracing a Mediterranean diet, rich in whole grains, vegetables, fruits, fish, shellfish, nuts, beans, and olive oil, with limited consumption of red meats.
• Incorporating regular physical activity into your routine. Aim for at least 30 minutes of exercise on most days of the week.
• Engaging your brain in mentally stimulating activities, such as solving puzzles, playing word games, and exploring other cognitive challenges. These activities may delay the onset of dementia.
• Maintaining an active social life. Interact with others, engage in discussions about current events, and keep your mind, heart, and spirit involved in various social interactions.

What are the risk factors for dementia?

Dementia risk factors include:

• Age: The most significant risk factor, with the likelihood of dementia increasing as you grow older, predominantly affecting individuals aged 65 and older.
• Family History: If you have biological parents or siblings who have experienced dementia, your risk of developing dementia is elevated.
• Down Syndrome: Individuals with Down syndrome are at risk of developing early-onset Alzheimer’s disease by middle age.
• Poor Heart Health: Conditions like high cholesterol levels, high blood pressure, atherosclerosis, or smoking contribute to an increased risk of dementia. These conditions, along with diabetes, can affect blood vessels, potentially leading to reduced blood flow and strokes.
• Race and Ethnicity: Black individuals face double the risk of developing dementia compared to white individuals, while Hispanic individuals have a 1.5 times higher risk than white individuals.
• Brain Injury: A history of severe brain injury raises the risk of developing dementia. 

Is there a cure for Dementia?

Regrettably, there is no cure for the most prevalent types of dementia. Currently, approved medications can, at best, only attenuate the progression of the condition.

What complications can arise due to Dementia?

Your brain oversees all of your body’s functions, and as its functions deteriorate, your overall health becomes vulnerable. Dementia can lead to various illnesses and conditions.

Potential complications of dementia comprise:

• Dehydration and malnutrition.
• Bedsores (pressure ulcers).
• Injuries and bone fractures resulting from falls.
• Strokes.
• Heart attacks.
• Kidney failure.
• Pneumonia and aspiration pneumonia (inhalation of food particles causing infection).
• Sepsis (infection).

What should I anticipate if I experience Dementia?

Receiving a dementia diagnosis is undeniably challenging. Various forms of dementia are irreversible, while others are associated with underlying severe diseases. Some dementia-like symptoms result from treatable and reversible conditions.

Your healthcare team, likely including a neurologist and/or a geriatric psychiatrist or geriatrician, will conduct the necessary tests for an accurate diagnosis. Present-day medications primarily aim to decelerate the decline.

The objective is to preserve the quality of life for you or your loved one. People with Alzheimer’s dementia can sometimes live for up to two decades, though the course varies for each individual. Researchers persist in their quest to comprehend the mechanisms underlying dementia and to explore diverse approaches for slowing down and, ideally, eventually curing this disease. 

When should I consult my physician regarding dementia?

Schedule an appointment with your healthcare provider if you, your friends, or family observe alterations in:

• Your memory.
• Your cognitive abilities.
• Your capacity to carry out daily tasks.
• Your conduct.
• Your personality.

As dementia gets worse, What happens to a person’s brain and body?

Regrettably, numerous forms of dementia are progressive conditions. As your brain becomes deprived of the vital nutrients and oxygen it requires or gets clogged with “junk” like abnormal proteins, your brain tissue begins to deteriorate.

Initially, conditions like Alzheimer’s disease and other dementias might manifest with memory loss or lapses in judgment, which can be managed for some time. However, as you experience increasing cognitive decline, essential life functions become affected. These crucial functions encompass breathing, digestion, heart rate, and sleep.

In the advanced stages of dementia, individuals are unable to perform the basic tasks necessary to sustain life. Brain damage and muscle weakness prevent even simple, essential movements. Without assistance, you can’t communicate, walk, speak, control bodily functions, feed yourself, or chew and swallow food.

When you reach a point where you can’t tend to your own needs, move independently, consume sufficient food and fluids, and experience mental decline, you become susceptible to other illnesses. Pneumonia is a common ailment observed in individuals with dementia. Given their now fragile bodies, they may struggle to fight infections or derive benefits from medications. Often, the distress and discomfort outweigh the potential benefits of treatment, which might offer only short-term relief.

In such circumstances, many families opt for hospice care for end-of-life support. Hospice prioritizes comfort care for people with dementia, emphasizing your quality of life over measures to extend life. It’s worth noting that individuals who pass away from dementia-related conditions may not have this specified on their death certificates. Instead, the cause of death, like pneumonia, may be listed. Additionally, some individuals may have never received an official dementia diagnosis before their passing.

What’s the life expectancy of a person with dementia?

Answering this question isn’t straightforward due to the wide range of conditions covered under the term “dementia.”

Each neurodegenerative disease type follows its distinct progression in each individual. Moreover, every person’s health status is unique, with some being relatively healthy and others managing various co-existing health concerns. These elements collectively influence the pace of decline in someone with dementia.

In a broader context, Alzheimer’s disease stands as the most prevalent type of dementia. On average, individuals survive around eight years after the initial symptoms appear. Nevertheless, some have lived for as long as 20 years following an Alzheimer’s disease diagnosis.