Dementia is a loss of normal cognitive functions that is severe enough to interfere with daily life. Dementia is the result of brain disease, and is not a normal part of aging. Symptoms include memory problems, difficulty finding words or understanding language, difficulty with attention and focusing on the task at hand, forgetting where things are or how to perform certain tasks, problems with visual perception, reasoning and judgment, and sometimes changes in personality. These symptoms can vary according to the type of dementia. Most dementias are due to gradual loss of brain cells (neurons) called neurodegeneration, and are slowly progressive. An exception is vascular dementia which results from multiple strokes and can present with sudden, stepwise declines in cognitive function.
The most common type of dementia is Alzheimer’s disease (AD), which accounts for 60 to 80% of people with dementia. More than 5.4 million Americans have AD, 96% of whom are over 65. The incidence increases dramatically with age. One out of every nine people aged 65 has AD, but by age 85, 30% to 50% of people may be affected. Alzheimer’s is a leading cause of death in the elderly. Of those who have AD by age 70, 61% will die before age 80. The most common early symptom of AD is trouble remembering newly learned information or recent events and conversations. Patients with early AD may not recognize that they are having memory problems which are more obvious to family and friends. This progresses to disorientation (not remembering where you are or the date), mood and behavior changes, confusion about when and where events happened, which can lead to unfounded suspicions about family, friends and professional caregivers. As time passes, memory loss becomes more severe and patients will not remember names of family members. There may be behavior changes and hallucinations, particularly at night. Ultimately there is difficulty speaking, swallowing and walking, and patients become mute and unable to care for themselves.
Evaluation and Treatment of Dementia
During the first clinic visit, we will get a detailed history from both the patient and family members about the nature of the problem. Specific examples can be very helpful. We will likely ask about memory issues that may have caused problems, such as trouble balancing the checkbook, leaving the bath water running or the stove turned on, and whether the changes came on suddenly or gradually. We will also do a careful neurological exam to see if there are other problems that might suggest a cause. Sometimes cognitive problems can be related to medications, vitamin deficiencies, thyroid problems or depression. We may perform a short screening test for cognitive function, and may refer you for more detailed neuropsychometric testing. Depending on the findings, a brain imaging study, lumbar puncture or EEG may be indicated. There are now several medications that have been shown to slightly slow the progression of Alzheimer’s disease, and we will discuss whether these may be appropriate. We will also discuss social issues such as designating a healthcare power of attorney to someone who is entrusted to make medical decisions when the patient is unable. For more information, please see the Alzheimer’s Association or request an appointment to be matched with a provider.