Dementia

What Causes Dementia?

Dementia symptoms stem from a wide range of causes. Some of these causes are distinct brain diseases, and others are neurological events that result in changes in brain function. The most common causes of dementia include:

• Alzheimer’s disease. Alzheimer’s is the most common cause of dementia, accounting for 60-80% of all cases. The disease results from abnormal protein clusters in the brain that interfere with and damage healthy neurons.
• Vascular dementia. The second-most common cause of dementia happens when blood flow to the brain is disrupted, often because of a stroke, injury, or other neurological event. This kind of dementia more often causes problems with thought processes than with memory loss.
• Lewy body dementia. This form of dementia is also linked to abnormal protein clumping in the brain, and it is associated with Parkinson’s disease as well as Alzheimer’s. Common symptoms include hallucinations and physical tremors.
• Frontotemporal dementia. This type of dementia is associated with the degeneration of neurons in the brain’s frontal and temporal lobes, the parts of the brain responsible for personality and language.
• Traumatic brain injury (TBI). Repetitive injuries to the brain over time can eventually cause symptoms of dementia. This type of dementia often affects athletes who experience trauma to the head frequently.

Other causes of dementia include brain tumors, nutritional deficiencies, Creutzfeldt-Jakob disease, Parkinson’s disease, amyotrophic lateral sclerosis, thyroid problems, infections, and medication side effects.

Is Dementia Hereditary?

Because there are so many different causes of dementia, it is important to understand the details of the family’s history of dementia to know if there is a risk of inheriting the problem. Some causes of dementia show a strong link to family history, but most do not.

• The most common cause of dementia, Alzheimer’s disease, may have a genetic component, but a family history of the disease does not necessarily increase risk. In general, heritability is most likely when a parent or grandparent develops the disease at a relatively early age.
• Vascular dementia is not heritable on its own, but the underlying cause of the dementia is often a condition such as heart disease or diabetes, which may have a family history connection.
• Frontotemporal dementia (FTD) does seem to be heritable. About 40% of people diagnosed with FTD have a relative who has experienced some form of dementia (although not necessarily FTD).

How is Dementia Detected?

Although many causes of dementia are progressive and incurable, early detection of symptoms can allow you to get treatment that can improve your quality of life over the course of the disease. Some causes of dementia are treatable and reversible, and early diagnosis of these forms of dementia is crucial in getting effective treatment.

The early indications of dementia include:

• Memory loss. Minor memory problems are a natural part of the aging process, but dementia-related memory loss typically includes forgetting names or dates, needing to be reminded of the same things over and over, and loss of memories that don’t come back.
• Problem-solving difficulties. These difficulties include having trouble doing tasks that you used to have no problem with, such as following a recipe or paying bills on time. Problems with attention or concentration are also a warning sign.
• Disorientation. People living with dementia often have trouble remembering where they are or what the day or date is. They might get confused about the passage of time or have difficulty understanding spatial relationships.
• Visual perception. Dementia often manifests itself in difficulties with color or depth perception or other visual problems. For example, these problems might show up while the sufferer is trying to read or drive.
• Language problems. Difficulty finding the correct words for a situation or participating in a conversation is a common early warning sign of dementia.
• Losing things. People living with Dementia often misplace everyday objects such as keys, glasses, and wallets.
• Poor judgment. People living with Dementia often make bad decisions about finances, social situations, grooming, or hygiene.
• Social struggles. People with Dementia also may begin to avoid social situations because of their difficulties in navigating them.
• Personality changes. Uncharacteristic, unexplained anxiety, frustration, confusion, or paranoia are common early signs of dementia.

How is Dementia Diagnosed?

To pinpoint the cause of dementia symptoms, doctors look for a pattern of symptoms, risk factors, and family history. The diagnostic process typically includes physical examinations, tests, a review of medical and family history, and, often, information gathered from caregivers or loved ones.

Diagnostic steps may include:

• A physical exam. This exam is aimed at ruling out specific physical conditions that could be causing the symptoms.
• Cognitive tests. These tests measure the patient’s ability to think clearly, and they target cognitive functions such as memory, reasoning, language, attention, and orientation.
• Neurological tests. These tests measure the function of the patient’s nervous system. They evaluate functions such as balance, reflexes, memory, visual perception, and language.
• Brain scans. These tests–such as MRIs, CTs, and PET scans–look for signs of bleeding in the brain, stroke, tumors, or protein deposits characteristic of Alzheimer’s.
• Blood and laboratory tests. These tests look at the patient’s blood chemistry for issues such as thyroid function, vitamin B-12 deficiency, or inflammation which may be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to look for signs of depression or other mental issues that may be linked to the symptoms.

How is Dementia Treated?

Progressive forms of dementia such as Alzheimer’s, Parkinson’s, Lewy body dementia, and frontotemporal dementia are not curable. No treatments have proven effective at slowing the progression of the disorder. Treatments are usually aimed at lessening the severity of the symptoms and improving quality of life as the disease progresses.

Medication

Several different kinds of medication may be used to treat symptoms of dementia. The medications prescribed will depend on the cause of the symptoms, the specific symptoms being experienced, and their severity.

• Cholinesterase inhibitors. These medications help to increase the level of a chemical called acetylcholine in the brain. Acetylcholine aids in transmitting neurological signals in the brain, and its absence can cause problems with memory and judgment. Cholinesterase inhibitors–which include donepezil, rivastigmine, and galantamine–are used most often to treat dementia in Alzheimer’s patients; they are also sometimes prescribed for Lewy body dementia, vascular dementia, and Parkinson’s-related dementia.
• Memantine. This medication works by limiting the level of a chemical called glutamate in the brain. Glutamate is a naturally occurring chemical that helps transmit neurological signals, but in this case, it’s thought that an excess of glutamate may cause damaging overstimulation of nerve cells. Memantine may help to improve memory and thought processes in people living with dementia.
• Antidepressants, antipsychotics, and other medications. Other medications are sometimes used to treat symptoms of dementia such as depression, hallucinations, or sleep disruptions.

Non-Drug Therapies

Non-drug therapies for treating dementia typically focus on making the sufferer’s environment as safe, comforting, and supportive as possible. For example, occupational therapy can be used to learn how to cope with the symptoms and progression of dementia, and modifications to the environment, such as increasing organization and decreasing distractions, can help the sufferer to stay safe and calm.

How Does Dementia Progress?

The most common types of dementia–including that caused by Alzheimer’s, Lewy body dementia, vascular dementia, and frontotemporal dementia–all get worse over time as the damage to the sufferer’s brain increases. Different types of dementia progress at different rates, with Alzheimer’s dementia usually being one of the slowest types.

• In Alzheimer’s, dementia typically progresses from mild memory and language problems, through increasingly severe states of confusion, to eventual extreme problems such as the inability to swallow, loss of speech, and incontinence.
• Vascular dementia, depending on the cause, may progress quickly or slowly, and in late stages, it often closely resembles Alzheimer’s.
• Lewy body dementia often causes hallucinations and movement problems in its early stages, but in its later stages, it also often resembles Alzheimer’s.
• Early stages of frontotemporal dementia are sometimes characterized by behavior changes, personality changes, and language problems. As with other types of dementia, later stages tend to resemble those of Alzheimer’s.

How is Dementia Prevented?

Researchers have yet to discover a reliable way to know who will develop dementia, and there is no known way to prevent the onset of the disorder. Some research has suggested, however, that taking steps to boost your brain health throughout your lifetime may help your body to stave off some forms of dementia. To have the best chance at keeping your brain healthy, follow these best practices:

• Get as much mental exercise as possible. It’s possible that reading, doing puzzles, playing games, and engaging in activities that keep your mind active can help delay the onset of dementia or decrease the severity of symptoms. Social activity likely helps, as well.
• Get physical exercise, too. Physical activity keeps your body strong, and a strong body is more able to support good brain health.
• Don’t smoke. In some studies, smoking, especially late in life, has been linked to an increased risk of developing dementia.
• Pay attention to your heart health.  Disorders such as diabetes, high cholesterol, and high blood pressure are stressful on your body’s cardiovascular system, and poor cardiovascular health can lead to neurological problems such as dementia. Treating these problems may lower your risk of developing dementia.
• Focus on good nutrition. A diet that includes enough fruits, vegetables, whole grains, omega-3 fatty acids, and vitamin D may also help prevent dementia.
• Get plenty of sleep. Poor sleep habits and sleep apnea have been implicated in the development of many long-term health problems, including dementia.

Dementia Caregiver Tips

Caring for someone with dementia is one of the most challenging responsibilities that any caregiver can face. Most caregivers are family members or loved ones. They are often unprepared and untrained for the extremely difficult job of keeping the sufferer safe and as comfortable as possible as the disease progresses. If you’re responsible for taking care of a person living with dementia, keep these tips in mind:

• Learn as much as possible about the specific type of dementia so that you understand what you’re facing now and what you’re likely to face in the future as the disorder progresses.
• Be as involved as possible with the sufferer’s medical care so that you can ask questions of doctors and other healthcare professionals.
• Don’t hesitate to ask for help from other family members or friends.
• Take advantage of support services in your community, such as respite care, if they’re available.
• Don’t feel guilty if you feel frustrated or angry with the sufferer.
• Take time to yourself whenever possible, and don’t neglect your own emotional and physical needs.
• Find a support group for caregivers.

Dementia Brain Science

Research into the causes and progression of dementia focuses on finding new ways to diagnose and treat the disorder. In addition, there is hope that a more thorough understanding of the chemical mechanisms involved could lead to drugs that prevent dementia or reverse its effects. As research is ongoing, scientists are finding ways to build on what they already know about dementia, and they are also regularly making new discoveries. For example:

• Researchers are working to develop new drugs that don’t just treat the symptoms of dementia, but that could disrupt the chemical processes in the brain that cause dementia in the first place. Scientists have a reasonably complete understanding of how protein clumping causes neurological damage in Alzheimer’s patients. For example, they are attempting to find drugs that halt the process that creates these protein clumps.
• Scientists are discovering new forms of dementia that seem to arise from different brain-chemistry problems than those that cause previously known forms of dementia. An example is limbic-predominant age-related TDP-43 encephalopathy (LATE), a recently identified type of dementia that looks like Alzheimer’s but that seems to be caused by an entirely different brain protein.

Dementia Research

Title: Developing and Testing the Enhancing Active Caregiver Training (EnACT) Intervention for Dementia Family Caregivers (EnACT)

Stage: Recruiting

Principal investigator: Jacqueline Eaton

University of Utah

Salt Lake City, UT

Persons with Alzheimer’s disease and related dementias (ADRD) experience behavioral symptoms such as agitation, combativeness, depression, and apathy. These behaviors increase caregiver stress, which leads to negative outcomes, such as poor health, depression, and increased caregiver burden. This project seeks to develop and test an intervention to enhance active caregiver skill training to prepare caregivers to better manage behavioral symptoms and improve ADRD caregiver well-being. This intervention is called Enhancing Active Caregiver Training (EnACT).

The study team will develop and conduct initial testing of EnACT techniques in a small group intervention with family caregivers of persons living with dementia. This intervention will first develop and refine EnACT through small group meetings with ADRD caregivers. Next, EnACT will be tested by two groups of ADRD caregivers to assess how achievable and beneficial caregivers find it to be. In addition, EnACT will be evaluated for its impact on caregiver preparation, stress process, and well-being.

Title: Dementia Symptom Management at Home Program

Stage: Recruiting

Principal investigator: Abraham Brody, MD

New York University School of Medicine

New York, NY

Alzheimer’s Disease and Related Disorders (dementia) pose a significant challenge to our public health. While many persons with dementia are cared for by friends and family in the community, with home healthcare assistance, most home healthcare clinicians and agencies are ill-prepared to care for this population. They, therefore, have difficulty assisting patients and caregivers in maintaining quality of life.  This leads to adverse patient outcomes, increased caregiver stress and burnout, and healthcare utilization. This study will therefore utilize a cluster randomized controlled design at 3 study sites to examine the ability of a multi-component evidence-based practice primary palliative care quality improvement program for home healthcare registered nurses, occupational therapists, and physical therapists to improve the quality of life and reduce healthcare utilization for persons with dementia and their informal caregiver.