Dr. Tom Ala, an associate professor of neurology and interim director of the Center for Alzheimer's Disease at Southern Illinois University School of Medicine, gives the details on what is dementia, its symptoms, how it is diagnosed and treatment.
Q. What is dementia?
A. Dementia refers to the permanent loss of brain function. People who become demented have difficulty doing things they were able to do in the past, such as remembering details, expressing themselves, understanding others, managing their own affairs and performing their usual activities like driving or cooking. People may only have mild dementia and could still live independently, or they may have a more severe condition and not be able communicate with others or even take care of themselves. Some patients may have such mild cases that only sophisticated cognitive testing can detect it.
Having dementia is different than being developmentally delayed or intellectually challenged. Dementia usually refers to a condition that is acquired after reaching adulthood. The other terms usually refer to a condition that the person has always had, from birth or early childhood.
A distinction should also be made between conditions that are reversible and those that are permanent. A person who is temporarily confused due to a medical condition such as dehydration or drug intoxication would hopefully recover fully once the medical condition is corrected. A general term for that reversible condition is delirium. Dementia, on the other hand, is permanent.
Q. What causes dementia?
A. Dementia may be caused by any condition that irreversibly injures the brain, such as a stroke, head trauma, multiple sclerosis or cardiac arrest. The most common cause of dementia in the elderly is Alzheimer's disease, which is a progressive neurodegenerative condition that gradually destroys the brain over many years. Not all causes of dementia worsen with time. Teenagers can become demented in a car accident and remain demented for the rest of their lives.
Q. What are the symptoms?
A. Dementia causes people to be "confused." People with dementia have trouble doing things they were able to do in the past. Mild symptoms may just be difficulty with memory and judgment. Or there could be a personality change. Others have problems balancing the checkbook, cooking, reading, writing or managing medications. They might have problems doing any cognitive activity that they were able to do in the past.
Because there are many causes of dementia and delirium that could affect different parts of the brain in different ways, there is no firm set of symptoms that proves one is demented or delirious. The symptoms depend on the circumstances. There is often uncertainty in mild cases, because isolated symptoms like short-term memory loss or word-finding difficulty may be due to many different conditions, such as a stroke, over-medication or depression, or a combination of factors including normal aging, and not be due to a dementing illness like Alzheimer's disease.
Q. How is dementia diagnosed?
A. Dementia is diagnosed by a physician or other trained health-care provider after a careful review of the patient's history, physical examination, cognitive evaluation and laboratory tests. A head imaging study like a CT scan or MRI scan is also usually included. Depending on the circumstances, other tests and evaluations may be done to rule out other medical and psychiatric conditions that mimic dementia.
Q. What are the treatments of dementia?
A. The treatment depends on the cause and symptoms of the dementia. Dementia caused by one or more strokes would be treated with physical and occupational therapy and other measures to help prevent additional strokes. Dementia caused by Alzheimer's disease may be helped by drugs like donepezil, rivastigmine, galantamine and memantine. In general, symptoms like agitation, depression, anxiety and other complications of dementia should be addressed on a case-by-case basis, regardless of the cause of the dementia. It is important to anticipate and address problems that a demented person may develop, such as medication mistakes and unsafe driving.
Q. How to reduce the risks of dementia?
A. Live healthy. Follow the advice of your physician and other health-care providers. Although it is not yet proven, most researchers dealing with Alzheimer's disease believe "what is good for the heart is good for the brain." Exercise, keep your weight down, eat a well-balanced diet, keep your cholesterol down and don't smoke.
Q. What services does the SIU Center for Alzheimer's Disease and Related Disorders (CADRD) provide?
A. SIU's Memory and Aging Clinic provides complete memory and cognitive assessment, treatment, education, referral and counseling services to patients and their families. The Memory and Aging Network is comprised of a variety of community-based providers throughout the 93 county CADRD service area.
Q. Where to go for more information?
A. Resources that the SIU Alzheimer's Center recommends are:
Dr. Tom Ala is an associate professor of neurology and interim director of the Center for Alzheimer's Disease at Southern Illinois University School of Medicine.