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Dementia refers to a loss of cognitive function (cognition) due to changes in the brain caused by disease or trauma.

The changes may occur gradually or quickly; and how they occur may determine whether dementia is reversible or irreversible.

Dementia also may result in behavioral and personality changes, depending on the area(s) of the brain affected.

Cognition is the act or process of thinking, perceiving, and learning. Cognitive functions that may be affected by dementia include the following:

Decision making, judgment Memory Spatial orientation Thinking, reasoning Verbal communication

Some dementia is reversible and can be cured partially or completely with treatment. The degree of reversibility often depends on how quickly the underlying cause is treated. Irreversible dementia is caused by an incurable condition (e.g., Alzheimer's disease). Patients with irreversible dementia are eventually unable to care for themselves and may require round-the-clock care.

Anticholinergics Barbiturates Benzodiazepines Cough suppressants Digitalis Monoamine oxidase inhibitors Tricyclic antidepressants

Symptoms develop when the underlying condition affects areas of the brain involved with learning, memory, decision-making, and language.

Memory impairment is often the first symptom to be noticed. Someone with dementia may be unable to remember ordinary information, such as their birth date and address, and may be unable to recognize friends and family members.

There is progressive decline in these cognitive functions as well: Decision making Judgment Orientation in time and space Problem solving Verbal communication Behavioral changes may include the following: Eating, dressing, toileting (e.g., unable to dress without help; becomes incontinent) Interests (e.g., abandons hobbies) Routine activities (e.g., unable to perform household tasks) Personality (e.g., inappropriate responses, lack of emotional control)

A diagnosis of dementia requires a medical history; physical examination, including neurological examination; and appropriate laboratory tests. Taking a thorough medical history involves gathering information about the onset, duration, and progression of symptoms; any possible risk factors for dementia, such as a family history of the disorder or other neurological disease; history of stroke; and alcohol or other drug (prescription or over-the-counter) use.

Criteria for the diagnosis of dementia: (1) erosion of recent and remote memory and (2) impairment of one or more of the following functions:
Language misuse of words or inability to remember and use words correctly (i.e., aphasia)

Motor activity
Recognition Executive function

unable to perform motor activities even though physical ability remains intact (i.e., apraxia)
unable to recognize objects, even though sensory function is intact (i.e., agnosia) unable to plan, organize, think abstractly

Symptoms often develop gradually and show a progressive deterioration in function.

Delirium Delirium is a transient, acute mental disturbance that manifests as disorganized thinking and a decreased ability to pay attention to the external world. Delirium is often caused by infectious disease, brain tumor, poisoning, drug or alcohol intoxication or withdrawal, seizures, head trauma, and metabolic disorders. It is important to treat underlying conditions promptly, as they may be life-threatening or progressive if left untreated.

Symptoms of delirium include the following: Disorientation as to person, place, and time Memory impairment Rambling, irrelevant, incoherent speech Reduced level of consciousness

PseudodementiaMany elderly people fear that their memory and other mental abilities are diminishing as they grow older, even if this is not the case. Some may be anxious, depressed, or suffering from pseudodementia, a type of severe depression that occurs mostly in elderly people. The cognitive changes that resemble dementia include slow motor movements and thinking and short-term memory loss. Patients who are depressed may be apathetic and answer questions without attempting to provide the correct response. They may exhibit poor eye contact and little spontaneous movement.

Depending on the patient's medical history and neurological examination, one or more diagnostic tests may be performed to identify the underlying cause of dementia. Neuropsychological tests are administered to assess difficulties in attention span, perception, memory, problem solving, and social and language skills. Responses to these tests may provide diagnostic clues. For example, a patient with Alzheimer's disease is usually cooperative, attentive, and gives appropriate responses, but will display memory loss. A patient with hydrocephalus is usually distracted and less cooperative.

Blood tests may be ordered if the history and physical examination indicates an infectious, metabolic, or toxic condition. The results help the physician rule out Alzheimer's and help determine an effective treatment plan.
B12, folate, thiamine levels Blood glucose Complete blood count (anemia) Drug screen Electrolytes (hypercalcemia, hypermagnesemia, hypernatremia) Liver function Lumbar puncture (normal-pressure hydrocephalus, encephalitis, meningitis) Thyroid function VDRLT (syphilis and HIV infection)

Huntington's disease is diagnosed by analyzing DNA in the blood sample and counting the number of times the genetic code for the mutated HD gene is repeated. Individuals diagnosed with HD usually have 40 or more such "repeats"; those without it, 28 or fewer. Similarly, an analysis of DNA in the blood sample may reveal the ApoE4 gene, which is found in about onethird of Alzheimer's disease patients.

Electroencephalography Alzheimer's disease generally reveals "slow" waves. An EEG can help distinguish a severely depressed or delirious patient whose brain waves are normal from a patient with a degenerative neurological disease. Imaging tests (CT scan or MRI) can detect structural, or physical changes in the brain caused by stroke, blood clots, tumors, head injury, or hydrocephalus. A CT scan can show the characteristic structural changes that occur with Huntington's disease.

In some cases, appropriate treatment for the underlying condition can resolve dementia completely or partially. The goal of treatment for irreversible conditions is to control symptoms. Three FDA-approved drugs may provide symptomatic relief for Alzheimers: donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon).

Tranquilizers and sedatives can ease agitation, anxiety, and aggression. Medications or devices may be used to help manage sleeplessness and incontinence.

Safety precautions are necessary to protect a person who is disoriented and may wander from home. Many patients with dementia eventually require 24-hour care in a health or residential facility.

Some studies indicate that a largely vegetarian diet high in betacarotene and vitamins E and C may lower the risk for dementia and Alzheimer's disease, but this is unproven. Nevertheless, eating a healthy diet that is low in saturated animal fat and not smoking tobacco can reduce the risk for stroke and other cardiovascular disorders that may lead to dementia.